An African solution to doctor shortages

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Across the developing world, there are simply not enough doctors to go around.  In Indonesia, the world’s 4th most populous nation, the shortage of doctors is disparaging.  Only 2,600 OB/GYNs are available to provide healthcare services to the women for Indonesia (total population – 240 million people).  African nations have long been challenged by low physician coverage which brain drain has prevented from improving.  In Africa alone, a McKinsey studyestimates that 300 new medical schools would need to be built to produce the 200,000 doctors needed for the continent to reach the WHO’s minimum doctor to patient ratio.  This simply won’t take place and many African Ministries of Health have known this for some time.  As a result, Africa has, over the past two decades, become the birth place of a new global movement to innovate our way out of the physician crisis.  Task shifting is the innovation, empowering non-physicians to perform clinical tasks historically reserved for doctors alone.  Interestingly the people fighting for task shifting in Africa are those who used to fight against this change – physicians!

The story of task shifting in Africa started in Mozambique over twenty years ago.  The protracted civil war decimated Mozambique’s public health sector leaving literally a handful of OB/GYNs in the entire country.  A compelling documentary by PBS portrays the challenges and victories of the first midwife in Mozambique to be trained on how to conduct a C-section. Since then, hundreds of midwives have been trained in C-section surgery in several African countries.  At first, the physician associations were reluctant to allow complex diagnostic and treatment tasks to be conducted by anyone lacking the training and credentials of a doctor.  Physicians who led the first class of midwife training had to prove the clinical competence of the midwives and convince the physician associations that task shifting would not erode quality of care or the prominence of physicians in their country.  Two decades later, this “non-physician clinician” model has now been adopted nationwide in Malawi, Tanzania, and Ethiopia.  These brave African physicians have blazed this innovative pathway of task shifting.  We hope physicians worldwide are open to this new model of care.  In Indonesia alone, 130,000 midwives stand ready to embrace task shifting and bring desperately needed services to a waiting populace.  

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5 Responses to “An African solution to doctor shortages”

  1. sbfphc Says:

    Physician concerns about eroding the quality of care emerge whenever such issues are discussed. I always argue that one cannot erode something that is not there. The non-existent physician’s non-existent care cannot be eroded – hence the need for competent people to provide care regardless of their title. The importance of thorough training, clear guidelines (sometimes called standing orders) and good supervision fill most gaps. Physicians are called on to do no harm, but denying rural communities basic care simply because the clinician is not a physician harms and kills.

  2. linch162 Says:

    I worked in central rural Australia where it generally is short of doctors. The most we have are nurse practitioners in emergency departments. Therefore I am actually very amazed that midwives in Mozambique can perform C-sections. I think it is a great move and I agree that, as long as there is proper training and clear guideline, it will be much better than no care at all.

  3. itseajuyah Says:

    Great piece here. I’ve worked in a rural type setting in a deserted state/local government hospital in a rural community in which we definately could not reach persons most in need. I therefore am totally completely disposed and convinced on task-shifting across to community health workers a whole host of duties/tasks.
    I’m still very much of ther opinion that not all tasks can be shifted. C-sections are emergency life-saving procedures that shouldd be availble to every pregnant woman if its need arises or this dleivery option is preferred. It still has its many risks even amongst skilled hands. I guess environmental context also applies here because just as health systems are stretched, so too is the capacity for monitoring these workers and their activities.
    If a whole lot (tasks and duties) is introduced to CHW’s including emergency procedures like this, it really may not be long before another public health problem arises especially in settings where people tend to exceed their bounds and with little capacity for monitoring.

  4. judypressleyphillips Says:

    I am a nurse practitioner. I believe with proper training and continued follow ups and inservices and tracking….of outcomes. …certainally this is obtainable. What are the women going to do? Die? Along with their babies!

  5. shirinkakayeva Says:

    I believe so too. Also, there is a need for capacity building among other types of health professionals, i.e. healthy facility administrators to be able to adhere to safety policies and guidelines and conduct monitoring of newly trained midwives’ activities. Most importantly, there is a need for overall health systems strengthening to address the shortages of trained health workers in affected communities.

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