A new health care profession in rural district hospitals: a case study of the introduction of Clinical Associates in Shongwe hospital

Bac, Martin; Hamm, J M A; Bodegraven, P C van; Pater, B; Louw, J M

doi:10.4102/safp.v59i1.4654

Cited by 5 publications

(8 citation statements)

References 2 publications

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“…The findings support the outcomes of the study conducted at a district hospital in Mpumalanga that looked into the introduction of ClinAs at their facility, which found that ClinAs assisted the hospital in maintaining and improving patient care. 9 The strong agreement among participants that more ClinAs will strengthen their hospitals' ability to provide the needed quality of healthcare services is evidence of the high regard for their contribution. The efficient use of HRH that include The study did not find strong agreement on the provision of putting measures in place or supported efforts to create the needed awareness for ClinAs as the new profession at hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…8 In a case study done in Mpumalanga, some healthcare professionals were not keen to work with ClinAs despite evidence of improved access to care for clients and a reduction in the waiting times in casualty and outpatient departments. 9 Clinical associates, together with other healthcare workers, are able to provide comprehensive healthcare to a large number of clients. A study in 2018 from the Tshwane district in South Africa found that almost 90% of circumcisions between 2014 and 2015 were done by ClinAs.…”

Section: Introductionmentioning

confidence: 99%

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Stakeholders’ views on the utility and employment strategies of clinical associates

Setlhapelo

Wolvaardt

2022

S Afr Fam Pract

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Background: Clinical associates (ClinAs) were introduced into the South African healthcare system to increase the numbers of skilled health professionals. Little is known on how they are viewed. This study explored stakeholder views on the utility and employment strategies of ClinAs in the public sector.Methods: A mixed-methods design was used. An online survey was used to collect data from operational stakeholders, while online interviews explored strategic stakeholders’ views.Results: Forty-five operational stakeholders participated. The view of ClinAs’ contribution to the joint management of four common health conditions was strong (91% – 96%). The poorest agreement was their perceived contribution to maternal health (38%). There was a strong agreement (mean = 6.13, s.d.: 0.94) that conditions of ClinAs practice are met. Clinical associates were viewed as being able to work with others (mean = 6.11, s.d.: 0.98) and contribute to service improvement (mean = 6.47, s.d.: 0.62). There was a low agreement regarding the positive impact of recruitment (mean = 2.93, s.d.: 1.99) and retention strategies on ClinAs (mean = 2.75, s.d.: 1.51). The six key strategic stakeholders ascribed the slow progress made in career development, career progression, post creation and professional autonomy to the uncertainty regarding the scope of practice and perceived lack of support.Conclusion: The utility of ClinAs to provide health services in the public sector is clear, and their contribution is valued. The lack of progress around many of the human resource issues is a constraint that needs a champion if this cadre is to fully realise their potential.Contribution: Clinical associates are valued at service delivery level, but appear overlooked higher up.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Stakeholders’ views on the utility and employment strategies of clinical associates

Setlhapelo

Wolvaardt

2022

S Afr Fam Pract

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“…For example, long-term disability requires sustained interactions with the medical and rehabilitative services [4,50,63]. Careful, strategic thinking on the mix of cadres, their roles, regulation, financing and training and supervision and management of teams and services are needed [64][65][66]. To inform this much more might be learned from better evaluation of existing experience.…”

Section: Implications and Future Considerationsmentioning

confidence: 99%

“…To inform this much more might be learned from better evaluation of existing experience. Governments, regulatory councils and training institutions also need to enable changes in education, legislation, policy and financing well in advance of future expansion of service scope and scale as producing the desired mix of professions and skills may take years or even decades [64,65].…”

Section: Implications and Future Considerationsmentioning

confidence: 99%

Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities

et al. 2021

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Background Demographic and epidemiological changes have prompted thinking on the need to broaden the child health agenda to include care for complex and chronic conditions in the 0–19 years (paediatric) age range. Providing such services will be undermined by general and skilled paediatric workforce shortages especially in low- and middle-income countries (LMICs). In this paper, we aim to understand existing, sanctioned forms of task-sharing to support the delivery of care for more complex and chronic paediatric and child health conditions in LMICs and emerging opportunities for task-sharing. We specifically focus on conditions other than acute infectious diseases and malnutrition that are historically shifted. Methods We (1) reviewed the Global Burden of Diseases study to understand which conditions may need to be prioritized; (2) investigated training opportunities and national policies related to task-sharing (current practice) in five purposefully selected African countries (Kenya, Uganda, Tanzania, Malawi and South Africa); and (3) summarized reported experience of task-sharing and paediatric and child health service delivery through a scoping review of research literature in LMICs published between 1990 and 2019 using MEDLINE, Embase, Global Health, PsycINFO, CINAHL and the Cochrane Library. Results We found that while some training opportunities nominally support emerging roles for non-physician clinicians and nurses, formal scopes of practices often remain rather restricted and neither training nor policy seems well aligned with probable needs from high-burden complex and chronic conditions. From 83 studies in 24 LMICs, and aside from the historically shifted conditions, we found some evidence examining task-sharing for a small set of specific conditions (circumcision, some complex surgery, rheumatic heart diseases, epilepsy, mental health). Conclusion As child health strategies are further redesigned to address the previously unmet needs careful strategic thinking on the development of an appropriate paediatric workforce is needed. To achieve coverage at scale countries may need to transform their paediatric workforce including possible new roles for non-physician cadres to support safe, accessible and high-quality care.

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“…Students with the BCMP degree are qualified to practise as clinical associates in South Africa (SA). [11] They spend most of…”

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confidence: 99%

A capability approach analysis of student perspectives of a medical consultation quality-improvement process

Louw

Marcus

Hugo

2021

AJHPE

Self Cite

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Person-centred practice is an ethical imperative [1,2] and an essential competency that has value for patients, clinicians and the health service. [3] At its core is a holistic view of the patient as a person with a unique illness experience, as well as the creation of a therapeutic relationship between patient and clinician. [1] Despite various interventions, research shows that person-centredness and its constituent elements decline during the training of medical students. [4][5][6] To understand this phenomenon, it is necessary to examine the underlying assumptions and effects of training interventions on person-centred practice. This, in turn, requires an understanding of learning and the learner.Marcus [7] refers to four dimensions of the learner as sources of human capacity and competency, i.e. physical and mental abilities, knowledge and beliefs, sense of self and identity and social relationships. When there is a disturbance to any, some or all of these dimensions, the person experiences uncertainty. This uncertainty becomes the trigger to several, preferably conscious, cognitive and metacognitive activities that lead to learning. These include reviewing the activities or events that triggered the disruption, finding new information and critically evaluating the new information against the disruption, while taking into account self and identity, relationships and competencies. All this is done to develop an appropriate plan of action. Through practice, learners improve or develop new competencies, and develop or deepen their understanding of themselves and others, thereby growing the ability to learn in a continuously iterative learning cycle. [8] The capability approach (Fig. 1) [7,9,10] enables learners to develop mastery and move towards self-directed learning over time. It needs to be made consciously visible, scaffolded and guided by mentors and teachers, for all individuals to learn how to use it. [9] In this article, we use the capability approach to assess Bachelor of Clinical Medical Practice (BCMP) students' learning of person-centred consultation skills during a quality-improvement (QI) process on the medical consultation. Students with the BCMP degree are qualified to practise as clinical associates in South Africa (SA). [11] They spend most of Background. Research shows that person-centredness declines during medical education. This study examines the underlying assumptions and effects of clinical associate training interventions on person-centred practice.Objectives. To understand student experiences of a medical consultation quality-improvement (QI) process in terms of a capability approach to learning and the effects of this process on their person-centredness. Methods. In a randomised controlled trial students from 8 clinical learning centres (CLCs) participated in a qualitative, medical consultation QI process. Qualitative data (focus group discussions and reflective reports) were analysed using a capability approach to the learning framework. Results. Learning was triggered by disruptio...

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A new health care profession in rural district hospitals: a case study of the introduction of Clinical Associates in Shongwe hospital

Cited by 5 publications

References 2 publications

Stakeholders’ views on the utility and employment strategies of clinical associates

Stakeholders’ views on the utility and employment strategies of clinical associates

Task-sharing to support paediatric and child health service delivery in low- and middle-income countries: current practice and a scoping review of emerging opportunities

A capability approach analysis of student perspectives of a medical consultation quality-improvement process

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