The Effectiveness of Clinical Associates in Addressing the Human Resources Challenge of Skills Shortage : A Case Study of Tshwane District Hospital ( South Africa )

One of the current challenges facing the National Department of Health of South Africa is the shortage of skilled healthcare professionals. Trained South African health professionals have been migrating abroad, largely due to push and pull factors. In response to this, the South African National Department of Health began to explore other available mechanisms of increasing the quantity of skilled healthcare providers. In 2004, a national task team was assembled to establish a training curriculum, identify a scope of practice and outcomes for a new healthcare provider. This new cadre of mid-level providers is known as Clinical Associates. Clinical Associates perform an important part of the medical team and work under the supervision of medical doctors. They undergo three years university training and work in district hospitals throughout South Africa upon completion. Clinical Associates are similar to physician assistants in the United States of America (USA) and non-physician clinicians in the United Kingdom (UK). Similar use has been identified in other African countries such as Kenya, Tanzania and Uganda. They perform many of the tasks previously performed by physicians, including examination, diagnosis, carry out investigations, and treat patients. A full evaluation of the impact of Clinical Associates has not yet been conducted and challenges have already been identified. In this study, both qualitative and quantitative research methodologies were used. The target population comprised of Clinical Associates, medical doctors, allied healthcare professionals and members of senior management. The measuring instrument used was multiple questionnaires, assessing the effectiveness of Clinical Associates in addressing the skills shortage of healthcare professionals at Tshwane District Hospital. The instrument focused on team capacity, efficiency, flexibility, the role and scope of practice of Clinical Associates.