|dc.identifier.citation||Brown, A., Cometto, G., Cumbi, A., de Pinho, H., Kamwendo, F., Lehmann, U., McCourt, W., McPake, B., Pariyo, G. & Sanders, D. (2011) Mid-level health providers: A promising resource, Revista Peruana de Medicina Experimental y Salud Publica, vol. 28, , pp. 308-315,||
|dc.description.abstract||Mid-level health providers (MLP) are health workers trained at a higher education institution for at least a total of 2-3 years,
and authorized and regulated to work autonomously to diagnose, manage and treat illness, disease and impairments, as
well as engage in preventive and promotive care. Their role has been progressively expanding and receiving attention,
in particular in low- and middle-income countries, as a strategy to overcome health workforce challenges and improve
access to essential health services and achieve the health related targets of the Millennium Development Goals.
Evidence, although limited and imperfect, shows that, where MLP are adequately trained, supported and integrated
coherently in the health system, they have the potential to improve distribution of health workers and enhance equitable
access to health services, while retaining quality standards comparable to, if not exceeding, those of services provided
by physicians. Significant challenges however exist in terms of the marginalization and more limited management support
of MLP in health systems. The expansion of MLP should have priority among the policy options considered by countries
facing shortage and maldistribution challenges. Improved education, supervision, management and regulation practices
and integration in the health system have the potential to maximize the benefits from the use of these cadres.||
|dc.description.referencetext||1. Health Workforce
Alliance. The Kampala Declaration and Agenda for Global
Action. Geneva: WHO; 2008.
2. International Labour Organization. The International
Standard Classification of Occupations (ISCO-88). Geneva:
3. World Health Organization, Western Pacific Region.
Mid-level and nurse practitioners in the Pacific: models
and issues. Manila: WHO/WPRO; 2001
4. Rosinski EF. A WHO Expert Committee looks at training
of medical assistants and other auxiliary personnel. Ann N
York Acad Sci. 1969;166(3):967-71.
5. United Nations Population Fund. Addis Ababa call to
action on human resources for maternal and newborn survival.
Addis Ababa: UNFPA; 2009.
6. Marchal B, De Brouwere V, Kegels G. Viewpoint: HIV/
AIDS and the health workforce crisis: what are the next
steps? Trop Med Int Health. 2005;10(4):300-4.
7. Mullan F, Frehywot S. Non-physician clinicians in 47 sub-
Saharan African countries. Lancet. 2007;370(9605):2158-
8. Lehmann U. Mid-level health workers. The state of the
evidence on programmes, activities, costs and impact
on health outcomes. A literature review. Geneva: WHO;
9. Cohen J, Ortiz O, Llaguno SE, Goodyear L, Billings
D, Martinez I. Reaching women with instructions on misoprostol
use in a Latin American country. Reprod Health
10. Zerbetto SR, Pereira MA. O trabalho do profissional de
n_vel mdio de enfermagem nos novos dispositivos de
ateno em sade mental. Rev Lat Am Enfermagem.
Rev Peru Med Exp Salud Publica. 2011; 28(2): 308-15. Mid-level health providers
11. World Health Organization, Regional Office for South-
East Asia. Improving maternal, newborn and child health
in the south-east Asia region: Bangladesh. New Delhi:
12. Libamba E Makombe SD, Harries AD, Schouten EJ, Yu
JK, Pasulani O, et al. Malawi's contribution to 3 by 5-:
achievements and challenges. Bull World Health Organ.
13. Ferrinho P, Omar C. The human resources for health situation
in Mozambique. Africa Region Human Development
Working Paper Series N. 91. Washington DC: The World
14. Cumbi A, Pereira C, Malalane R, Vaz F, McCord C, Bacci
A, et al. Major surgery delegation to mid-level health
practitioners in Mozambique: health professionals' perceptions.
Hum Resour Health. 2007;5:27.
15. World Health Organization. Increasing access to health
workers in remote and rural areas through improved retention,
background paper to expert consultation. Geneva:
16. Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T,
Bryce J, et al. Countdown to 2015 decade report (2000-
10): taking stock of maternal, newborn, and child survival.
17. Dovlo D. Using mid-level cadres as substitutes for internationally
mobile health professionals in Africa. A desk review.
Human Resour Health. 2004;2:7.
18. Pereira C, Cumbi A, Malalane R, Vaz F, McCord C, Bacci
A, et al. Meeting the need for emergency obstetric care
in Mozambique: work performance and histories of medical
doctors and assistant medical officers trained for surgery.
19. Dolea C, Stormont L, Braichet JM. Evaluated strategies
to increase attraction and retention of health workers
in remote and rural areas. Bull World Health Organ.
20. Frehywot S, Mullan F, Wayne P, Ross H. Compulsory
service programmes for recruiting health workers in remote
and rural areas: do they work? Bull World Health
21. Bradley S, McAuliffe E. Mid-level providers in emergency
obstetric and newborn health care: factors affecting their
performance and retention within the Malawian health system.
Human Resour Health. 2009;7:14
22. Lighter DE, Fair DC. Quality management in health care:
principles and methods. 2th edition. London: J & B Publishers;
23. Malone MI. The performance of clinical officers in the outpatients
department of a district hospital in Kenya. East Afr
Med J. 1981;58(8):557-69.
24. Steinlechner C Tindall A, Lavy C, Mkandawire N, Chimangeni
S. A national survey of surgical activity in hospitals
in Malawi. Trop Doct. 2006;36(3):158-60.
25. Chilopora G, Pereira C, Kamwendo F, Chimbiri A, Malunga
E, Bergstrm S. Postoperative outcome of caesarean
sections and other major emergency obstetric surgery
by clinical officers and medical officers in Malawi. Human
Resour Health. 2007;5:17
26. Kruk ME, Pereira C, Vaz F, Bergstrm S, Galea S. Economic
evaluation of surgically trained assistant medical
officers in performing major obstetric surgery in Mozambique.
27. Pereira C, Bugalho A, Bergstrm S, Vaz F, Cotiro M.
A comparative study of caesarean deliveries by assistant
medical officers and obstetricians in Mozambique. BJOG.
28. Bolton-Moore C, Mubiana-Mbewe M, Cantrell RA,
Chintu N, Stringer EM, Chi BH, et al. Clinical outcomes
and CD4 cell response in children receiving antiretroviral
therapy at primary health care facilities in Zambia. JAMA.
29. Hounton S, Newlands D, Meda N, De Brouwere V. A
cost-effectiveness study of caesarean-section deliveries
by clinical officers, general practitioners and obstetricians
in Burkina Faso. Human Resour Health. 2009;7:34
30. Kolstad PR, Burnham G, Kalter HD, Kenya-Mugisha N,
Black RE. Potential implications of the integrated management
of childhood illness (IMCI) for hospital referral
and pharmaceutical usage in western Uganda. Trop Med
Int Health. 1998;3(9):691-9.
31. McCourt W, Awases M. Addressing the human resources
crisis: a case study of the Namibian health service. Human
Resour Health. 2007;5:1.
32. World Health Organization. Health workers: a global
profile. In: WHO. World Health Report 2006 - working together
for health. Geneva: WHO; 2006.||