A New Generation of Physicians in Sub-Saharan Africa? Comment on "Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians"

Abstract

This commentary follows up on an editorial by Eyal and colleagues in which these authors discuss the implications of the emergence of non-physician clinicians (NPCs) on the health labour market for the education of medical doctors. We generally agree with those authors and we want to stress the importance of clarifying the terminology to describe these practitioners and of defining more formally their scope of practice as prerequisites to identifying the new competencies which physicians need to acquire. We add one new competencies domain, the utilization of new communication technologies, to those listed in the editorial. Finally, we identify policy issues which decision-makers will need to address to make medical education reform work.

Supervision as a tool for building surgical capacity of district hospitals: the case of Zambia

“…This paper also aims to contribute to a broader understanding of how to optimise supervisory models for NPCs working at DLHs in sub-Saharan Africa (SSA). Although similar initiatives have been implemented in other countries [25], to date, NPC supervision is still irregular or often lacking in rural health care systems [15,29], and there is little evidence about the practical implementation of NPC supervision models. This study to our knowledge was the first one to explore these dimensions in practice.…”

“…As suggested by recent studies, one way to support surgically active NPCs is through continuing education and in-service training, including programmes of regular visits by specialists to facilitate skills transfer through practical learning [9,12,13]. Supervision allows specialists to monitor the surgical performance of district hospital-level NPCs, while offering opportunities to further develop NPCs surgical skills in a safe and controlled environment [6,9,[14][15][16]. This may contribute to reducing risks and ensuring overall quality of care in DLHs [6,9,[14][15][16].…”

“…Supervision allows specialists to monitor the surgical performance of district hospital-level NPCs, while offering opportunities to further develop NPCs surgical skills in a safe and controlled environment [6,9,[14][15][16]. This may contribute to reducing risks and ensuring overall quality of care in DLHs [6,9,[14][15][16].…”

Coordinating Between Medical Professions’ Tasks to Optimize Sub-Saharan Health Systems: A Response to Recent Commentaries

“…Some respondents 4 , 6 criticize our definition of NPCs, originally by Mullan and Frehywot, according to which NPCs are “health workers who have fewer clinical skills than physicians but more than nurses.” 7 On any definition by clinical skill, inter-individual skill variance may count as variance in professional–affiliation. To prevent that quirk, one might try to define the skill level as the mean level among practitioners in the relevant country.…”

“…Some respondents point out additional non-clinical skills that have become necessary: mHealth and eHealth skills; the ability to “mobilize and coordinate with other stakeholders in the community [and] aid agencies” 6 ; in-practice training of generalist providers in primary healthcare 11 ; and the willingness to accept further training from highly experienced NPCs. 4 These possibilities merit further exploration.…”