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Abstract
Many countries have health-care providers who are not trained as physicians but who
take on many of the diagnostic and clinical functions of medical doctors. We identified
non-physician clinicians (NPCs) in 25 of 47 countries in sub-Saharan Africa, although
their roles varied widely between countries. In nine countries, numbers of NPCs equalled
or exceeded numbers of physicians. In general NPCs were trained with less cost than
were physicians, and for only 3-4 years after secondary school. All NPCs did basic
diagnosis and medical treatment, but some were trained in specialty activities such
as caesarean section, ophthalmology, and anaesthesia. Many NPCs were recruited from
rural and poor areas, and worked in these same regions. Low training costs, reduced
training duration, and success in rural placements suggest that NPCs could have substantial
roles in the scale-up of health workforces in sub-Saharan African countries, including
for the planned expansion of HIV/AIDS prevention and treatment programmes.