Social Innovations Journal 2021-07-15T00:00:00-07:00 Nicholas Torres Open Journal Systems <p>Social Innovations Journal (SIJ) is dedicated to social innovators and entrepreneurs who work at the cross section between the private sector, government, and not-for-profits and aligns them toward collective social impact goals and public policy. SIJ chronicles social innovations and enterprises addressing the world’s most challenging issues surrounding social policy, leadership, human capital, and systems. In collaboration with government, philanthropy, not-for-profits and universities, the Journal bridges formal research and real-life experience.</p> <p><strong>Social Innovations Journal (SIJ) provides immediate open access to its content on the principle that making research freely available to the public supports a greater exchange of knowledge.</strong></p> <p><strong>This journal is open access journal which means that all content is freely available without charge to users or / institution. Users are allowed to read, download, copy, distribute, print, search, or link to full text articles in this journal without asking prior permission from the publisher or author as long as acknowledge the original author as stated in the Creative Commons License. </strong></p> <p>The mission of the Social Innovations Journal is to promote innovative ideas informed by data and research, incubate social innovation and thought leadership, and to spark a culture of innovation leading to improved social sector products and services, systems and policies. SIJ is creating a new standard for social innovations and enterprise publications by including the “why” behind their innovation, their bottom line impact (social and financial), and the system and policy implications.</p> <p>The Organisation for Economic Co-Operation and Development (OECD) defines social innovation as a mechanism that “can concern conceptual, process or product change, organizational change and changes in financing, and can deal with new relationships with stakeholders and territories.” The OECD’s Forum on Social Innovation identifies the core components of social innovation as: </p> <ul> <li class="show">“identifying and delivering new services that improve the quality of life of individuals and communities; and </li> <li class="show">“identifying and implementing new labour market integration processes, new competencies, new jobs, and new forms of participation, as diverse elements that each contribute to improving the position of individuals in the workforce.” </li> </ul> <p>In the words of the OECD, <strong>“Social innovation is distinct from economic innovation because it is not about introducing new types of production or exploiting new markets in itself but is about satisfying new needs not provided by the market (even if markets intervene later) or creating new, more satisfactory ways of insertion in terms of giving people a place and a role in production.</strong></p> <p>“The key distinction is that social innovation deals with improving the welfare of individuals and community through employment, consumption or participation, its expressed purpose being therefore to provide solutions for individual and community problems.”</p> <p><strong>Open Access, Licensing, and Copyright</strong> </p> <p>The Social Innovations Journal is loyal open access for academic work, permitting any users to read, download, copy, distribute, print, search, or link to the full texts of its articles and to use them for any other lawful purpose. All the articles published in this journal are free to access immediately from the date of publication. We do not charge any fees for any reader to download articles for their own scholarly use.</p> <div id="deed-conditions" class="row"> <h3><strong>The Social Innovations Journal permits the Creative Commons License:</strong></h3> <h2><span class="cc-license-title">Attribution-NonCommercial-NoDerivs 3.0 Unported</span> <span class="cc-license-identifier">(CC BY-NC-ND 3.0)</span></h2> <h3>Under the following terms:</h3> <ul class="license-properties col-md-offset-2 col-md-8" dir="ltr"> <li class="license by"> <p><strong>Attribution</strong> — You must give <a id="appropriate_credit_popup" class="helpLink" tabindex="0" title="" href="" data-original-title="">appropriate credit</a>, provide a link to the license, and <a id="indicate_changes_popup" class="helpLink" tabindex="0" title="" href="" data-original-title="">indicate if changes were made</a>. 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The license may not give you all of the permissions necessary for your intended use. For example, other rights such as <a id="publicity_privacy_or_moral_rights_popup" class="helpLink" tabindex="0" title="" href="" data-original-title="">publicity, privacy, or moral rights</a> may limit how you use the material</li> </ul> <h3><strong>Copyright and Publishing Rights </strong></h3> <p>For the licenses indicated above, authors retain the copyright and full publishing rights without restrictions.</p> </div> <p> </p> A Healthcare Cadre That Meets A Country’s Needs 2021-06-07T17:08:56-07:00 Mary Showstark <p>A global healthcare workforce crisis exists.&nbsp; Physician Assistant/Physician Assistant Comparable (PA/PA-comparable) professions can help fill this gap especially in areas such as obstetrics/gynecology, surgery, and infectious disease.&nbsp; These professions, recognized by the World Health Organization (WHO) include: Physician Assistants/Physician Associates (PA), Clinical Officers/Clinical Associates, and Assistant Medical Officers. &nbsp;They exist in over 50 countries under numerous different names as there is no unifying, international title for this cadre.<sup>1</sup> (Table 1). The International Labour Organization (ILO) classifies these providers as Paramedical Practitioners in the International Standard Classification of Occupations (ISCO) document; however, the ILO classification has brought some confusion around the name as being confused with Ambulance Workers which is a separate ISCO classification.<sup>2</sup> For the purpose of this paper, we will refer to these professions as PA/PA-comparable cadre. &nbsp;In each country, the PA/PA-comparable, like medical doctors, have variations in education, accreditation, regulation, licensing, and scope of practice. There is limited research on this group and very little written by local PA/PA-comparables themselves, thus the following articles are a medical anthropological start to gathering the PA/PA-comparable history from the perspective of this international cadre.&nbsp;</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Mary Showstark To a Blueprint for Rural Health 2021-06-21T06:13:49-07:00 Alan Bruce Chater <p>Addressing the issue of <em>Rural and Remote Health</em> has been a practical and policy challenge over centuries. Evidence on how to address this emerged in the 1970s and have been built on since then. Rural Wonca initially developed policies on <em>Training for Rural Practice</em> and <em>Rural Practice and Rural Health</em>. Although initially based on studies into the needs of rural doctors especially in high income countries, the evidence had been found to be generalisable to other professions and low income and middle income countries (LMIC). Rural Wonca in its literature review funded by WHO, found substantial evidence in LMIC. As the evidence for this has built through the literature, the WHO have published first, Increasing<em> access to health workers in remote and rural areas through improved retention in 2010, </em>and then the <em>WHO Guideline on health workforce development, attraction, recruitment and retention in rural and remote areas in 2021. </em>These have been complemented by other initiatives and publications internationally including substantial evidence from the World Bank<em>.</em></p> <p>During the last 2 decades, increasing evidence has emerged about not only about what to do but how to do it.&nbsp; These &nbsp;have been encapsulated in <strong>Blueprint for Rural Health</strong>(1) from the 17<sup>th</sup> International Rural Health Conference . The Blueprint outlines several important principles that should underline rural and remote health &nbsp;including the importance of advocacy, primary health care, universal health care, public health, community infrastructure, access and workforce. In this paper I will highlight some important new concepts and themes including, end to end planning and integrity, clinical courage, rural health education in rural for rural, immersive community engaged education (ICEE), rural exposure - any is good - more is better, grow your own, redundancy, stepladder education, engaging young doctors, the right health worker, rural generalism, rural origin, ruralisation, rural policy and localising economic benefit<em>. </em></p> <p>This provides a framework for further developments in Rural and Remote Heath for the benefit of rural people and communities.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Alan Bruce Chater Lessons Learned from Workforce Diversity Tracker for Global Health 2021-06-04T17:51:46-07:00 Toyese Oyeyemi Edward Salsberg Sara Westergaard Jenee Farrell <p>Health disparities experienced by subsets of the US population are similarly experienced in countries around the world, albeit not necessarily by racial or ethnic subsets of the population. The Health Workforce Diversity Tracker is effective in identifying baseline diversity data needed to address the health impact of these disparities and has four major components: (1) collection and analysis of data on the diversity of the health workforce; (2) dissemination of the data and findings; (3) support for research on the impact of interventions/strategies to increase diversity and; (4) advocacy through targeted distribution of the findings and convening of organizations.&nbsp;A key component of the Diversity Tracker is the “Diversity Index” which is the ratio of the percentage of graduates (or practitioners) in a health profession compared to the percentage of individuals in the population of that race/ethnicity. This index allows for comparison of performance across diverse states and professions as well as over time. Our findings indicate that regions and institutions may support their local workforce diversity efforts through modifying a similar model of monitoring and publicizing available data on health workforce.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Toyese Oyeyemi, Edward Salsberg, Sara Westergaard, Jenee Farrell Medicine from Down Under: Physician Assistants in Australia 2021-06-01T05:38:17-07:00 Ando Kerlen <p>The need for physician assistants in Australia has been identified for decades, mainly to alleviate a maldistribution of medical staff to the detriment of rural areas.<sup>1,2</sup> Since the turn of the century various organisations, including state and federally sanctioned institutions have called for PA implementation,<sup>3-5</sup> but there has also been the strong opposition to the role however, particularly from the nursing and medical domains.<sup>6-9</sup> PA pilots were conducted in Queensland and South Australia in 2009 and 2010 respectively, both concluding with positive outcomes.<sup>3,10</sup> Despite precarious political positioning at the time, the University of Queensland decided to start a PA Master’s degree in 2009,<sup>1</sup> but unfortunately closed its doors after 2 cohorts and graduating around 40 PAs.<sup>11</sup> James Cook University in Northern Queensland also started a course, in 2012, which was a 3 year Bachelor’s degree but with a health care training and experience entry requirements. This program has graduated around 25 PAs to date but is currently considering &nbsp;a new and innovative advanced clinician model to replace the PA program. There are an estimated 20 PAs working in formal physician assistant roles. Furthermore, there are already clear indications that the COVID-19 crisis is leading to call for the formation of more PA positions because of the limits placed on international medical graduates.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Ando Kerlen Medical Assistants/ Sub-Assistant Community Medical Officer: The Physician Assistant Comparable in Bangladesh 2021-05-31T13:25:12-07:00 Khondoker Hossen <p>The Medical Assistant Training (MAT) course began in 1976 after the partition of Bengal in 1947 resulted in the development of both the State Medical Faculty of East Pakistan and State Medical Faculty of Bangladesh. These faculties have been holding examinations and awarding diplomas and certificates to candidates who have completed their course requirements.</p> <p>The State Medical Faculty of Bangladesh was established in 1972 from the continuation of The Bengal Act-1914 for the purpose of holding examinations and awarding diplomas to L.M.F. and M.M.F doctors. After partition of Bengal in 1947, The State Medical Faculty of East Pakistan was created for the same purpose. Subsequently Compoundership, Dressership, Para-medical Technicians, Medical Assistant and Village Doctor (Palli Chikitshak) courses have been introduced and this Faculty has been holding examinations and awarding diplomas and certificates to the successful candidates. To prescribe syllabi for Medical Assistants, Palli Chikitshaks and all kinds of Technicians namely, Community Health Workers, Mid-Level Ophthalmic Assistant, Health and Sanitary, Laboratory Medicine, Radiology &amp; Imaging, Dentistry, Sanitary Inspectorship, Physiotherapy, Radiotherapy, Occupational therapy, Operation Theatre Assistant, Intensive Care Assistant, Cardiac Perfusion, Cardiology and Prosthetic &amp; Orthotics.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Khondoker Hossen Botswana’s Doctor Assistant 2021-05-31T07:36:39-07:00 Shepherd Mothebe <p>Botswana is a landlocked country in Southern Africa.&nbsp; Its borders are South Africa, Namibia, Zambia, and Zimbabwe.&nbsp; Botswana has a relatively small population with little over 2 million persons residing in the country.&nbsp; Despite the small population, there is still a shortage of doctors.&nbsp; Botswana healthcare workforce officials noted that several African, European, and North American countries had a mid-level cadre to take care of patients.&nbsp; In South Africa, this cadre is known as clinical associates and in Zimbabwe the cadre is known as clinical officers. Thus in 2015, the title of Doctor Assistant was chosen, and the Doctor Assistance course was introduced in Botswana. The Doctor’s Assistance training program was set up in the medical school at DDT College of Medicine.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Shepherd Mothebe Burundi-In the Heart of Africa: techniques paramédicales 2021-05-31T13:36:58-07:00 Colombe Bizumuremyi Jean NGENDAKUMANA <p>The program name for Clinical Officer training is referred to as "sciences et techniques paramédicales" in Burundi.&nbsp; Unfortunately, the Clinical Officers Profession has not been integrated in the Burundian Health Care System.</p> <p>&nbsp;</p> <p>The techniques paramédicales program started in Burundi in 2001.&nbsp; The program started as a 4- year Bachelor’s degree program, but in 2014 the Burundian education system requirements for a Bachelor’s degree changed from 4 to 3 years.&nbsp; The techniques paramédicales program also transitioned to a 3-year program.&nbsp;&nbsp;</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Colombe Bizumuremyi, Jean NGENDAKUMANA Physician Assistants in Canada 2021-06-01T05:27:00-07:00 Leslie St. Jacques Sahand Ensafi Maitry Patel Richard Tsang <p>Physician Assistants began working in the Canadian Armed Forces over 50 years ago and were initially called “medical assistants”. The name changed to physician assistants (PAs) in 1991 (1).</p> <p>PAs work in team settings, with an individualized scope of medical practice similar to their supervising physicians. PAs are flexible and nimble in the work assigned based on clinical need, patient volumes, wait times and gaps in the clinical care process. PAs may work shifts and participate in on-call activities. Specialized roles are adopted by PAs who have had the requisite training andexperience as determined by the supervising physician. This includes performing procedures and assisting in the operating room.</p> <p>PAs work under the supervision of physicians and can have multiple supervisors. Supervisors in academic hospitals may delegate some aspects of the supervisory role to physicians in post-graduate training programs such as residents and fellows. Experienced PAs can achieve a high level of autonomy but are not independent practitioners. Legislation governing the medical acts civilian PAs perform is determined at the provincial level and may involve the use of a scope of practice document or medical directives.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Sahand Ensafi, Maitry Patel, Leslie St. Jacques, Richard Tsang Health Officer: A Physician Assistant Comparable Role in Ethiopia 2021-06-07T11:45:23-07:00 Fitsum Negash <p>The College of Public Health at Gondar in Ethiopia created the Health Officer training in 1954 to mitigate the concern that there was no training of medical doctors in Ethiopia to meet the needs of health disparities that existed in rural communities throughout the country. Shortly after its development, the need for further training medical doctors (MD) superseded Health Officer (HO) training, putting a temporary stop on the profession. However, it was evident that public health needs could not be met with MDs alone, so the Ethiopian Ministry of Health (MOH) concluded training of Health Officers should continue. Currently, about 100 students per year will graduate with a BSc Health Officer title and move on to advanced degrees such as regular MPH, Masters in Nutrition, Masters in Reproductive health and PHD or Join Integrated innovative Masters in Emergency surgical officers or PHD Tracks. These Officers are trained and&nbsp;equipped with the knowledge, skills, professional ethics, and wisdom that is&nbsp;required to solve and manage the common clinical disorders as well as the preventable public health concerns.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Fitsum Negash Emergency Surgical Officer: The Ethiopian Integrated Innovative Masters PA Analogue Profession 2021-06-01T04:48:24-07:00 Fitsum Negash <p>Emergency Surgical Officers training arose in Ethiopia in 2010 to address the problems which exist after construction of Hospitals, Human Resource gap that existed for both surgical and maternal health care as specialists are limited to capital cities. It was designed as a task sharing profession by the Ministry of Health (MOH) and the Ministry of Education (MOE) in the country at a time when maternal and neonatal mortality rates were exceedingly high and paralleled by a shortage of specialist doctors.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Fitsum Negash Germany Physician Assistants 2021-06-01T05:48:13-07:00 Marie Stolte Peter Heistermann Peter Stollwerck <div><span lang="EN-US">The profession began in Germany in 2005 in response to need for additional personnel in surgical departments. </span></div> <div><span lang="EN-US">In 2005 the first PA degree course with a focus on cardiac surgery was offered at the Steinbeis University in Berlin, introducing a new academic profession to the health system.&nbsp; In Germany, these professionals are called Physician Assistants (PA) and Medical Assistants – Surgery (MAC).</span></div> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Marie Stolte, Peter Heistermann, Peter Stollwerck The Evolution of Training and Practice of Physician Assistantship in Ghana 2021-05-21T07:59:41-07:00 Rebecca Bantey Anthony Arkoh <p>The PA training is a four (4) year didactic and clinical programme designed with foundational, introductory, and clinical courses with an additional one (1) year post-graduation mandatory internship with approximately 100 students admitted per year per Institution. PA Training begins with a strong foundational courses in the sciences such as advanced chemistry, biochemistry, physics, nursing, basic computer science, African studies, information skills, microbiology. These foundational courses are the building blocks for introductory courses such as clinical anatomy, physiology, pathophysiology, pathology, clinical biochemistry, applied pharmacology, basic epidemiology, statistics, diagnostic imaging and laboratory medicine.&nbsp; The student is then prepared for the clinical courses such as internal medicine, emergency medicine, general surgery and traumatology, public and community health medicine, &nbsp;paediatrics, child health, reproductive health, obstetrics and gynaecology, health systems research, medical ethics and law, health system management, project work, preceptorship and clerkship. These courses are structured to fit the need of the population.</p> <p>The evolution of Physician Assistantship training in Ghana had seen a significant boost in recent years. The program evolved from a certificate to an advanced diploma and now a bachelor's degree (BSc). Additionally, it has shifted from the traditional ways of only training nurses as PAs to senior high school graduates' training. The latter has been a substantial breakthrough in the advancement of the profession.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Rebecca Bantey, Anthony Arkoh India Physician Assistants 2021-05-31T13:46:43-07:00 Anitha Chandrasekhar <div><span lang="EN-US">The PA program in India took its birth in the year 1992 at a private, tertiary healthcare institute in Chennai, India. It was born out of the necessity to fulfil the vacancies due to the constant exodus of resident doctors in pursuit of higher education. This, along with the rising disease burden, led to the introduction of PAs in India to even out the imbalance in health care delivery. Inspired by the success of PA profession in the United States, Dr. K. M. Cherian, renowned cardiac surgeon, believed that a similar profession might mitigate the problem of the floating population of resident doctors. After his return from USA, Dr. Cherian introduced the PA concept in India by starting the PA program in Chennai in the year 1992 at the Institute of Cardiovascular disease as a Diploma program and the first PA graduated in 1994. Subsequently, a 2-yearMaster’s degree PA program was started. In 1996, an integrated 4-year undergraduate bachelor’s degree course was established. Soon PA profession proved to be a vital workforce in the institute. The physicians who were exposed to this concept spread the message to other health care institutes. PAs were found to be of immense use in whichever institute they worked. Anticipating the demand of this profession in health care arena, more institutions started the program in collaboration with reputed universities across the country.&nbsp;</span></div> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Anitha Chandrasekhar Ireland Physician Associates 2021-05-31T13:54:10-07:00 Maria Macken <p>The Physician Associate profession began in 2016 as a pilot-study. Four US / Canadian PAs began working in surgical specialities in a large teaching hospital in Dublin. That same year, six students commenced their training in the Royal College of Surgeons, Dublin (RCSI). The students qualified as PAs at the end of 2017 and entered the Irish healthcare system in 2018.</p> <p>There are 30 PAs in practice in Ireland. Twenty-six of these PAs trained in the RCSI, and four PAs trained in the UK.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Maria Macken Israel Physician Assistants 2021-05-31T14:04:21-07:00 Roi Ozer Oren Berkowitz <p>The profession began in Israel in 2016 when the Ministry of Health began training veteran paramedics to work in emergency medicine, following the recommendations of the Israeli MOH Physician Assistant Committee, published during July 2013. In the first cohort, 33 students graduated, and an additional 30 students graduated in 2018. A third course was planned to begin in 2020 but has been postponed due to the outbreak of the COVID-19 pandemic, during mid-March 2020.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Roi Ozer; Oren Berkowitz Clinical Officers: The Heart of Kenyan Healthcare 2021-05-31T14:18:11-07:00 Akello Akinyi Joseph Choge <p>The birth of Clinical Officers (CO) began in 1928 when Kenya, then occupied by the British, decided to train a select group of natives to practice medicine and provide care to the local population. Without official Kenyan doctors present inside its own borders, the goal was to fill the gaps in provision of healthcare to the constituents of the country. After acquiring independence from Great Britain in 1963, medical training in Kenya adopted a four-year medical school system recognized by the United States over the previously promoted six-year model in the United Kingdom. Funding arose from the African American Students Foundation (AASF) and was further supported by the Kennedy Airlift which led to hundreds of young Kenyan students getting scholarships to study in American institutions. Upon their return, Kenyan students joined the civil service helping support the newly independent country.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Akello Akinyi, Joseph Choge Laos Medical Associate 2021-05-31T14:33:06-07:00 Alicia Quella Khampho Thammavongxay <p>In Laos (officially the Lao People's Democratic Republic), the midlevel health care worker,&nbsp; known as the Medical Associate, began in the 1990s.&nbsp; The profession became less active over time and was reestablished in 2010.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Alicia Quella, Khampho Thammavongxay Liberia Physician Assistants 2021-05-31T14:39:24-07:00 Jerry Kollie <p>The establishment of the Physician Assistant (PA) profession in Liberia is far dated as 1964. Its establishment was initiated by the Government of Liberia with support from the World Health Organization (WHO) and UNICEF after they realized the need for well-trained and highly qualified health care providers in addition to nurses in rural and remote areas of the country.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Jerry Kollie Two for One: The Tandem PA Comparable in Malawi 2021-06-01T02:18:44-07:00 Solomon Chomba <p>Malawi has multiple levels of mid-level medically trained clinicians. In 1890 the medical assistant position was created, Because of the physician shortage, the Clinical Officer (CO) profession was established in 1979 as a short-term measure. The CO proved to be so critical in health systems which made the Ministry of Health (MoH) to continue developing the CO profession. The MoH recognized that this well-trained cadre worked well in compliment with the MA and became the backbone of health care in Malawi.</p> <p>While there are two terms for the profession, Clinical Associate (CA) is the formal title given to mid-level providers within the country.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Solomon Chomba Malaysia Assistant Medical Officers 2021-06-01T02:48:36-07:00 Alias Mahmud Zulhelmi Abdullah <p>The Medical Assistant (currently known as Assistant Medical Officers) profession is one of the earliest in Malaysia and has been in existence for more than 230 years. The early days began when two military Medical Assistants named Michael Cgaffe and Henry Warring served in medical affairs and medical administration during Francis Light's reign in Penang in 1786 (Noraini, 2010). The two Medical Assistants, together with a doctor, Dr James Hutton, are the pioneering medical staff in modern medical services in the country.</p> <p>&nbsp;</p> <p>The Medical Assistants (MA) profession is originally known as Apothecaries. Under the government of British Malaya, Apothecaries is also known as the Sub-Assistant Surgeon or Dresser. But the profession was once widely known by the rural community as 'Dresser'. The profession has undergone a transformation of titles in line with its growing role in the healthcare system namely Hospital Assistants (1963), Medical Assistants (1985) and now Assistant Medical Officers (since March 20, 2007) (Alias, 2016).</p> <p>&nbsp;</p> <p>The role of Medical Assistants is also growing in line with the development of healthcare services itself. In the past, MAs played an essential role in providing health services to rural and estate communities, but currently, the role has expanded and extended in the area of emergency and pre-hospital care, primary health, and specialized units. Therefore, the numbers are increasing. In 2019, 17,895 Medical Assistants were serving in government and private hospitals and health facilities in the country (Health Facts, 2020).</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Alias Mahmud, Zulhelmi Abdullah Nepal Health Assistants: The Physician Assistant Comparable 2021-06-01T02:55:20-07:00 Tika Luitel Rakshya Parajuli <p>Nepal is a country in Asia, landlocked by India and China and lies in the southern slopes of the Himalayan mountain range.&nbsp; The country has many people living in remote, rural locations to which Health Assistants serve as the primary health provider.</p> <p>&nbsp;</p> <p>The Health Assistant profession has existed for over 40 years with possible speculation that the profession may date back as early as 1800 AD; however, there were no official training programs. &nbsp;</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Tika Luitel, Rakshya Parajuli The Netherlands Physician Assistant 2021-06-01T05:56:49-07:00 Geert Brink Quinten Driesschen Lian Elfering <p>The PA profession was introduced to the Netherlands in 2001 as a temporary pilot. In 2003, the Universities of Nijmegen and Utrecht launched the first accredited PA Master’s degree programs in the country.&nbsp; This was followed by programs in Amsterdam, Groningen and Rotterdam. The number of programs is limited by the government and students enrollment is capped at 250 to 270 per year.&nbsp; Since July 1st, 2018 the title “Physician Assistant” in the Netherlands is a protected title that only PAs can use who successfully completed an accredited Master’s degree in Physician Assistant.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Geert Brink, Quinten Driesschen, Lian Elfering New Zealand Physician Associates 2021-06-01T06:04:49-07:00 Lisa deWolfe <p>Similar to other countries, the Physician Associates (PA) profession began in New Zealand as a pilot demonstration with US trained PAs due to a projected shortage of General Practitioners in the future.&nbsp; In 2012, seven US trained PAs were recruited to work in primary care and rural emergency medicine. This successful pilot has led to the recruitment of additional PAs to work throughout the country.&nbsp; There are currently 10 PAs working in the country. The program is still in its infancy in New Zealand; however, PAs are working hard to develop the framework for expansion of the role and the creation of an educational program to create homegrown PAs.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Lisa deWolfe The Russia Feldsher Overview 2021-06-01T03:01:36-07:00 Alexey Romanov <p>The feldsher is sometimes considered the physician assistant (PA) prototype. The profession was developed in Russia during the 19th century to serve in the military.&nbsp; Many of the retired military feldshers after their service moved to rural locations to take care of the underserved populations. Feldshers were key &nbsp;healthcare personnel at a time of physician scarcity. &nbsp;Feldshers have provided medical services throughout the Russian Empire, later Soviet Union, and now the Russian Federation.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Alexey Romanov Rwanda, the Land of a Thousand Hills and Clinical Officers 2021-06-01T03:08:14-07:00 Nathan RUTATINA Charles Nsanzabera <p>Rwanda is a country in East Africa which is known as the Land of a Thousand Hills. In 2018, there was 1 doctor to provide care for approximately 9,000 people and&nbsp; reports from 2020 state the country’s total population is over 12 million.&nbsp; The Clinical Officer profession was recognized to benefit the country and serve as part of the primary health care after a need’s assessment in 2010.&nbsp; Clinical Officers are an important health profession; however, it has not been fully integrated in the Rwandan Health care system.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Nathan RUTATINA, Charles Nsanzabera Saudi Arabia Physician Assistants 2021-06-01T06:23:20-07:00 Naveed Ahmed David Fahringer <p>The Kingdom of Saudi Arabia is the largest Arab state in the Gulf Cooperation Council and makes up 80% of the Arabian Peninsula. &nbsp;In pursuit of providing the most advanced healthcare available to its people, the Medical Services Division (MSD) of the Ministry of Defense &amp; Aviation, adopted the Physician Assistant profession as an adjunct model which was initiated in 2010 through collaboration with George Washington University Medical Faculty Associates (GWU-MFA), Dept. of Emergency Medicine</p> <p>The program was guided by high standards set forth by the U.S. based Accreditation Review Commission on PA Education (ARC-PA) and focused on the core competencies of Physician Assistant medical practice established by the U.S. National Commission for the Certification of Physician Assistants (NCCPA).</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Naveed Ahmed, David Fahringer Sierra Leone and the Community Health Officer 2021-06-01T04:54:53-07:00 Lawrence Kargbo Musa Sillah <div> <p><span lang="EN-US">The CHO profession began as a response to the growing demand for improvement in primary health care after the Alma Ata Conference in 1978. Its Paramedical School, established in 1983,&nbsp;would go on to produce the country’s inaugural graduates in 1986. Initially, the institution was funded by the European Union (EU) and was mandated to train scientifically oriented and multivalent health workers to replace those dispensers and Endemic Disease Control Units (EDCU) Assistants that were manning Peripheral Health Units (PHU) within the country. After three years, graduates were deemed Community Health Technicians (CHT). Further need for medical training to keep pace with the healthcare demands within the country would promote the development of a more advanced training program for which CHTs could also participate to further their knowledge base and skill sets.</span></p> </div> <div> <p><span lang="EN-US">During its initial years, CHO programs were under the control of the MOH of Sierra Leone. At this time, they were only allowed to enroll 30 students per program and administer a certificate for the program. It wasn’t until 2005 when Njala University—the only school to maintain a program in the country—took over, increasing enrollment to 150 students per program and implementing a Higher Diploma for Community Health and Clinical Sciences (for CHOs). In 2008, the first set of Community Health Assistants (CHA) were admitted and graduate with a Diploma in Community Health and Clinical Sciences (as CHA). The first Bsc (Honors) in Community Health and Clinical Sciences started in 2015. Now, over a 100 students per year will graduate from the Njala University Bo Campus (formerly Paramedical School, Bo) to join the approximate 2,100 graduates who practice throughout the country.</span></p> </div> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Lawrence Kargbo, Musa Sillah Somaliland: The Clinical Health Officer 2021-06-01T05:09:02-07:00 Khalid Omar <p>Somaliland is in the Horn of Africa bordered by Djibouti, Ethiopia, and Somalia.&nbsp; Somaliland declared independence from Somalia in 1991.&nbsp; This fact still goes unrecognized by many despite Somaliland having&nbsp; a democracy and regular elections.&nbsp; Somaliland provides its people with opportunities and has its own army, police, and coast guard as well as its own currency.<sup>1</sup>,<sup>2</sup>&nbsp; Somaliland strives to bring healthcare to its people and has many training programs especially for Clinical Health Officers.&nbsp; Formerly a British protectorate, Somaliland still has relations with the UK.<sup>3</sup>&nbsp; The Clinical Health Officer profession started in 2010.&nbsp; The UK has helped with the budget of the National Clinical Officer’s Training Curriculum.&nbsp; Sometimes the profession is known as Clinical Officers, Clinical Health Officers, or Clinical Public Health Officers.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Khalid Omar CLINICAL ASSOCIATES IN SOUTH AFRICA – A BRIEF HISTORY OF THE PROFESSION 2021-06-01T03:29:25-07:00 Scott Smalley Lumbani Tshotetsi <div><span lang="EN-ZA">Clinical Associates are a value-add health professional within the South African healthcare system, joining the ranks in 2011. The clinical associate (ClinA) is a burgeoning healthcare professional modelled after the physician assistant in the United States and the clinical officer in much of East Africa.<sup>1</sup> In 2005, the South African Family Medicine Education Consortium along with the National Department of Health developed a three-year bachelor degree curriculum to train high school graduating students as clinical associates.</span></div> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Scott Smalley, Lumbani Tshotetsi Switzerland Physician Associates, Clinical Specialists 2021-06-01T03:35:19-07:00 Anita Bonnard <p>The program began as a path for career progression for healthcare professionals in 2016 at the Kantonsspital Winterthur, Switzerland.&nbsp; The first certificate course began at Zurich University of Applied Sciences (ZHAW) in 2017.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Anita Bonnard Tanzania Assistant Medical Officers and Clinical Officers 2021-06-01T03:41:10-07:00 Duncan Ndimbo <p>In 1961 the implementation and construction of a training center in Tanzania, named the Rural Aid Centre was created with assistance from President Mwalimu Nyerere and Geigy Pharmaceutical Company and The Basel Foundation for the Advancement of Developing Countries.&nbsp; The goal of this center was to support a training program in Ifakara, Tanzania, which offered a three-month basic first aid training to prepare locals to work in village dispensaries.</p> <p>&nbsp;</p> <p>In 1973, with the success of the Rural Aid Centre, the Ministry of Health and the faculty at Dar es Salaam asked The Basel Foundation to help upgrade the center to a Medical Assistant Training Centre (MATC). The Foundation agreed to support the MATC for five years, including financing new infrastructure (e.g., new lecture halls and dormitories), and then transition it to local ownership. COs were amongst the first&nbsp; cadre trained.&nbsp;</p> <p>&nbsp;</p> <p>In 1978, the Tanzanian government took responsibility for the MATC. Heavy seasonal rains and inadequate maintenance left the MATC in disrepair. The head of another local health institution recounted, “The MATC was really starting to go down, not enough funding, poor management, no innovation and leadership is lacking.” In 1994, the MATC upgraded to again to become a Clinical Officer Training Center (COTC).&nbsp; Clinical Officers then had the ability to train as a CO or extended training to become an Assistant Medical Officer.&nbsp; The Clinical Officer and Assistant Medical Officer profession has had a few name changes and undergone many trials and tribulations but has come out as one of the main health cadres providing care to the country.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Duncan Ndimbo Clinical Officers in Uganda: “The Pearl of Africa” 2021-06-01T06:32:32-07:00 Annet Namugosa <p>The Uganda CO profession was crafted by a gentleman named Sir Dr Albert Cook. Cook originally arrived in Uganda as a missionary in 1918, establishing Mengo Hospital, one of the oldest hospitals in East Africa. Cook went through extraordinary lengths to train Africans to become skilled medical workers, training African Medical Assistants (MA) at Mulago during World War I, opening a school for midwives at Mengo, and encouraging the opening of the first medical college. In 1929, the government took over the training of these professionals, which would be renamed in 1996 from the term “MA” to “Medical Clinical Officer” through the Allied Health Professionals Council Act CAP 268. Since then, COs have served on the front lines of multiple national pandemics including but not limited to Ebola, Marburg, Yellow Fever, Measles and Rift Valley Fever. During the COVID-19 Pandemic, COs have been assigned to various border points and surveillance facilities to assist in tracking, testing, and future vaccination of the country’s constituents.&nbsp;Also COs are also working at health center III in-charge of all managerial activities.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Annet Namugosa United Kingdom Physician Associates 2021-06-01T03:48:09-07:00 Kate Straughton Alexandra Chase <p>Physician Assistants (PAs) were first introduced to the UK in 2002 when two PAs were employed from the USA [1]. A further 11 PAs followed, working in a similar region, with a report commissioned in 2004 to evaluate the impact of the role [2], followed by a further pilot scheme in Scotland [3].&nbsp; In 2005, the UK Association of Physician Assistants (UKAPA) was registered as the professional organization.&nbsp;</p> <p>&nbsp;</p> <p>In 2013, the profession changed its title from Physician Assistant to Physician Associate, to aid further progress towards statutory regulation. In 2015, UKAPA and the Royal College of Physicians collaborated to develop and launch the Faculty of Physician Associates (FPA); the first non-doctor faculty of the college.&nbsp;</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Kate Straughton, Alexandra Chase A Brief Overview of Physician Assistants in the United States 2021-06-01T05:16:36-07:00 Mary Showstark David Mittman <p>The PA profession was established in 1965 at Duke University in North Carolina. The first four graduates were Navy Corpsmen (military medical experience). Upon graduation in 1967, they all started practicing at Duke University. Today, there are approximately 150,000 PAs practicing across all 50 states in the US (NCCPA, state information 2020). PAs have more than 400 million patient interactions per year (2019 AAPA Salary Survey). The profession in America is now very well-established.&nbsp;</p> <p>&nbsp;</p> <p>There is increasing specialization&nbsp;with 75% of the practicing PAs specialize (AAPA, 2016).&nbsp; There is an increasing proportion of women with over 69% of all PAs; 73% of students are women (AAPA/PAEA, 2016).&nbsp; PAs demonstrate high levels of patient acceptance, quality of care, and clinical flexibility. All PAs must graduate from an ARC-PA accredited program to practice in the USA, which means that PAs that intend to work in the US must train at a US university.&nbsp; There are no bridging programs at the current moment that allow for PAs from other countries to work in the US as a PA.&nbsp; The PA education training would need to be repeated.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Mary Showstark, David Mittman Zambia: The Medical Licentiates and the Clinical Officer Duo 2021-06-01T03:55:29-07:00 Musonda Kamfwa <p>Clinical officers date back to 1950s. Training of advanced diploma candidates began in the late 1990s and early 2000s. A Degree in Clinical Officer training started in 2011, with many Clinical Officers graduating with a degree in clinical medicine, clinical ophthalmology, mental health and psychiatry, or clinical anesthesia etc. The names of profession in Zambia are Clinical&nbsp;Officer and Medical Licentiate.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Musonda Kamfwa Zimbabwe Clinical Officers 2021-06-01T04:00:28-07:00 Maria Chikono <p>The profession started in 1975 at Mpilo hospital in Bulawayo, Zimbabwe.</p> 2021-07-15T00:00:00-07:00 Copyright (c) 2021 Maria Chikono