Africa's pool of middle-ranking health workers offers an overlooked but inexpensive way of ramping up access to AIDS drugs, according to a paper published by The Lancet on Thursday. It identifies so-called non-physician clinicians (NPCs) -- workers with more clinical skills than nurses but fewer than doctors -- that play an invaluable, grassroots role in more than two dozen sub-Saharan countries.
NPCs are typically nurse practitioners, clinical officers and doctors' assistants who have had secondary-school education followed by three to four years' training in basic healthcare. Fitzhugh Mullan and Seble Frehywot of George Washington University School of Public Health and Health Services in Washington say the NPCs vary widely in their role and numbers. In nine countries of the 47 countries the pair investigated, NPCs equalled or exceeded the numbers of fully trained physicians.
The finding is important, as many African countries combatting AIDS are suffering a disastrous shortage of doctors, many of whom are lured to Europe or the United States by higher salaries, the paper says. NPCs could help fill the gap by carrying out many of the diagnostic and clinical duties that a physician would perform, such as questioning a patient about any side-effects to drugs and examining him for opportunistic disease.
Mullan and Frehywot point out that it is quicker and cheaper to train an NPC than a doctor, with the cost of a three-year course ranging between 3,000-6,000 dollars per person. In addition, the training offers practical advantages, because it is rooted in local health problems, they note. Sub-Saharan Africa accounts for almost two-thirds of all people infected with HIV and 72 percent of global AIDS deaths, the UN agency UNAIDS reported last November.
As of June 2006, around one million Africans were receiving antiretroviral drugs which roll back the AIDS virus, a tenfold increase since December 2003. But this was still less than a quarter of the estimated 4.6 million people in need of the drugs. The rollout of antiretrovirals in Africa was delayed for years by a barrier of high prices.
But another obstacle was an argument voiced by many in the pharmaceutical industry that these powerful, complex drugs had to be administered by trained doctors with laboratory backup, which was inappropriate for Africa, where medics and labs are scarce. Several recent studies into how the drugs are being administered in such "resource-poor" settings have concluded that a patient can be treated effectively and with little risk of drug resistance if simple diagnostic procedures are followed and he is encouraged to follow his daily drug regime.