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Most countries in sub-Saharan Africa have a chronic and serious shortage of doctors. Many are responding by training secondary school leavers and nurses to do a wide range of clinical activities, including diagnosing, prescribing, and in some cases carrying out surgery. It is hard to know the exact scale of this workforce. But an investigation by health policy analysts in the US recently found so called “non-physician clinicians” practising in 25 of the 47 countries in sub-Saharan Africa. In nine countries their numbers equalled or exceeded the numbers of doctorsdoctors.
Non-clinician physicians are quicker and cheaper to train than doctors. They are also more likely to come from and work in the rural areas that desperately need health personnel. So they are an attractive option for cash starved health services, say the investigators. Many governments, such as those in Zambia, Ethiopia, Sudan, and Lesotho are scaling up their non-doctor workforces, partly to meet the demands of HIV treatment programmes. In Kenya and Malawi, non-physician clinicians are already the backbone of the health system.
The expansion has drawn a mixed response from doctors, who worry about the competition, and nurses who suspect their own skills are being overlooked in the rush.