ArticleHuman resources for health2017
Non-physician clinicians in rural Africa: lessons from the Medical Licentiate programme in Zambia.
Article in Human resources for health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 35 papers, 1 of them a synthesis that pooled it.
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Who cites it
35 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Task Shifting and Task Sharing to Strengthen the Surgical Workforce in Sub-Saharan Africa: A Systematic Review of the Existing Literature.World journal of surgery · 2023Pooled it
- The contribution of non-physician clinicians to the provision of surgery in rural Zambia-a randomised controlled trial.Human resources for health · 2019Trial
- New onset seizure etiologies and outcomes among adults with HIV in the era of broadly available antiretroviral therapies.Seizure · 2026Article
- Surgical task-sharing in Sierra Leone: barriers and enablers from provider and facilitator perspectives.BMJ global health · 2025Article
- Article
- Consensus-based recommendations for strengthening emergency care at primary health care level: a Delphi study.Global health action · 2023Article
- Perspectives of health workers engaging in task shifting to deliver health care in low-and-middle-income countries: a qualitative evidence synthesis.Global health action · 2023Review
- Evaluating the Effectiveness of Interactive Virtual Patients for Medical Education in Zambia: Randomized Controlled Trial.JMIR medical education · 2023Article
- Patient, Provider, and Health Systems Factors Leading to Lumbar Puncture Nonperformance in Zambia: A Qualitative Investigation of the "Tap Gap".The American journal of tropical medicine and hygiene · 2023Article
- "I Need to Be the First One with a Different Approach and to Make a Difference to the People": A Mixed Methods Pilot Study on Non-Physician Clinicians Training in Malawi.Advances in medical education and practice · 2023Article
- Using participatory action research to empower district hospital staff to deliver quality-assured essential surgery to rural populations in Malawi, Zambia, and Tanzania.Frontiers in public health · 2023Article
- Stakeholders' views on the utility and employment strategies of clinical associates.South African family practice : official journal of the South African Academy of Family Practice/Primary Care · 2022Article
- Doctor Retention in a COVID-World: An Opportunity to Reconfigure the Health Workforce, or "Plus ça change plus c'est la meme chose"? A Response to the Recent Commentaries.International journal of health policy and management · 2022Article
- Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in District Hospitals in Malawi.International journal of health policy and management · 2022Article
- Electronic logbooks (e-logbooks) for the continuous assessment of medical licentiates and their medical skill development in the low-resource context of Zambia: A mixed-methods study.Frontiers in medicine · 2022Article
- Article
- Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia.International journal for quality in health care : journal of the International Society for Quality in Health Care · 2021Article
- Surgical ambulance referrals in sub-Saharan Africa - financial costs and coping strategies at district hospitals in Tanzania, Malawi and Zambia.BMC health services research · 2021Article
- Identifying knowledge needed to improve surgical care in Southern Africa using a theory of change approach.BMJ global health · 2021Article
- Underutilization of Operative Capacity at the District Hospital Level in a Resource-Limited Setting.The Journal of surgical research · 2021Observational
Corrections and comments
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Authors and funding
8 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
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.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.