Table 2 Description of primary health care providers and services in five African countries
From: Human resources for primary health care in sub-Saharan Africa: progress or stagnation?
Level | Details | Uganda | Mali | Sudan | Botswana | South Africa |
|---|---|---|---|---|---|---|
Traditional health practitioners (THPs) and traditional birth attendants (TBAs) | Personnel | Many THPs practice although there is no national association. TBAs are banned from conducting deliveries. | 5875 THPs are registered with 135 local associations, and there is a national federation of THPs’ associations. TBAs conduct deliveries. | Traditional healers (TH) are practising all over Sudan. Also, there are many TH centres that belong to special religious groups (Tarriga). TBAs (Habil Midwives) are doing home deliveries. | 3100 THPs are registered with their associations | About 185 500 traditional African healers. 29 000 belong to traditional healer organizations. |
Community health workers | Name | Village health teams (VHTs) | “Relais” and “Agents de Santé Communautaire” (ASCs) | Community health workers (CHWs); mother support groups. | Village health committees, led by nurses from the primary clinic | Community health workers |
Personnel | Volunteer community members | Volunteer community members | CHWs are paid community members, active and motivated to help in providing care | 920 community home-based volunteers and in some places community health nurses | 80 000 – young (mostly matriculants) with basic and non-standardized training of 10 days to 1 year. | |
Roles | Health promotion. Integrated Community Case Management (ICCM) is being piloted. | Relais: mobilizing villagers for vaccination. ASCs: screening for malnutrition; ICCM | Help in providing essential PHC services addressing community needs | Provide basic care to patients with terminal or debilitating conditions in the home setting, under supervision of registered nurses | Mostly health screening and education, follow up on adherence and social problems | |
Lowest level health facility | Name | Health centre II | Maternité | Basic health unit (BHU) | Mobile stops (outreach clinics), health posts | Primary health care clinic (occasionally mobile clinic) |
Personnel | 9 staff, led by enrolled nurse or midwife | Matrone (midwifery assistant) | Medical assistant/nurse/midwife | Registered nurses | 5–23 nurses (professional and enrolled) | |
Services | Basic curative consultations; preventive interventions; emergency deliveries | Basic curative consultations; antenatal care and normal deliveries | Basic comprehensive services, MCH | Basic preventive (immunizations) and curative services | Basic preventive (immunizations) and curative services per standard treatment guidelines for nurse management | |
Population covered | 5000 | Not specified | 5000 | 400–500 | 10 000 | |
Next-level health facility | Name | Health centre III | Centre de Santé Communautaire (CSCOM) | Family health centre (FHC) | Primary care clinics with and without maternity | Community health centre (with and without maternity obstetric units (MOUs)) |
Personnel | 19 staff, led by a generalist doctor; most are led by a nurse or midwife | Usually led by a nurse; few have a doctor. | Planned to be led by family medicine physician/GP or medical officer | Registered nurses and midwives | 1–5 medical officers, 30–92 nurses and midwives | |
Services | As above, plus laboratory services, maternity and small inpatient unit | As above, plus responsible for vaccination, etc. in health subdistrict | Comprehensive services including MCH/non-communicable diseases. | Preventive and curative services and antenatal and postnatal services. | Comprehensive services, usually including deliveries | |
Population covered | 20 000 | 15-km radius, c. 20–30 000 | 20 000 | 1000–3000 | 50 000 |