Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia

Human Resources for Health

Research

Eric Borgstein¹  Leon Bijlmakers²  Ruairi Brugha³  Tracey McCauley³  Jakub Gajewski³  John Kachimba⁴  Carol Mweemba⁴  Mweene Cheelo⁴ 

[1] College of Medicine, Malawi, Mahatma Gandhi, Blantyre, Malawi;Radboud University Medical Centre Netherlands, Geert Grooteplein Zuid 10, 6525, Nijmegen, GA, Netherlands;Royal College of Surgeons in Ireland, 123 St Stephens Green, Dublin 2, Ireland;Surgical Society of Zambia, Department of Surgery, University Teaching Hospital, Nationalist Road, Lusaka, Zambia;

关键词: Surgery;    Non-physician clinicians;    Surgical training;    Health workforce retention;    Medical licentiates;   

DOI  :  10.1186/s12960-017-0233-0

 received in 2017-03-03, accepted in 2017-08-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundMost sub-Saharan African countries struggle to make safe surgery accessible to rural populations due to a shortage of qualified surgeons and the unlikelihood of retaining them in district hospitals. In 2002, Zambia introduced a new cadre of non-physician clinicians (NPCs), medical licentiates (MLs), trained initially to the level of a higher diploma and from 2013 up to a BSc degree. MLs have advanced clinical skills, including training in elective and emergency surgery, designed as a sustainable response to the surgical needs of rural populations.MethodsThis qualitative study aimed to describe the role, contributions and challenges surgically active MLs have experienced. Based on 43 interviewees, it includes the perspective of MLs, their district hospital colleagues—medical officers (MOs), nurses and managers; and surgeon-supervisors and national stakeholders.ResultsIn Zambia, MLs play a crucial role in delivering surgical services at the district level, providing emergency surgery and often increasing the range of elective surgical cases that would otherwise not be available for rural dwellers. They work hand in hand with MOs, often giving them informal surgical training and reducing the need for hospitals to refer surgical cases. However, MLs often face professional recognition problems and tensions around relationships with MOs that impact their ability to utilise their surgical skills.ConclusionsThe paper provides new evidence concerning the benefits of ‘task shifting’ and identifies challenges that need to be addressed if MLs are to be a sustainable response to the surgical needs of rural populations in Zambia. Policy lessons for other countries in the region that also use NPCs to deliver essential surgery include the need for career paths and opportunities, professional recognition, and suitable employment options for this important cadre of healthcare professionals.

【 授权许可】

CC BY   
© The Author(s). 2017