Workforce Innovations to Expand the Capacity for Surgical Services

Authors: Staffan Bergström, Barbara McPake, Caetano Pereira, Delanyo Dovlo


The lack of highly trained surgeons affect health care in many low-income countries (LICs) leading to the recommendation that governments invest in training nonphysician clinicians (NPCs) or associate clinicians (sometimes called assistant medical officers) for task-shifting of diagnostic and clinical functions. The World Health Organization (WHO) has established a list of surgical procedures performed at first-level hospitals that facilitates the classification of various interventions and can help training schools establish which essential interventions can be safely shifted to NPCs. In Mozambique, assistant medical technicians called técnicos de cirurgia (TCs), despite acceptance by the medical community, express dissatisfaction with working conditions that combine heavy workloads and low pay. Initiatives to improve the capacity to provide adequate supervision and management can improve work satisfaction, performance, and quality of work in remote settings. NPCs are trained for two years in surgery, and general practitioners receive six months of training to perform emergency surgery in rural areas. These personnel are cost-effective compared with specialists.


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