On the HIFA2015 site there is somewhat of a debate between task-shifting to non-physican health care providers versus focusing on increased physician training. This is not the main thrust of the discussion (it's more about developing the primary care infrastructure in general) but there's a side thread that got me thinking. There are some who view non-physician health care providers as inadequate and of poor quality, there are others who view them (us) as indespensable to rehabilitating primary care, and others still who see us as a Western import. I'll include a few of the resources mentioned in this conversation, as well as a few exerpts.
A few of the HIFA comments include:
- "It should be task delegation. Someone is still responsible for those tasks being delegated to others. As pointed out...Community Health Extension Workers are all over the place venturing into areas they were forbidden from getting into. No one is asking questions, and no one is evaluating their output. Nigeria is a peculiar country, and we cannot run away from this fact. Until we are able to sort out the mess in the health sector occasioned by ill-informed laws, unnecessary competitions, encroachment into areas people had no training on, economically-induced elongation of training programmes to 'meet up' and the lack of political will on the part of our leaders, any attempt to add another group of non-physicians to the field will only add fuel to a raging fire. Let us be careful."
- "I will never subject my health to a non-physician, I will also not allow even my enemy to be touched by them. Those who probably have obtained grants to run those programmes should please think of something more useful to do with the money or return them to their owners....we have chosen that which is compatible with our cultures, beliefs and sensibilities. That is the way to go; we must not import everything foreign into our land. No more room for non-physicians other than the little they are permitted to do now."
- "Part of the problem with that programme today is that those trained to anchor it are no longer interested in doing that; every body wants to come into the hospital and function there; no one wants to remain at the primary level except a few patriotic ones. Unfortunately, government is not helping matters...The community health extension workers were developed to serve the rural communities, but government, through corrupt practices, has elevated them to the highest level in civil service (director), for which reason they all are now seeking employment in the main centers and Ministries where they can become directors. There is no longer any middle level cadre staff in Nigeria's health sector.
"Moving forward Nigeria must recreate the middle level workforce in the health sector, politics must be separated from health matters. It is for this reason the Nigerian Medical Association has been advocating for the establishment of the office of Surgeon General to insulate health from the vagaries of politics. It is also for the same purpose of improving the health of the people and guarantee them a minimum health package that NMA has been at the forefront of the campaign for the passage and signing into law of the National Health Bill. Unfortunately, other health workers whose only interest in health sector is personal welfare have been against these two noble advocacies. They have ganged up to work against any initiative by doctors, no matter how excellent the initiatives might be. Government of Nigeria need to be strong and resolute if things must improve."
- "...[others], instead of providing leadership by supporting primary care (much of which is routineizable and fully within the scope of non-doctors), while concentrating their expertise on the provision of excellent secondary and tertiary (specialist) care, chose to view his concepts as some kind of colonialist trick to consign the population to permanent second class care! (Many US doctors have been comparably short sighted in opposing midwives and nurse practitioners, despite their excellent education and the preponderant evidence of the excellence of the care they provide!)."
Link leads to: http://www.unicef.org/rightsite/sowc/pdfs/SOWC_Spec%20Ed_CRC_Main%20Report_EN_090409.pdf