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”

Document Type : Commentary


1 World Health Organization (WHO) Africa Region Office, Brazzaville, Congo

2 SUN Business Network, Global Alliance for Improved Nutrition, Abuja, Nigeria

3 Department of Health System Policies and Operations, World Health Organization Regional Office for Africa (AFRO) Brazzaville, Congo


The changing demands on the health sectors in low- and middle-income countries especially sub-Saharan African countries continue to challenge efforts to address critical shortages of the health workforce. Addressing these challenges have led to the evolution of “non-physician clinicians” (NPCs), that assume some physician roles and thus mitigate the continuing shortage of doctors in these countries. While it is agreed that changes are needed in physicians’ roles and their training as part of the new continuum of care that includes NPCs, we disagree that such training should be geared solely at ensuring physicians dominated health systems. Discussions on the workforce models to suit low-income countries must avoid an endorsement of a culture of physician focused health systems as the only model for sub-Saharan Africa (SSA). It is also essential that training for NPCs be harmonized with that of physicians to clarify the technical roles of both.




Watch the Video Summary here



Main Subjects



  1. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-Saharan African countries. Lancet. 2007;370(9605):2158-2163. doi:10.1016/s0140-6736(07)60785-5
  2. Hooker R, Cawley J, Asprey D. Physician Assistants Policy and Practice. FA Davis Company; 2009.
  3. Nyamtema A, Pemba S, Mbaruku G, Rutasha F, van Roosmalen J. Tanzanian lessons in using non-physician clinicians to scale up comprehensive emergency obstetric care in remote and rural areas. Hum Resour Health. 2011;9(1):28. doi:10.1186/1478-4491-9-28.
  4. Rao K, Sundararaman T, Bhatnagar A, Gupta G, Kokho P, Jain K. Which doctor for primary health care? Quality of care and non-physician clinicians in India. Soc Sci Med. 2013;84:30-34. doi:10.1016/j.socscimed.2013.02.018
  5. Emdin C, Chong N, Millson P. Non-physician clinician provided HIV treatment results in equivalent outcomes as physician-provided care: a meta-analysis. J Int AIDS Soc. 2013;16:18445.doi:10.7448/ias.16.1.18445
  6. Sherr K, Micek M, Gimbel S, et al. Quality of HIV care provided by non-physician clinicians and physicians in Mozambique: a retrospective cohort study. AIDS.  2010;24(Suppl 1):S59-S66. doi:10.1097/01.aids.0000366083.75945.07
  7. Vasan A, Kenya-Mugisha N, Seung K, et al. Agreement between physicians and non-physician clinicians in starting antiretroviral therapy in rural Uganda. Hum Resour Health. 2009;7(1):75. doi:10.1186/1478-4491-7-75.
  8. Eyal N, Cancedda C, Kyamanywa P, Hurst S. 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
  9. Kinfu Y, Dal Poz M, Mercer H, Evans D. The health worker shortage in Africa: are enough physicians and nurses being trained? Accessed May 29, 2016. Published 2016.
  10. Mullan F, Frehywot 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
  11. Chandler C, Chonya S, Mtei F, Reyburn H, Whitty C. Motivation, money and respect: A mixed-method study of Tanzanian non-physician clinicians. Soc Sci Med. 2009;68(11):2078-2088.
  12. Orcutt V. The supply and demand of physician assistants in the United States: A trend analysis [Ph.D thesis]. Denton, Texas: University of North Texas; 2007.
  13. Reynolds E, Bricker J. Nonphysician clinicians in the neonatal intensive care unit: meeting the needs of our smallest patients. Pediatrics. 2007;119(2):361-369.
  14. Richards MR, Polsky D. Influence of provider mix and regulation on primary care services supplied to US patients. Health Econ Policy Law. 2015;11(2):193-213. doi:10.1017/S1744133115000390
  15. WHO/AFRO. African Health Workforce Observatory website. 2012.
  16. Zachariah R, Ford N, Philips M, et al. Task shifting in HIV/AIDS: opportunities, challenges and proposed actions for sub-Saharan Africa. Trans R Soc Trop Med Hyg. 2009;103(6):549-558.
  17. Ellard D, Simkiss D, Quenby S, et al. The impact of training non-physician clinicians in Malawi on maternal and perinatal mortality: a cluster randomised controlled evaluation of the enhancing training and appropriate technologies for mothers and babies in Africa (ETATMBA) project. BMC Pregnancy Childbirth. 2012;12:116. doi:10.1186/1471-2393-12-116
  18. Garr R, Dewe P. A qualitative study of mentoring and career progression among junior medical doctors. Int J Med Educ. 2013;4:247-252.
  19. De Souza B, Viney R. BMJ Careers - Coaching and mentoring skills: necessities for today’s doctors. BMJ Careers website. Published 2016.
  20. Cuba – health in the Americas. Pan America Health Organization website. Published 2012.
  21. World Health Organization (WHO). Package of essential non-communicable (PEN) disease interventions for primary care in low-resource settings. Geneva: WHO; 2010.


  • Receive Date: 08 June 2016
  • Revise Date: 15 August 2016
  • Accept Date: 09 August 2016
  • First Publish Date: 01 February 2017