%0 Journal Article
%T Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review
%A Delanyo Dovlo
%J Human Resources for Health
%D 2004
%I BioMed Central
%R 10.1186/1478-4491-2-7
%X A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires.The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services.The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.The term "substitute health worker" (SHW) is used in this report to mean cadres of health workers who have taken on jobs, functions and roles that are normally the tasks of internationally recognized health professionals such as doctors, nurses and pharmacists. These "substitutes" usually receive shorter pre-service training than the original cadres and perform some or parts of the tasks normally carried out by the higher cadre. However, some observers say the term "substitute" is a misnomer, as these cadres fulfill clear and defined roles in health services. The term is thus used advisedly for alternative cadres that have been used in Africa for the traditional cadres that are recognized internationally.There is renewed interest in such health cadres
%U http://www.human-resources-health.com/content/2/1/7