Lastina Lwatula | October 2015
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Presentation at the Global Maternal Newborn Health Conference, October 21, 2015

Background: Medical Licentiates (ML), also known as Associate Clinicians are members of the mid-level workforce in thirteen countries in Sub-Saharan Africa (SSA). The education program for MLs at Chainama College of Health Sciences, Zambia, was inaugurated in 2002, primarily as an interim solution to address physician shortages at district and health center levels of the health care system, especially in rural areas. The Government has continued to support ML education because evidence has shown that they provide an array of health services ranging from basic/primary care to critical surgical services to the country. However, it   became evident that the curriculum of studies needed to be reconsidered, to reflect the evolving country burden of disease, and to affirm the appropriate contemporary ML scope of practice.

Methodology: A 408-item task analysis survey was conducted among 57 ML (49% of current MLs in practice) and 12 ML supervisors. Respondents expressed an opinion about how important it was that each task be performed by an ML, the frequency of performance, whether the task was learned in pre-service or through continuing education, and to identify additional essential tasks

Results: The majority of tasks in the current curriculum were considered essential to the scope of ML practice, with specific emphasis on internal medicine, primary care, management of malaria, communicable diseases, and response to trauma. Tasks that should be included in a revised curriculum included basic administration and management, acute mental health conditions, male circumcision, and anesthesia. Basic delivery and newborn care tasks could be de-emphasized, substituting advanced and emergency care when mothers require surgical intervention.

Conclusions: Results of the TA led to action-oriented recommendations for curriculum revision that would support the current and desired expansion of the ML scope of practice in Zambia. Cross-country sharing results could help to standardize this mid-level credential in SSA.