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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