Emergence of allied healthcare assistants: A policy with many perspectives
To state that allied healthcare professionals are inadequate in Ghana is indeed an understatement. There is persistent shortfall in the supply of these professionals against demand owing partly to the late commencement of allied health training programmes in the country. The professions include dieticians, occupational therapists, physiotherapists, radiographers and medical laboratory scientists.
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Similar scenario in general medical practice has led to the emergence of lower cadre staff such as medical assistants, auxiliary nurses, pharmacy assistants etc.
It has been reported that the country’s doctor and nurse population ratio is one doctor to 10,452 and one nurse to 1,251 (Growth and Development Agenda, 2010 – 2013).
The situation remains the same to date and the ratio is worse in the case of allied healthcare professions. It thus becomes imperative to train supportive staff, not necessarily to take over the primary duties of the professionals but to provide necessary support that could facilitate smooth healthcare delivery. Ideally, "technical supportive services" should be simple, routine tasks and procedures that may be safely performed by assistants who have limited training and who function under the supervision of fully qualified professionals.
Allied healthcare assistants are primarily required to perform basic administrative, clerical and technical supportive services as permitted by law. In other words, assistants may not be allowed to perform patients’ assessment, administration of specialised skills and performance/analysis of sensitive tests. It suffices to state that this group of health workers should work under the supervision of the professionals. "Supervision" is defined to require the licensed professionals to be physically present in the treatment facility during the performance of any assigned procedures. There are many perspectives to this development that could be highlighted as follows:
Government perspective
It is the cardinal responsibility of any government to provide healthcare needs for the citizenry irrespective of the geographical locations, tribes and beliefs. It must, however, be stated that healthcare provision in Ghana is still largely institution-based, which allows for concentration of healthcare facilities in the urban centres, thereby denying the rural dwellers such healthcare provision in the cities. This is particularly true of allied health services suchas physiotherapy, speech therapy, radiography, dietetics, and occupational therapy which are virtually absent in must rural health facilities. The challenge is compounded by the unwillingness of the young graduates of these professions to practise in the rural areas. The time-honoured option is the training of the lower cadre staff who could offer the basic services where such are lacking. It thus remains the onus on the government to provide these essential services to the rural communities.
Healthcare regulation perspective
The question also arises as to how the activities of the assistants will be guided? The government has established a council (according to the dictated of the Health Professions Regulatory Bodies-Act 857 of 2013) that is tasked to regulate the practices of all allied healthcare professionals and by extension, the assistants as regards their training and mode of practice upon graduation. Although the responsibilities of the council are clear, implementation is being hindered by such factors as inadequate number of personnel and logistics to ensure proper surveillance. There is no doubt in the ability of the council if it is adequately equipped with the necessary human and material resources.
Employment perspective
Youth employment remains the topmost priority of any civil government. Thus, school leavers who are unable to gain direct entry into the mainstream training of various allied healthcare professions often take advantage of assistant health training programme in order to gain employment upon completion. In advanced countries health assistants have been targeted as a key group for future development.
Education and training perspective
The provision of formal training has a number of benefits, not just to the qualified staff, but also to patients, managers and health assistants themselves. Qualified staff could be confident that their assistants are competent to support them if they are sure of their training background which equips themwith the required knowledge and skills for support. Such training can stimulate a desire to pursue further education in the healthcare field.
Practice perspectives
There is fear that healthcare professionals would drift away from direct patient care to indirect supervisory roles. This calls for caution as the time of more qualified staff could be spent on the supervision of assistants, leaving little time for other professional interventions.
From the foregoing, it can be concluded that allied health assistants who are trained by and are working under the licensed healthcare professionals should be recognised to ensure the development of common standard and a single mode of professional conduct. It appears, therefore, that formal training of health assistants could be beneficial if the training programmes are well regulated by the government in conjunction with other stakeholders like the medical schools.
The writer is Senior Lecturer, Department of Physiotherapy, School of Biomedical and Allied Health Sciences, University of Ghana.
