Using Mid-level Cadres as Substitutes for Internationally Mobile Health Professionals in Africa: A Desk Review

Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. This desk review was conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization. The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. The findings raise interest in expanding the use of substitute cadres, as the demand 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. [from abstract]