similar care in the same setting. however, nurses re-trained to become cos have been associated with more adverse outcomes as shown in a study using 2004-2005 hospital data from six regions of burkina faso, which associated them with higher maternal and neonatal mortality when they performed caesarian sections. the observed higher fatality rate pointed to a need for refresher courses and closer supervision of the nurses. ethiopia the first medical school in ethiopia was initially a "health officer" training institution. the training of health officers started at gonder university in 1954. health officers training programs across ethiopia require that students have some of the highest scores in national university entrance examination to be admitted. health officers hold bachelor's degrees and undergo a three-year training program plus one-year internship. those who complete a 2–3 years master's degree programs provide advanced care (e.g. emergency surgery). ghana in ghana, medical assistants (mas) have traditionally been experienced nurses who have undergone an 18-month post-basic course to become mas. high school graduates can now attend a three-year diploma course to become mas. in ghana, from 2012, the nomenclature medical assistant had been changed to physician assistant.. the new name physician assistant is not known among most ghanaians the term physician assistant (pa) refers to three distinct groups of health professionals trained on the medical model to practise medicine and dentistry. they are the pa-medical, pa-dental and also known as community oral health officers and pa-anaesthesia (also known as nurse anesthetists). these groups of mid-level health providers were trained exclusively in the past by health training institutions (htis) under the ministry of health with the aim of extending care to the populace where physician numbers were scanty or not present. currently, there are eight universities in ghana offering a 4-year bachelor of science degree in physician assistantship. the objective of the bachelor of physician assistantship programme is to train graduates who will possess the ability to evaluate the health status of an individual, diagnose and treat acute illness as well as life saving interventions, manage chronic diseases, deliver preventive care and counsel individuals on psychosocial problems in independently or in collaboration with a physician. in 2016, the pa-anaesthesia group broke away and became certified registered anaesthetist (cra) according to the health professions regulatory acts 857 which addressed them as certified registered anaesthetist. pas are qualified by graduation from the pa educational programme and certification by the ghana medical and dental council. newly qualified pas who are successful in their licentiate examinations by the mdc are issued with provisional registrations to enable them undertake one-year internship in an accredited institution, a prerequisite for permanent registration which would also serve as national service but without pay for the twelve months. pa students in all pa training schools belong to the physician assistant association of ghana (pasag). in order to foster unity, camaraderie and bond among members of the association, and to promote excellence in the discharge of their professional mandate, quiz competitions are held every year. the maiden edition was won by the presbyterian university college, ghana. after permanent certification, among other things, pas diagnose and treat illnesses, conduct physical examinations, counsel individuals on preventative health issues, and order and interpret laboratory tests. in addition, pas are first or second assistants in major surgery, and provide pre- and post-operative care, and for that matter are trained and well versed in surgical skills. thus, pas play roles in preventive medicine, as well as in educational, research, and administrative activities. the physician assistant is part of the medical team and is placed above the nurse but below the medical officer they perform tasks originally performed by doctors. some call pas as "village doctors" or "chiefs." to the patient, a pa is a doctor, since the pa practises medicine just as a doctor the ghana physician assistant association-medical at their last annual delegate congress, voted for a name change from the current name physician assistant to clinical officer. the members of the association believes that the assistant attached to their name is limitation to what the pa actually does. the pa is not an assistant but an independent medical professional trained and licensed to practise medicine and dentistry. the association has therefore presented a new job description and the new name clinical officer to the ministry of health. the meeting which was chaired by the chief director of the ministry of health dr. afisah zakariah who promised to address the grievances of the pas soon to be known as clinical officers liberia in liberia, the tubman national institute of medical arts (tnima) was established in 1945. in 1965, the physician assistant (pa) programme was established as a joint venture between the liberian government, who and unicef. initially it was a one-year course, but currently it is a three-year diploma course accredited by the liberia national physician assistant association (linpaa) and the liberia medical and dental association board. in order to legally practice medicine as a pa one must sit and pass a state exam administered by the medical board. mozambique