School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Glob Health Action. 2013 Jan 24;6:19282. doi: 10.3402/gha.v6i0.19282.
Mid-level medical workers play an important role in health systems and hold great potential for addressing the human resource shortage, especially in low- and middle-income countries. South Africa began the production of its first mid-level medical workers - known as clinical associates - in small numbers in 2008.
We describe the way in which scopes of practice and course design were negotiated and assess progress during the early years. We derive lessons for other countries wishing to introduce new types of mid-level worker.
We conducted a rapid assessment in 2010 consisting of a review of 19 documents and 11 semi-structured interviews with a variety of stakeholders. A thematic analysis was performed.
Central to the success of the clinical associate training programme was a clear definition and understanding of the interests of various stakeholders. Stakeholder sensitivities were taken into account in the conceptualisation of the role and scope of practice of the clinical associate. This was achieved by dealing with quality of care concerns through service-based training and doctor supervision, and using a national curriculum framework to set uniform standards.
This new mid-level medical worker can contribute to the quality of district hospital care and address human resource shortages. However, a number of significant challenges lie ahead. To sustain and expand on early achievements, clinical associates must be produced in greater numbers and the required funding, training capacity, public sector posts, and supervision must be made available. Retaining the new cadre will depend on the public system becoming an employer of choice. Nonetheless, the South African experience yields positive lessons that could be of use to other countries contemplating similar initiatives.
中层医疗工作者在卫生系统中发挥着重要作用，对于解决人力资源短缺问题具有巨大潜力，尤其是在中低收入国家。南非于 2008 年开始小规模生产第一批中层医疗工作者，即临床助理。
我们描述了实践范围和课程设计的协商方式，并评估了早期的进展。我们为其他希望引入新型中层工作人员的国家提供了经验教训。
我们在 2010 年进行了快速评估，包括对 19 份文件的审查和对各种利益相关者的 11 次半结构化访谈。进行了主题分析。
临床助理培训计划成功的关键是明确界定和理解各利益相关者的利益。在考虑临床助理的角色和实践范围时，考虑到了利益相关者的敏感性。通过以服务为基础的培训和医生监督来解决护理质量问题，并使用国家课程框架来设定统一的标准，从而实现了这一点。
这种新的中层医疗工作者可以提高区医院的护理质量，并解决人力资源短缺问题。然而，还面临着许多重大挑战。为了保持和扩大早期成果，必须增加临床助理的数量，并提供所需的资金、培训能力、公共部门职位和监督。保留新的医务人员队伍将取决于公共系统成为首选雇主。尽管如此，南非的经验提供了积极的经验教训，可供其他考虑类似举措的国家借鉴。
