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”

Document Type : Commentary


1 College of Medicine, University of Ibadan, Ibadan, Nigeria

2 College of Health Sciences, Makarere University, Kampala, Uganda

3 Department of Medical Education, Walter Sisulu University, Mthatha, South Africa


Recent proposals for re-defining the roles Africa’s health workforce are a continuation of the discussions that have been held since colonial times. The proposals have centred on basing the continent’s healthcare delivery on non-physician clinicians (NPCs) who can be quickly trained and widely distributed to treat majority of the common diseases. Whilst seemingly logical, the success of these proposals will depend on the development of clearly defined professional duties for each cadre of healthcare workers (HCW) taking the peculiarities of each country into consideration. As such the continent-wide efforts aimed at health-professional curriculum reforms, more effective utilisation of task-shifting as well as the intra – and inter-disciplinary collaborations must be encouraged. Since physicians play a major role in the training mentoring and supervision of physician and nonphysician health-workers alike, the maintenance of the standards of university medical education is central to the success of all health system models. It must also be recognized that, efforts at improving Africa’s health systems can only succeed if the necessary socio-economic, educational, and technological infrastructure are in place.



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  1. Eyal E, Cancedda C, Kyamanywa P, Hurst SA. Non-physician clinicians in sub-Saharan Africa and the evolving role of physicians. Int J Health Policy Manag. 2015;5(3):149-153. doi:10.15171/ijhpm.2015.215.
  2. 2.     Thorp E. Ladder of Bones: The Birth of Modern Nigeria From 1853 to Independence. London; Glasgow Collins; 1966.
  3. World Health Organization (WHO). Tasks shifting: rational redistribution of tasks among health workforce teams: Global recommendations and guidelines. Geneva, Switzerland: WHO; 2008.
  4. Deller B, Tripathi V, Stender S, et al. Task shifting in maternal and newborn healthcare: key components from policy to implementation. Int J Gynaecol Obstet. 2015;130(2):s25-s31. doi:10.1016/j.ijgo.2015.03.005.
  5. Ellard DR, Shemdoe A, Mazuguni F, et al. Can training non-physicians/associate clinicians (NPCs/ACs) in emergency obstetric, neonatal care and clinical leadership make a difference to practice and help towards reductions in maternal and neonatal mortality in rural Tanzania? The ETATMBA project. BMJ Open. 2016;6(2):e008999. doi:10.1136/bmjopen-2015-008999.
  6. Monekosso GL. A brief history of medical education in Sub-Saharan Africa. Celebrating_accountable_medical_education_in_Africa.pdf. Accessed June 10, 2016. Published 2010.
  7. Monekosso GL. A brief history of medical education in sub-Sahara Africa. Acad Med. 2014;89(8):S11-S15.
  8. Church Missionary Society Archive. Accessed June 8, 2016.
  9. Melamby K. The birth of Nigeria’s University. London: Methuen; 1958.
  10. Iliffe J. East African Doctors: A History of the Modern Profession. Cambridge: Cambridge University Press; 1998. 
  11. Mullan F, Freywot S, Omaswa F, et al. Medical schools in sub-Saharan Africa. Lancet. 2011;377(9771):1113-1121. doi:10.1016/S0140-6736(10)61961-7
  12. Dgedge M, Mendoza A, Necochea E, Bossemeyer D, Rajabo M, Fullerton J. A survey of sub-Saharan African medical schools. Hum Resour Health. 2012;10:4. doi:10.1186/1478-4491-10-4
  13. Kiguli-Malwadde E, Olapade-Olaopa EO, Kiguli S, et al. Competency-based medical education in two sub-Saharan African medical schools. Adv Med Educ Pract. 2014;5:483-489.
  14. Olaleye DO, Odaibo GN, Carney P, et al. Enhancement of health research capacity in Nigeria through north-south and in-country partnerships. Acad Med. 2014;89(8 Suppl):S93-S97. doi:10.1097/ACM.0000000000000353
  15. Cancedda C, Farmer PE, Kerry V, et al. Maximising the impact of training initiatives for health professionals in low-income countries: frameworks, challenges and best practices. PLoS Med. 2015;12(6):e1001840. doi:10.1371/journal.pmed.1001840
  16. Olapade-Olaopa EO, Baird S, Kiguli-Malwadde E, Kolars JC. Growing partnerships: leveraging the power of collaboration through the Medical Education Partnership Initiative. Acad Med. 2014;89(8Suppl):S19-S23. doi:10.1097/ACM.0000000000000345
  17. Benavides B, Caffrey M. Incorporating lay human resources to increase accessibility to antiretroviral therapy: a home-based approach in Uganda. Chapel Hill: The capacity project; 2006. -Accessed June 8, 2016.
  18. Chu K, Rosseel P, Gielis P, Ford N. Surgical task shifting in sub-Saharan Africa. PLoS Med. 2009;6(5):e1000078. doi:10.1371/journal.pmed.1000078
  19. Fulton BD, Scheffler RM, Sparkes SP, Auh EY, Vujicic M, Soucat A. Health workforce skill mix and task shifting in low income countries: a review of recent evidence. 2011. Human Resour Health. 2011;9:1. doi:10.1186/1478-491-9-1
  20. Johan du Plessis, Pitcher R. Towards task shifting? A comparison of the accuracy of acute trauma-radiograph reporting by medical officers and senior radiographers in an African hospital. Pan Afr Med J. 2015;21:308. doi:10.11604/pamj.2015.21.308.6937
  21. Labhardt ND, Balo J, Ndam M, Grimm J, Manga M. Task shifting to non-physician clinicians for integrated management of hypertension and diabetes in rural Cameroon: a programme assessment at two years. BMC Health Serv Res. 2010;10:339. doi:10.1186/1472-6963-10-339.
  22. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370(9605):2158-2163.
  23. Yaya Bocoum F, Kouanda S, Kouyate B, Hounton S, Adam T. Exploring the effects of task shifting for HIV through a systems thinking lens: the case of Burkina Faso. BMC Public Health. 2013;13:997. doi:10.1186/1471-2458-13-997
  24. Lehmann U, Van Damme W, Barten F, Sanders D. Task shifting: the answer to the human resources crisis in Africa? Hum Resour Health. 2009;7:49. doi:10.1186/1478-4491-7-49
  25. Rustagi AS, Manjate RM, Gloyd S, et al. Perspectives of key stakeholders regarding task shifting of care for HIV patients in Mozambique: a qualitative interview-based study with Ministry of Health leaders, clinicians and donors. Hum Resour Health. 2015;13:18. doi:10.1186/s12960-015-0009-3
  26. Munga MA, Kilima SP, Mutalemwa PP, Kisoka WJ, Malecela MN. Experiences, opportunities and challenges of implementing task shifting in underserved remote stings: the case of Kongwa district, central Tanzania. BMC Int Health Hum Rights. 2012;12:27. doi:10.1186/1472-698X-12-27
  27. Dambisya YM, Matinhure S. Policy and pragmatic implications of task shifting in Uganda: a case study. BMC Health Serv Res. 2012;12:61. doi:10.1186/1472-6963-12-61
  28. Olapade-Olaopa EO, Sewankambo NK, Iputo J, et al. Consensus on African Physician Competencies. Presentation at: the 2015 MEPI  Symposium; July 15, 2015; Harare, Zimbabwe.
  29. Kwizera EN, Iputo JE. Addressing social responsibility in medical education: the African way. Med Teach. 2011;33(8):649-653. doi:10.3109/0142159X.2011.590247
  30. Iputo JE. Faculty of Health Sciences, Walter Sisulu University: training doctors from and for rural South African communities. MEDICC Rev. 2008;10(4):25-29.
  31. Gilbert JH, Yan J, Hoffman SJ. A WHO report: framework for action on inter-professional education and collaborative practice. J Allied Health. 2010;39(Suppl 1):196-197.
  32. World Health Organization (WHO). Transforming and scaling up health professionals' education and training. Geneva: WHO; 2013.
  33. American Academy of Physician Assistants (AAPA) website. Accessed June 6, 2016.
  34. Eric A, Friedman JD. An action plan to prevent brain drain: building equitable health systems in Africa. Boston MA: Physicians for Human Rights; 2004. Accessed June 6, 2016.