Why Clinical Associates matter

ClinAs (Clinical Associates) are an important new mid-level category of healthcare providers in the new healthcare model. They are trained to assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician. Initially, the ClinAs work in district hospitals where they strengthen healthcare services in the district and address the shortage of doctors at the level of district hospital and community health centres.

The district hospitals are the ideal starting point for this initiative due to their well-defined and manageable level of care. ClinAs can get sufficient supervision during their community services and before going into their specialist training fields of choice. They are part of teams in different units in the district hospital (emergency unit, outpatient departments, and medical surgical and maternity units).

In operating theatres, the ClinAs assist doctors with basic procedures, such as incisions, spinal anaesthesia, drainage, circumcisions, evacuations and caesarean sections. The scope of practice of the ClinAs is intended to fill the gap that exists in the medical field, where a large proportion of the clinical work of doctors is related to emergency care, diagnostic and therapeutic procedure and inpatient care, HIV and TB care.

The major shortage of healthcare workers in South Africa impacts negatively at the level of patient care and access to quality healthcare services. It also compounds the work burden of healthcare workers when they are unable to provide adequate care to patients as a result of a shortage of equipment and medication, and delays to providing care and treatment to HIV/TB patients.

There is a great advantage for Clinical Associates who are trained and learn in rural areas. The gain skills and a concrete understand of the fundamental challenges of health care in remote and poverty-stricken districts. For the patients, the introduction of Clinical Associates has brought great relief, while offering employment opportunities to the youth and alleviating the workloads of doctors and nurses.

However, there are still places where Clinical Associates are underutilised. The major cause is the delay in the signing of the scope of practice by the Health Professions Council of South Africa (HPCSA), which must be finalised before it can be put into action. Some provinces have failed to include ClinAs in their health programmes and to budget for training and employing ClinAs, in spite of paying for bursaries for students.

There are a number of immediate steps that must be taken. These include:

• Including ClinAs in staffing models for all district facilities.
• Introducing compulsory community service for ClinAs.
• Developing a nationwide commuted overtime policy and budget for ClinAs.
• Finalising and implementing a scope of practice by the HPCSA and minister’s office.

There are currently a number of challenges that must be addressed urgently. A scope of practice has still not been finalised and is sitting with the HPCSA for review. There needs to be clarity as to when this process will be finalized.

The career path for theses workers remains unclear. There are also no overtime policies and allowances in place – salary levels are still very low and does not take their workload into account.

There’s remains a shortage of posts for graduate ClinA’s and some of them are sitting at home without a monthly income

The profession has also not been introduced officially by minister of health. He needs to state its primary role and function within the South African health system as many health care professionals and patients still don’t know what ClinA’s are and what they do.

Leballo is a Clinical Associate at Dr JS Moroka Hospital in Thaba Nchu and the chairperson of the Profesional Association of Clinical Associates in South Africa (PACASA).