The use of more non-physician clinicians in sub-Saharan Africa could be a cost-effective way to boost the healthcare workforce in the region, and help deliver specific projects such as the planned expansion of HIV/AIDS prevention and treatment programmes. The findings are reported in a Public Health study published early Online and in an upcoming edition of The Lancet.
Professor Fitzhugh Mullan and Dr Seble Frehywot, George Washington University School of Public Health and Health Services, Washington, DC, USA, and colleagues did an analysis of numbers of “non-physician clinicians” (NPCs), and their various roles, in 47 sub-Saharan African countries.
The authors say: “Many nations have a history of health-care provision by staff who are not trained as physicians but who are capable of many of the diagnostic and clinical functions of medical doctors.” They add that this would include clinical officers, health officers, nurse practitioners, and physician assistants.
They add: “The growing HIV/AIDS epidemic and the health targets established by the Millennium Development Goals have brought global attention to the shortage of health workers in Sub-Saharan Africa, and the necessary challenge of scaling-up the health workforce.”
The researchers found that roles of NPCs varied widely between countries, and in nine countries numbers of NPCs equalled or exceeded numbers of fully trained physicians. All NPCs did basic diagnosis and medical treatment, and some were trained in certain specialty activities, such as caesarean section, opthamology, and anaesthesia.
Many NPCs were recruited from rural and poor areas, and worked in those same regions, and many of them have a pivotal role in the implementation and maintenance of antiretroviral treatment campaigns.
The authors conclude: “Low training costs, reduced training duration, and success in rural placements suggest that NPCs could have substantial roles in the scale-up of health workforces in sub-Saharan African countries, including for the planned expansion of HIV/AIDS prevention and treatment programmes.”
In an accompanying comment, Dr Piya Hanvoravongchai, Department of Preventive and Social Medicine, Chulalongkorn University, Bangkok, Thailand, says: “The crisis in the health workforce in Africa needs urgent, systematic and collaborative action, and scaling up NPCs to address health-workforce shortages is a promising solution that many countries are currently pursuing.
“It is important that this rush towards actions is accompanied by active pursuit of evidence and knowledge about the management of health workforces and systems.”
Journal
The Lancet