Table 1 Summary: types of substitution
Substitution type | Brief description | Examples |
|---|---|---|
1. Indirect substitution: Delegation of some Professional Tasks | Substituting a professional with an existing but different professional (changes scope of practice of another cadre to cope with delegated tasks) | 1. Enhanced midwives' roles in Ghana 2. Nurse anesthetists 3. Enhanced abortion management roles for nurses in Zambia and South Africa |
2. Direct substitution: Delegation of most professional skills | Substituting an existing profession with a newly created cadre (both cadres may coexist, with overlapping professional functions) | 1. Clinical officers/ medical assistants in Malawi and Ghana 2. Assistant medical officers and surgical technicians in Tanzania and Mozambique |
3. Intra-cadre skills assignment or delegation | Delegating some specific "specialist" tasks to professionals with less training, in the same profession | 1. Diploma ophthalmologists, psychiatrists, ENT specialists, WAHC 2. Theatre and intensive care nurses without formal training, in Ghana |
4. Delegation of non-professional tasks | Delegating certain aspects of tasks in order to relieve professionals of unwarranted workload | 1. Health aides in Ghana. 2. Pharmacy assistants in Ghana |
5. Informal substitution. | Existing "lower-trained" cadres, especially in remote and rural areas, will carry out tasks in the absence of the appropriately recognized professional | Happens in many rural areas in Africa |