South Africa made a decision in 2002 to develop so-called mid-level medical workers, now known as clinical associates.
This article describes the background to this decision, and the national process of developing the profession and its
scope of practice, which was aligned with the needs of the health service, particularly those of rural district hospitals. A
common national curriculum was then developed, with implementation in three faculties. The first graduates have
entered the profession, starting in 2011, and are in the process of establishing themselves across the country. They are
already making an important contribution to rural health care, and are seeking ways in which the profession can be
enhanced to ensure sustainability. The profession needs to adapt itself to the changing realities of the South African