Finding New Ways to Help One Another: Diversifying Delivery of Care

In today’s world, robots and computers have taken over many of the tasks we used to perform ourselves. While technological advances have certainly had a huge impact on many healthcare processes, the best drugs and the most innovative tools are meaningless if we do not have skilled individuals to prescribe and operate them. At the beginning and end, healthcare is about people caring for people. So what do we do if there are just not enough doctors to go around? While nearly all countries are feeling this challenge,(1) the response clearly varies. Here in the US, issues such as the increased need to serve an aging population, coupled with a chronically high physician attrition rate, is being addressed by shifting work to mid-level providers, with hospital units increasingly staffed with PAs and NPs.

This is not necessarily a negative development. Well-trained mid-level providers can provide crucial services to improve population health. For example, a Bulletin of the World Health Organization issued in January of 2009 recommends that all qualified mid-level health care providers be authorized to carry out first-trimester abortions.  In low-resource areas, especially in HIV/AIDS burdened countries of sub-Saharan Africa, severe shortages of qualified health care providers have renewed interest in community health workers. These individuals play a crucial role in antiretroviral treatment provision, taking over tasks from professional health workers. (2)

In many places across the globe, individuals are taking matters into their own hands. In South Africa, for example, Ashoka fellow Veronica Khosa has taken the training of alternative human resources for health to a very practical level. In a country ravaged by the HIV/AIDS pandemic and wracked with chronic shortages of health care providers, Ms. Khosa has developed a home-based healthcare program capitalizing on family members and friends of patients to serve as trained care providers. While this is not exactly a new approach, it shows creativity and promise.

The health care worker shortage is a complex problem which needs to be tackled internationally on a political and social level, as well as within national healthcare frameworks. Global health policy makers must take the lead to inform a shift towards the training and utilization of more varied health care personnel.

While there has long been cause for concern, the outlook is even more daunting in light of Monday’s UN announcement of the world’s population surpassing its 7th billion. As the dynamic world of health care evolves in an effort to meet the needs of this ever-growing population, the strain on providers seems only to be on the rise. While we cannot all be like Veronica Khosa, perhaps we can still learn from her example, stretching the capacities of existing health care resources by finding more creative solutions to caring for one another.




1.) L. Chen, T. Evans, S. Anand, J.I. Boufford, H. Brown, M. Chowdhury, M. Cueto, L. Dare, G. Dussault, G. Elzinga, E. Fee, D. Habte, P. Hanvoravongchai, M. Jacobs, C. Kurowski, S. Michael, A. Pablos-Mendez, N. Sewankambo, G. Solimano, B. Stilwell, A. de Waal, and S. Wibulpolprasert. (Nov 2004). Human resources for health: overcoming the crisis. Lancet, 364(9449): 1984-1990.

(2) K. Hermann, W. Van Damme, G. Pariyo, E. Schouten, Y. Assefa, A. Cirera, W. Massavon (April 2009) Community health workers for ART in sub-Saharan Africa: learning from experience – capitalizing on new opportunities. Human Resources for Health.  7:31.



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