"Non-physician clinicians" in low income countries
A potential solution to lack of human resources for maternal health

The crisis in human healthcare resources disproportionately affects the poorest women in low income countries. The World Health Organization reports that net numbers of doctors, nurses, and midwives in Africa will decrease between 2000 and 2015.1 Furthermore, because of population increases, the number of healthcare workers relative to the number of people they need to treat will decrease even more markedly.1 In the linked systematic review (doi:10.1136/bmj.d2600), Wilson and colleagues assess the effectiveness and safety of clinical officers (mid-level healthcare providers who are not medical doctors, yet are trained to perform tasks that are usually undertaken by doctors) in caesarean section surgery, compared with doctors.2 

It has been increasingly recognised that human resources were not sufficiently considered when the Millennium Development Goals were formulated. A review of the link between human resources and health reported that current spending on human resources is inefficient and fragmented.3 The review also looked at “health worker density”: according to its population sub-Saharan Africa has a tenth of the nurses and doctors that Europe has, and Ethiopia has a 50th compared with Italy. …