Abstract:
BACKGROUNG: South Africa’s health care system grapples with persistent challenges, including
health care provider shortages and disparities in distribution. In response, the government
introduced clinical associates (Clin-As) as a novel category of health care providers.
AIM: This study mapped Clin-As’ history and practice in South Africa, assessing their roles
in the health workforce and offering recommendations.
METHODS: Following the framework outlined by Arksey and O’Malley, we conducted a
comprehensive literature search from January 2001 to November 2021, utilising PubMed,
Scopus and EBSCOhost databases. One thousand six hundred and seventy-two articles were
identified and then refined to 36 through title, abstract and full-text screening.
RESULTS: Strengths of the Clin-A cadre included addressing rural workforce shortages and
offering cost-effective health care in rural areas. Challenges to the success of the cadre included
stakeholder resistance, rapid implementation, scope of practice ambiguity, inadequate
supervision, unclear roles, limited Department of Health (NDoH) support, funding deficits,
Clin-As’ perceived underpayment and overwork, degree recognition issues, inadequate medical
student training on Clin-A roles, vague career paths and uneven provincial participation.
CONCLUSION: As a health care provider cadre, Clin-As have been welcomed by multiple
stakeholders and could potentially be a valuable resource for South Africa’s health
care system, but they face substantial challenges. Realising their full potential necessitates
enhanced engagement, improved implementation strategies and precise scope definition.
CONTRIBUTION: This study acknowledges Clin-As in SA as a promising solution to health care
workforce shortages but highlights challenges such as stakeholder resistance, insufficient
NDoH support and unclear policies, emphasising the need for comprehensive efforts to
maximise their potential.
