Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians

Document Type : Editorial


1 Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA

2 Division of Global Health Equity, Brigham and Women’s Hospital, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

3 School of Medicine, University of Rwanda, Butare, Rwanda

4 Institute for Ethics, History, and the Humanities, Faculty of Medicine, Geneva University, Geneva, Switzerland


Responding to critical shortages of physicians, most sub-Saharan countries have scaled up training of nonphysician clinicians (NPCs), resulting in a gradual but decisive shift to NPCs as the cornerstone of healthcare delivery. This development should unfold in parallel with strategic rethinking about the role of physicians and with innovations in physician education and in-service training. In important ways, a growing number of NPCs only renders physicians more necessary – for example, as specialized healthcare providers and as leaders, managers, mentors, and public health administrators. Physicians in sub-Saharan Africa ought to be trained in all of these capacities. This evolution in the role of physicians may also help address known challenges to the successful integration of NPCs in the health system.


Commentaries Published on this Paper

  • The Evolving Role of Physicians - Don’t Forget the Generalist Primary Care Providers; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF

  • Have Non-physician Clinicians Come to Stay?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF

  • Is the Role of Physicians Really Evolving Due to Non-physician Clinicians Predominance in Staff Makeup in Sub-Saharan African Health Systems?; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF

  • The Evolution of the Physician Role in the Setting of Increased Non-physician Clinicians in Sub-Saharan Africa: An Insistence on Timing and Culturally-Sensitive, Purposefully Selected Skill Development; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF

  • 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 | PDF

  • Defining Sub-Saharan Africa’s Health Workforce Needs: Going Forwards Quickly Into the Past; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF

  • Non-physician Clinicians – A Gain for Physicians’ Working in Sub-Saharan Africa; Comment on “Non-physician Clinicians in Sub-Saharan Africa and the Evolving Role of Physicians”

          Abstract | PDF


Authors' Response to the Commentary

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

          Abstract | PDF



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Main Subjects



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