Review Article

The role of clinical associates in South Africa as a health workforce: A scoping review

Sanele Ngcobo, Lynn Bust, Ian Couper, Kathryn Chu
African Journal of Primary Health Care & Family Medicine | Vol 16, No 1 | a4421 | DOI: https://doi.org/10.4102/phcfm.v16i1.4421 | © 2024 Sanele Ngcobo, Lynn Bust, Ian Couper, Kathryn Chu | This work is licensed under CC Attribution 4.0
Submitted: 28 November 2023 | Published: 09 May 2024

About the author(s)

Sanele Ngcobo, Department of Family Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
Lynn Bust, Centre for Global Surgery, Department of Global Health, Faculty of Medicine, Stellenbosch University, Stellenbosch, South Africa
Ian Couper, Department of Global Health, Faculty of Medicine, Stellenbosch University, Stellenbosch, South Africa
Kathryn Chu, Department of Global Health, Faculty of Medicine, Stellenbosch University, Stellenbosch, South Africa

Abstract

Background: South Africa’s health care system grapples with persistent challenges, including health care provider shortages and disparities in distribution. In response, the government introduced clinical associates (Clin-As) as a novel category of health care providers.

Aim: This study mapped Clin-As’ history and practice in South Africa, assessing their roles in the health workforce and offering recommendations.

Methods: Following the framework outlined by Arksey and O’Malley, we conducted a comprehensive literature search from January 2001 to November 2021, utilising PubMed, Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were identified and then refined to 36 through title, abstract and full-text screening.

Results: Strengths of the Clin-A cadre included addressing rural workforce shortages and offering cost-effective health care in rural areas. Challenges to the success of the cadre included stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits, Clin-As’ perceived underpayment and overwork, degree recognition issues, inadequate medical student training on Clin-A roles, vague career paths and uneven provincial participation.

Conclusion: As a health care provider cadre, Clin-As have been welcomed by multiple stakeholders and could potentially be a valuable resource for South Africa’s health care system, but they face substantial challenges. Realising their full potential necessitates enhanced engagement, improved implementation strategies and precise scope definition.

Contribution: This study acknowledges Clin-As in SA as a promising solution to health care workforce shortages but highlights challenges such as stakeholder resistance, insufficient NDoH support and unclear policies, emphasising the need for comprehensive efforts to maximise their potential.


Keywords

clinical associates; human resources for health; bachelor of clinical medical practice; district hospitals; clinical officers; physician assistants; physician associates; mid-level health workers; mid-level medical workers.

Sustainable Development Goal

Goal 3: Good health and well-being

Metrics

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