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Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates

BACKGROUND: Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates...

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Autores principales: Doherty, Jane, Conco, Daphney, Couper, Ian, Fonn, Sharon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Co-Action Publishing 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556716/
https://www.ncbi.nlm.nih.gov/pubmed/23364079
http://dx.doi.org/10.3402/gha.v6i0.19282
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author Doherty, Jane
Conco, Daphney
Couper, Ian
Fonn, Sharon
author_facet Doherty, Jane
Conco, Daphney
Couper, Ian
Fonn, Sharon
author_sort Doherty, Jane
collection PubMed
description BACKGROUND: Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. OBJECTIVE: We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. METHODS: We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. RESULTS: Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. CONCLUSIONS: This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives.
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spelling pubmed-35567162013-01-28 Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates Doherty, Jane Conco, Daphney Couper, Ian Fonn, Sharon Glob Health Action Building New Knowledge Supplement BACKGROUND: Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers – known as clinical associates – in small numbers in 2008. OBJECTIVE: We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker. METHODS: We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed. RESULTS: Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards. CONCLUSIONS: This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives. Co-Action Publishing 2013-01-24 /pmc/articles/PMC3556716/ /pubmed/23364079 http://dx.doi.org/10.3402/gha.v6i0.19282 Text en © 2013 Jane Doherty et al. http://creativecommons.org/licenses/by/2.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Building New Knowledge Supplement
Doherty, Jane
Conco, Daphney
Couper, Ian
Fonn, Sharon
Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title_full Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title_fullStr Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title_full_unstemmed Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title_short Developing a new mid-level health worker: lessons from South Africa's experience with clinical associates
title_sort developing a new mid-level health worker: lessons from south africa's experience with clinical associates
topic Building New Knowledge Supplement
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3556716/
https://www.ncbi.nlm.nih.gov/pubmed/23364079
http://dx.doi.org/10.3402/gha.v6i0.19282
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