Table 3 Training opportunities and scope of practices related to paediatric and child health for different professional cadres in Kenya, Uganda, Tanzania, Malawi and South Africa

Physicians

Most countries have 5–6 years entry-level Bachelor of Medicine and Bachelor of Surgery (MBBS) or equivalent degrees that include 3–4 months internship in paediatrics. Most countries also have Master of Medicine degree in Paediatrics and Child Health that last 2–4 years and require some working experience before entry. Some countries also offer further paediatrics sub-specialty training either through fellowship (Kenya, Uganda), Master of Science (Tanzania) or Master of Philosophy/Senior registrar (South Africa)

Master of Medicine training in major specialties including but not limited to family medicine, general surgery, internal medicine, obstetrics and gynaecology, emergency medicine that last 2–7 years and require some working experience. Similarly further sub-specialty trainings are available through fellowship, Master of Science or Master of Philosophy/Senior registrar

Scope of practice for general physicians is generally broad and findings suggest limited specific recommendations on which procedures can be performed or not. Medical specialists are allowed to carry out specialized care in their relevant field. Additionally, in some countries physicians’ responsibility include teaching and supervising students and staff (Kenya, Uganda, Tanzania), for example Kenya’s general medical officers’ duties include teaching medical and nursing students and clinical officer interns

Non-physician clinicians (Clinical officers in Kenya, Uganda, Tanzania, Malawi, assistant medical officers in Tanzania, clinical associates in South Africa)

Most countries have 3–4 years entry-level diploma or Bachelor of science degrees for non-physician clinicians which include paediatrics and child health training as an element and usually include some short internship period in paediatrics. For some countries, there are advanced diplomas in paediatrics (Kenya), child and adolescent health/paediatrics palliative care (Uganda) or post-basic Bachelor of science in paediatrics and child health (Malawi) that last 1–3 years and require some working experience before entry

Advanced diploma in other specialties that last 1.5–2 years, most commonly in family medicine, ENT, anaesthesia, ophthalmology (Kenya, Uganda, Tanzania). In Malawi there is post-basic Bachelor of Science in internal medicine, obstetrics and gynaecology, general surgery, anaesthesia and intensive care (3 years). South Africa currently offers only an honours degree in emergency medicine (1 year). Kenya also has a Master-level course for clinical officers in family medicine, emergency medicine, forensic medicine (3 years)

Scope of practice for non-physician clinicians focuses on acute infectious diseases, essential newborn care, immunization and malnutrition. Prescription of common medications is usually within the scope of practice for non-physician clinicians. Non-physician clinicians are sometimes the highest cadre in district and primary care services listed in staffing norm documents. Non-physician clinicians are usually allowed to perform minor surgery and provide emergency care as listed explicitly in their scheme of service document: e.g. Kenya’s clinical officers and Tanzania’s assistant medical officers are allowed to perform surgery per training, South Africa’s clinical associates are allowed to perform within a list of nearly 90 procedures including lumbar puncture, neonatal and paediatrics resuscitation and initiate CPAP in RDS. For chronic conditions, usually only counseling is explicitly listed in scopes of practice

Nurses and nurse specialists*

Aside from entry-level certificate/diploma/Bachelor degree in general nursing, most countries have advanced diploma in paediatrics nursing (1–2 years) and sometimes paediatrics nursing in certain speciality (neonatal nursing in Kenya and South Africa, critical care nursing in Kenya) (1.5–2 years). Malawi also has a Bachelor of Science in paediatrics nursing aside from general nursing (4 years). Master-level training in either paediatric or neonatal nursing is also common in most countries and requires a Bachelor’s degree for entry

Most countries offer advanced diplomas in nursing for other specialties, e.g. family health nursing, psychiatric or mental health nursing, palliative care nursing, critical care nursing, ophthalmic nursing (1–2 years). In Malawi there is also a Bachelor of Science in adult health nursing and community health nursing (4 years). Similarly, there is usually master-level courses in other specialties though the entry requirement for these courses includes a Bachelor’s degree

Scope of practice for nurses focuses on acute infectious diseases, essential newborn care, immunization. Prescription of essential medication is mostly not allowed for general nurses other than in Kenya where nurses are allowed to proscribe selected drugs (e.g. relating to HIV/AIDS and tuberculosis) and Malawi where nurses are allowed to prescribe at primary care level. Surgery and emergency care treatment are usually not within nurses’ scope of practice. Most countries allow nurses for mental health counseling either in task-sharing policies (Kenya, Tanzania, Malawi) or stand-alone child and adolescent mental health policies (Uganda). Malnutrition treatment is within nurses’ scope in Kenya and Tanzania. Specialist nurses usually have broader scopes of practice though rarely explicitly listed out for each different specialty