Cost effectiveness of clinical associates: A case study for the Mpumalanga province in South Africa

Abstract

BackgroundThe National Department of Health of South Africa decided to start a programme to train mid-level healthcare workers, called clinical associates, as one of the measures to increase healthcare workers at district level in rural areas. Unfortunately, very little is known about the cost effectiveness of clinical associates.AimsTo determine, on a provincial level, the cost effectiveness of training and employing clinical associates and medical practitioners compared to the standard strategy of training and employing only more medical practitioners.MethodsA literature study was performed to answer several sub questions regarding the costs and effectiveness of clinical associates. The results were used to present a case study.ResultsThe total cost for a province to pay for the full training of a clinical associate is R 300 850. The average employment cost per year is R196 329 and for medical practitioners these costs are R 730 985 and R 559 397, respectively.EffectivenessClinical associates are likely to free up the time of a medical practitioner by 50–76%. They can provide the same quality of care as higher level workers, provided that they receive adequate training, support and supervision. Furthermore, they seem more willing to work in rural areas compared to medical practitioners.ConclusionsThe case study showed that training and employing clinical associates is potentially a cost-effective strategy for a province to meet the increasing demand for rural healthcare workers. This strategy will only succeed when clinical associates receive adequate training, support and supervision and if the province keeps investing in them.

A Checklist for Implementing Rural Pathways to Train, Develop and Support Health Workers in Low and Middle-Income Countries

“…• What are the cost-benefits of training a new worker and who will share the costs of training? (27,28,32,(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70) Education and training Optimal education and training for rural practice occurs through exposure to rural and remote practice, teams, and health systems. Learning the range of skills needed is effective through distributed training systems using locally-available qualified teachers and supervisors, in the place where people are going to practice and involving of the people that the workers are going to help after they finish training.…”

Stakeholders’ views on the utility and employment strategies of clinical associates

“…11 The employment of ClinAs is cost-effective without compromising the quality of healthcare, and this in turn has the potential to increase Human Resources for Health (HRH) in peripheral and rural communities. 12 Global findings suggested that midlevel medical workers provide quality healthcare services with outcomes that are similar to medical practitioners. 13 The effectiveness of mid-level medical workers in other countries is attributed to the ongoing support and recognition of this profession.…”

Clinical associates and access to healthcare in the Eastern Cape province of South Africa

“…To mention a few, Bac et al 7 found that using ClinAs in a rural district hospital led to improvement in quality of patient care by reducing waiting times in casualty and outpatient departments (OPD) because the ClinAs took on much of the workload of the medical team. Hamm et al 8 looked at the cost of training and employing ClinAs in South Africa and found that the ClinAs were two and a half times less costly to train than doctors, and about three times less costly to employ. In the same study, ClinAs were found to free up the time of doctors by 50% -70% while providing the same quality of care.…”