New study praises healthcare staff

Less qualified health workers such as nurses, midwives, and surgical assistants can do as good a job as qualified doctors when treating some complex medical conditions including psychiatric disorders, premature births, performing of caesarean sections and HIV infection, a new international study has found.

The study, which was released on Friday and published in The Bulletin of the World Health Organization (WHO) - an international public health journal - found that not only were nurses effective in treatment of ailments that are traditionally treated by clinicians, but in some disciplines such as antenatal care, their outcomes outperformed that of doctors. Titled "Quality of care provided by mid-level health workers: systematic review and meta-analysis", the review, which analysed more than 50 studies from around the world over the past two decades, is hoped to debunk myths that extensive use of nurses might lead to poorer services.

The study showed that when care for mothers and newborns was provided by midwives only, as opposed to midwives working with doctors as a team, the rates of episiotomy (surgical incision to ease delivery) and the use of painkillers were much lower. Women were also more satisfied with care from midwives alone than care from doctors working with midwives in a team. Another significant finding was that care provided by nurses in various fields of health - including prevention and treatment of heart disease, diabetes, psychiatric conditions and HIV infection - was as effective as that provided by physicians.

There was no significant difference between depression patients managed by nurses and those patients managed by doctors. While researchers commended the use of health workers instead of medical doctors, describing it as success, they warned that without adequate training the quality of care could be poor. There was no suggestion that physicians should be entirely replaced by nurses, but it was clear that in certain health areas health workers did just as well, if not better, than physicians.

Researchers suggested that in poorly resourced countries, which were facing severe shortages of health workers, task-sharing was ideal as it would speed up the improvement of Millennium Development Goals. The latest findings were also relevant for countries which were striving to provide people with universal and affordable healthcare. South Africa is one such country as it is preparing to roll out its universal healthcare, the National Health Insurance. It would also be cheaper for countries to train and employ health workers rather than medical doctors.

The authors wrote that health workers were easier to retain in rural areas. However, it must be remembered that task-sharing alone could not produce large-scale changes where there was a shortage of personnel. They said any task-sharing strategy should be implemented alongside other strategies designed to increase the total number of healthcare workers. Dr Giorgio Cometto, a co-author from the Global Health Workforce Alliance, which funded the research, said a shift from an expensive doctor-led provision of healthcare that focused on curative services was needed by many countries even though universal health coverage was still a challenge. He said when mid-level health workers were given a more prominent role, healthcare services might respond better to citizens' needs. This approach might also save money in the long run.

Sipokazi Fokazi: Cape Argus, 4 November 2013