Table 1 |
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Summary: types of substitution |
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| Substitution type |
Brief description |
Examples |
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| 1. Indirect substitution: Delegation of some Professional Tasks |
Substituting a professional with an existing but different professional (changes scope
of practice of another cadre to cope with delegated tasks) |
1. Enhanced midwives' roles in Ghana 2. Nurse anesthetists 3. Enhanced abortion management roles for nurses in Zambia and South Africa |
| 2. Direct substitution: Delegation of most professional skills |
Substituting an existing profession with a newly created cadre (both cadres may coexist,
with overlapping professional functions) |
1. Clinical officers/ medical assistants in Malawi and Ghana 2. Assistant medical officers and surgical technicians in Tanzania and Mozambique |
| 3. Intra-cadre skills assignment or delegation |
Delegating some specific "specialist" tasks to professionals with less training, in
the same profession |
1. Diploma ophthalmologists, psychiatrists, ENT specialists, WAHC 2. Theatre and intensive care nurses without formal training, in Ghana |
| 4. Delegation of non-professional tasks |
Delegating certain aspects of tasks in order to relieve professionals of unwarranted
workload |
1. Health aides in Ghana. 2. Pharmacy assistants in Ghana |
| 5. Informal substitution. |
Existing "lower-trained" cadres, especially in remote and rural areas, will carry
out tasks in the absence of the appropriately recognized professional |
Happens in many rural areas in Africa |
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Dovlo Human Resources for Health 2004 2:7 doi:10.1186/1478-4491-2-7 |
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