The Charter for Humanities and Social Sciences (Department of Higher Education and Training 2011) describes an aspirational direction for scholars working within and across the diverse array of disciplines typically found within faculties of humanities at South African universities. The Charter emphasises the central role of the humanities in creating a citizenry that is socially aware, responsible and ethical, and in defining a post-apartheid scholarship that is sensitive to, and relevant for, both the immediate and long-term developmental needs of South Africa, specifically, and the global South, more broadly.

Psychology is, almost invariably, a centrepiece of humanities faculties at South African universities. It attracts large numbers of undergraduate and postgraduate students, offering a broad range of training opportunities in research methods (including ethics), quantitative and qualitative data analysis, clinical work, and community initiatives. Of particular importance for this article is that psychologists have been at the forefront of scholarly initiatives aimed at decolonising and transforming African higher education spaces and at ensuring that university coursework is locally relevant and addresses the needs of the communities to which staff and students will deliver services (Kessi et al. 2020; Painter et al. 2013; Ratele 2017).

The subdiscipline of neuropsychology, which focuses on brain-behaviour relations and the effects of organic insults (e.g. stroke, viral infections) and environmental challenges (e.g. food insecurity, low socio-economic status) on cognitive performance, is a fast-growing branch of psychology that incorporates both experimental research and clinical practice. This growth encompasses not only the depth of thought within the subdiscipline, but also the emergence of training programmes globally, including in South Africa and other low- and middle-income countries (LMICs). The growth on those fronts does not, however, extend to the development of a local identity for neuropsychological research, clinical practice and (crucially for this article) training. This lack of transformation may be attributed to various interrelated causes. These include the relative youth of the subdiscipline (the Health Professions Council of South Africa [HPCSA] only recognised neuropsychology as a specialist registration category within the past 5 years; even the United States, where most neuropsychologists are trained, only developed formal guidelines for training relatively recently, in the 1970s); the fact that the small number of fully trained and qualified neuropsychologists who guide neuropsychological education in South Africa were, for the most part, all trained in strongly Euro-American principles; and the subject matter of the subdiscipline, which encourages a narrow focus on the brain as the source of all behaviour and places less emphasis on interpersonal and social aspects of psychology. Hence, we offer neuropsychology as a case study for how transformation can proceed in areas of the academy where the humanities meet the health sciences, where training programmes are relatively immature but discipline-specific knowledge is exploding, and where clinical service delivery elements are essential.

In this article, we use an overarching framework of decolonial theory and a specific framing perspective of Osmer’s (2008) practical theology questions to develop a foundation that can guide transformation of neuropsychology training programmes in South African universities. Ultimately, we encourage a transformational process that will seek to ensure that those training programmes, and the research and clinical approaches emanating from them, are relevant, equitable and inclusive.

Here, we describe the context and characteristics of neuropsychology training programmes at South African institutions of higher learning. Before delving into the details of those programmes, however, we give a brief account of the broader landscape of neuropsychology in this country.

Recent review articles describing the state of the subdiscipline in developing countries suggest that, in terms of research output, the extent of clinical service delivery, and the maturity of training programmes, South African neuropsychology represents an exceptionally positive case compared with other African countries (Hill-Jarrett, Ikanga & Stringer 2018; Kissani & Naji 2020; see also Ikanga & Mbakile-Mahlanza 2022). Moreover, the reviews refer explicitly to the fact that the roles South African neuropsychologists play in the country’s health system, and how they play those roles, are closely aligned with what might be expected of their professional counterparts in Western Europe and North America. Implicit in this statement may be a critique that African systems of knowledge and specific local concerns and challenges are not addressed adequately.

Three recent articles by South African neuropsychologists shed further light on the state of the field in the country (Ferreira-Correia 2016; Truter et al. 2017; Watts & Shuttleworth-Edwards 2016). Although published before the HPCSA’s formal recognition of neuropsychology as a professionally registrable practice category, these articles nonetheless provide useful information and context.

In their article reviewing the history and current status of neuropsychology in South Africa, Watts and Shuttleworth-Edwards (2016) concluded that, at the time of their writing, the availability of neuropsychology in South Africa was ad hoc and institution-dependent. This conclusion was supported by Truter et al. (2017), who reported that almost 20% of respondents to their survey (N = 95 individuals involved in South African neuropsychology, as either academics/researchers or clinicians, or both) indicated that their training included no formal clinical supervision. Ferreira-Correia (2016) notes that such supervision is a critical component of training for neuropsychologists, and that its absence in South African neuropsychological training is a gap long recognised as needing attention. The same author notes that while neuropsychological training and professional requirements ‘should somehow answer to an international standard’ (p. 67), local (and, by implication, cross-cultural) relevance should be prioritised.

Overall, a strong theme in reporting across these papers suggested that a lack of formal training programmes and opportunities was a strong barrier to the growth of the discipline. This is an ongoing concern. Currently, only one university offers formal training leading to qualification for a clinical internship and eventual HPCSA-sanctioned registration in the category of neuropsychology (Bush et al. 2023).

In terms of our own contribution to the empirical task, here we describe existing neuropsychology-related courses and curriculum offerings at South African higher education institutions. In the absence of direct input from relevant stakeholders at those institutions, we base our description on an informal review of publicly available information about neuropsychology-related offerings at 26 South African public universities (Businesstech 2015). We gathered this information (see Table 1) from official university websites and by consulting relevant literature on the history and current status of neuropsychology (and psychology more generally) in South Africa. We acknowledge that this is not an exhaustive or systematic review (e.g. we did not search for information from private colleges or other similar tertiary institutions, and our literature search, although comprehensive, did not use a formal set of eligibility criteria).

Regarding the web-based information we gathered for this article, our cursory search indicates that 20 of the 26 candidate institutions offered at least some neuropsychology coursework. Of the six that did not, five were universities of technology, and the other offered only courses in translational neuroscience and neurotherapeutics. Almost 70% of the institutions (n = 18) listed offerings at the postgraduate level; almost 40% (n = 10) clearly listed offerings at the undergraduate level; and almost one-quarter (n = 7) listed offerings at both undergraduate and postgraduate levels.

Overall, then, there appears to be an encouraging (although inconsistent and uneven) emergence of neuropsychology-related educational opportunities at South African universities. Offerings range from first-year courses in biological psychology through third-year courses focused on clinical neuropsychology to elective Honours modules taking a broad overview of the field. At the Master’s level, there are clear opportunities for neuropsychology research. However, across universities, these offerings are still limited in terms of accredited training leading to registration as a neuropsychologist.

Finally in this section, a key contextual concern is the demographic makeup of neuropsychologists in South African academic and clinical (i.e. private practice and hospital) settings. Unfortunately, there are no granular nationwide data regarding the demographics of neuropsychologists in academic settings (i.e. those employed as supervisors in training programmes). Regarding the overall population of neuropsychologists in the country (i.e. those who work in clinical practice and/or in academia), Truter et al. (2017) reported that: (1) fewer than one-third of the 95 participants who completed their online survey had more than a Master’s degree (n = 28); (2) the vast majority (n = 84) were female; (3) slightly more than half (n = 50) worked in private practice; and (4) fewer than 10% (n = 9) worked full-time at an institution of higher learning. The average age of this sample was approximately 47 years (range = 25–73 years).

A 2017 HPCSA survey (N = 2081) covering all psychology practitioner categories registered at that time described similar patterns of data. Most respondents to that survey were female (78.8%), white (73.8%), English-speaking (70.4%) and aged 31–50 years (32.7%). Of note is that fewer than 20% of respondents reported having a home language of one of the nine official African languages, and that black practitioners represented only about a quarter of the sample (24.7%), with most of those being in the Registered Counsellor category (which represented approximately 15% of the total sample).

The usefulness of the Truter et al. (2017) and HPCSA (2017) surveys is, for the current purposes, limited by their small sample sizes, their restrictions on access (participants needed stable internet connectivity to complete the survey), and the fact that they were conducted before the HPCSA established the neuropsychology registration category. However, their findings remain relevant for two reasons. Firstly, the vast majority of respondents to the Truter et al. survey will now be formally registered neuropsychologists practising in South Africa. Secondly, the demographic composition of the population of practising neuropsychologists is, given the similar admission criteria for MA-level qualifications, unlikely to differ substantially from that of other practitioner populations.

Taken together, the results from our web and literature search suggest some growth in neuropsychology. This growth is, however, inconsistent and ad hoc. As neuropsychology emerges in South Africa, and against the backdrop of the description above, it is critical to determine how such growth proceeds and, crucially, who it includes and who it accommodates.

Here, we interrogate why (and, to some degree, how) the context and characteristics of training programmes, as described above, have come to exist as they do.

The historical epistemologies underpinning apartheid-era psychology in South Africa allowed discrimination and oppression to thrive through institutional and scientific racism (Louw 1997). During apartheid, race was not perceived as a socio-political construct, but was solidified into an ontological truth, deeply embedded in the epistemological fabric of the field of psychology and other social and natural sciences (Cooper & Nicholas 2012). Apartheid political frameworks were also heavily influenced by nativist views of intelligence, which had, as one of their cornerstones, the inherent intellectual inferiority of non-European racial groups (Herrnstein & Murray 1994). Such epistemology rationalised the subjugation of black South Africans by presenting their marginalisation as the inevitable and undeniable consequence of a natural and justified societal order founded on Christian nationalism, eugenics and social Darwinism (Nicholas & Cooper 1990).

Such perspectives, as well as direct government funding and related pressure to produce findings that would support racialised social oppression, permeated the scientific investigations of the day. These investigations, in psychology and other scientific domains, were often framed by governmental authorities as being politically neutral, but in reality sought to elevate race to a physical basis for discrimination and to hide the fact that it was a construct strategically deployed to sustain systems of oppression (Duncan et al. 2001). For instance, Fick’s (1929) study used racially biased intelligence tests to assert the intellectual superiority of white children over black children. Such studies (see also Jansen van Rensburg 1938; Junod 1920) reinforced racial hierarchies and hegemonic power relations, justifying inequities in access to education, resource distribution and employment opportunities. Black South Africans were portrayed as naturally suited for manual labour to rationalise the systemic oppression embedded in apartheid policies (e.g. the Bantu education system) and to allow industry to exploit their labour (Sehlapelo & Terre Blanche 1996; Soudien, Kallaway & Brier 1999). In summary, between the two World Wars, scientific research in South Africa was co-opted by the apartheid regime to legitimise discriminatory policies in political, educational, geographical and economic domains (Louw 2021).

These ideological and political agendas had profound implications for psychology research and practice in apartheid-era South Africa. Individual academics, tertiary institutions and statutory bodies took on these biases in an attempt to gain professional credibility, rather than contesting the prevailing system of institutional disenfranchisement and overt discrimination. As one illustration of this positioning, Van Ommen and Painter (2008) highlight the significant absence of black and female voices in academic psychology publications during apartheid.

This kind of systemic marginalisation was endemic in the South African academy, in its staffing complement and in the products of its professional endeavours. In a cruel irony, the discipline of psychology directly perpetuated entrenched racial inequities and socio-economic deprivation of black South Africans through the use of inherently biased Western-based psychometric testing, which invariably recommended a racially split dispensation of supervisory versus menial roles in the workplace (Cooper et al. 2014).

Further regarding the participation of black psychologists in teaching, research and clinical practice, apartheid policies (particularly with regard to educational inequities) restricted their opportunities. For instance, professional programmes used biased selection criteria to reserve the bulk of training opportunities for white candidates (Hayes 2000; Swartz, Gibson & Swartz 1990). Furthermore, although black individuals were permitted to be the subjects of psychological research studies, black communities were denied the agency to examine psychological phenomena from their own cultural and social perspectives (Van Ommen & Painter 2008).

With specific regard to clinical neuropsychological assessment, apartheid ideologies and policies shaped both theory and practice. Disproportionate resources were allocated to developing assessment tools that favoured the white minority. For instance, in 1953 a division of neuropsychology was formed within the Council for Scientific and Industrial Research (CSIR). The work of this division, which was primarily used to assist in the selection of workers in the military and mining sectors, was funded by the ruling National Party and hence aligned with their segregationist objectives (Foxcroft 2011). Such practices fuelled distrust in psychological assessments broadly, and in neuropsychological assessments particularly, because they tended to be used to perpetuate scientific racism in areas such as intelligence estimation and to overpathologise and misdiagnose black individuals (Laher 2024; Laher & Cockcroft 2017).

This mistrust persisted even after South African universities (ostensibly independently of National Party influence) began introducing postgraduate neuropsychology courses and curricula in the 1970s. These courses and curricula were often facilitated by academics defying international sanctions against apartheid South Africa and were almost invariably based on Western neuropsychological practice (Boyle et al. 2023). Hence, early research efforts emerging from those academic programmes prioritised the adaptation of Western-developed assessment instruments to local contexts, rather than creating culturally specific and locally appropriate tools. This prioritisation persisted in the immediate post-apartheid era, despite growing awareness of the limitations of applying tests designed for WEIRD (Western, Educated, Industrialised, Rich, and Developed) populations to samples drawn from more diverse cultural settings (Aghvinian et al., 2021; Cockcroft & Laher 2022).

In summary, marginalisation of black academics and the lack of diverse representation not only distorted the field of psychological research, but also perpetuated a one-dimensional view of human behaviour, propagated the dominance of Eurocentric narratives, disempowered diverse cultural subjectivities and oppressed the potential of the broader South African population (Dlamini, Tesfamichael & Mokhele 2021; Duncan et al. 2001). Even post-1994, the legacy of this institutional and scientific racism continues to shape the subdiscipline of neuropsychology, from student admissions and staffing through curricula, training and service delivery¹ (Harriman et al. 2022; Joosub 2019; Sorsdahl et al. 2023; Truter et al. 2017).

Here, we propose ways in which training programmes ought to be transformed in order to be more inclusive and to respond appropriately to local context-specific needs. We focus on five areas in which transformation is particularly important:

We are not implying that these are discrete or isolated issues; instead, we argue that they interact strongly with one another and with the overall project of decolonising South African neuropsychology training programmes.

Here, we attempt to ascertain which sorts of practical and realistic steps can be taken by staff, students and other stakeholders in order to realise the desired transformation. We consider how resource constraints, access barriers and other limiting factors (be they sociopolitical, financial or environmental) might affect the work that Task 3 has imagined must be done. Reflective strategic responsiveness and consequent transformative action may redress entrenched contextual challenges related to neuropsychological training. As a first step, then, all stakeholders must reflect on and critically engage with: (1) the current situation, (2) the desired direction for transformation and (3) the practical realities that impede change.

Regarding the current situation, as described above, the legacy of the apartheid regime’s systematically racist policies persists. Unequal access to and funding for specialised training programmes, such as those serving neuropsychological education, has resulted in a lack of diversity within both the academy and the professional ranks (Ikanga & Mbakile-Mahlanza 2022; Watts & Shuttleworth-Edwards 2016). Moreover, the envisaged growth in academic programmes following the promulgation of registration regulations by the HPCSA in 2019 has not materialised. The development of the discipline is further circumscribed by South Africa’s disparate healthcare model and the limited availability of neuropsychological services and training opportunities catering for the majority of the population.

Over and above these structural barriers is the fact that many, if not most, South African neuropsychologists are not well-prepared to manage the complexities of the cultural and linguistic diversity that characterises their patient populations. The slow progress towards category registration resulted in inadequate opportunities for student supervision and the development of contextually relevant professional skills (Ferreira-Correia 2016; Truter et al. 2017). Furthermore, student exchange programmes and research collaboration disproportionately favour the global north, further perpetuating the marginalisation of African voices in academic discourse and training (Kissani & Naji 2020).

Regarding the desired direction for transformation, the overall goal is to take the shared input of staff, students, community members and other stakeholders and use it to align neuropsychological training with a social justice agenda. Hence, transformation of training programmes must centre on enhancing cultural relevance and improving inclusivity. The first of these is, as noted earlier, a non-negotiable element of a decolonised and transformed training programme. Uncritical appropriation of knowledge systems from the global north often creates an epistemological dissonance and, consequently, clinical services that lack applicability to the African context (Adetula et al. 2022). Training programmes often overlook the inclusion of indigenous practices to foster decolonial praxis (taking the form of, for instance, cultural competence, humility and responsiveness) in assessment and intervention. Relatedly, training that emphasises continuous adaptation to and alignment with evolving community needs is critical for ensuring that assessments and interventions are derived from contextually relevant frameworks (Cockcroft 2020).

Inclusivity might be enhanced by increasing training opportunities for individuals from historically marginalised communities. One might use a tiered approach to provoke such an increase: firstly, establish more practicum training opportunities, secondly, more internship positions, and thirdly, more mandatory community service posts (Bush et al. 2023). Such systemic shifts in training pathways require not only pedagogical reform, but also transdisciplinary collaborations among universities, healthcare providers, community organisations and governmental agencies.

Other opportunities for collaboration, and hence for increased inclusivity, should be sought on the African continent. Historically, South African neuropsychology has shown little appetite for engagement with other African nations. This lack of exchange represents an underutilised opportunity for fostering research and clinical advancements through a more inclusive and regionally informed approach.

The practical factors that might hinder these efforts towards transformation include limited resources, a lack of professional capacity and intrinsically Euro-American curricula. Although training programmes do not have the means to address chronic and nationwide resource constraints directly, academic staff and students can play a vital role in advocating for policy reform by disseminating evidence-based research that exposes the inequalities in neuropsychological training and service delivery across South Africa. Such work on resource allocation gaps and exclusionary policies can further inform the development of decolonial training frameworks and may help promote new models of care grounded in local communities.

Addressing the lack of professional capacity (i.e the relatively small number of fully trained and registered neuropsychologists in a country that faces a high burden of disease) is a long-term project that requires intense collaboration by, among others, universities, government health departments, public and private hospitals, and non-governmental organisations. This collaboration should focus on the development of sustainable training programmes by implementing, for example, scaffolding strategies such as online instruction, satellite campuses and mobile clinics as a means to expand educational and instructional possibilities across the country.

Finally, there is the critical matter of changing intrinsically Euro-American curricula. Here, we envision a multipronged strategy that includes:

Globally, the teaching and practice of neuropsychology, as well as its research methods and research foci, tend to operate within a framework that is rooted in Western, individualistic and androcentric ontologies. In South Africa and other LMICs of the global south, this Euro-American framework has marginalised indigenous epistemologies and healing practices and discouraged wide-reaching and inclusive participation in the delivery of clinical services, production of research knowledge and advocacy for healthcare policy formulation.

The South African context is marred even further by the lingering scars of the apartheid era. During that era, non-European cultural practices were pathologised as indicative of societal dysfunction, intellectual inferiority and mental illness, reinforcing systematic marginalisation and cultural erasure. Today, the reverberations of those historic injustices persist. Black South Africans continue to be under-represented as both staff and students in training programmes and the population of practitioners and, as patients, they have relatively restricted access to private healthcare, tending instead to rely on the failing infrastructure of the public system. Moreover, academic collaborations tend to favour partnerships from the global north rather than intercontinental and regional relations.

We encourage neuropsychology training programmes in South Africa to participate actively in rejecting these epistemic and historic injustices. Although cross-cultural neuropsychologists have long acknowledged the need to adapt local practices to align with cultural understandings and ecological validity, few have framed their proposals within strong theoretical frameworks or described precise methods for change. We advocate for a decolonial approach, allied to a convivial attitude and task-related practices a la Osmer. Training programmes transformed following those approaches, attitudes and practices will not only benefit staff, students and clinical professionals, but will also ensure that the field of neuropsychology in South Africa is more equitably accessible and relevant and can make meaningful contributions to individual and societal health and well-being.

We end with a cautionary note. This article is a conceptual piece that critiques the current state of the neuropsychology training programmes (and, by extension, the current state of the discipline) in South Africa. We add to the dialogue regarding decolonial approaches to the transformation of higher education in this country, and offer practical suggestions for how to effect socially just changes in what has been, to this point, an unchecked area of the academy. This article is not, however, intended as a static blueprint for how to transform South African (or African, or LMIC) neuropsychology training programmes. A crucial tenet of decolonial approaches is that they are sensitive to context, and context changes not only spatially but also temporally. Areas we may identify as being in need of transformation now may not be as relevant to neuropsychologists in other countries, or in future times. Their approach may therefore be different to ours. Nonetheless, we urge all who are involved in these training programmes to invest in multiple ways of learning and knowing, to prioritise cultural sensitivity, and to resist complacency by continuing to engage critically with apparently entrenched perspectives.