New project to drive policy changes and advocacy for Medical Licentiate practitioners in Zambia

A new international research project to drive evidence-based policy and advocacy for Medical Licentiate practitioners in Zambia has been announced by the RCSI Institute of Global Surgery, Heidelberg Institute for Global Health, SolidarMed, and the Surgical Society of Zambia.

The Medical Licentiate Development Tracker (MeLD Track) will generate important evidence to inform policymakers at the highest levels of the Zambian government to help drive decisions that will ultimately underpin health systems strengthening efforts, and improve health service provision to Zambians.

With an estimated population of 16.2 million, with 60.5% living in rural areas, Zambia faces a critical health workforce shortage. The country deploys non-physician clinicians, known locally as Medical Licentiates, as the main surgical workforce at the district level, filling a major gap due to shortages or absence of doctors.

Medical Licentiates have been trained in Zambia for over 20 years and, in that time, more than 600 qualified practitioners have been delivering life-saving medical and surgical procedures to the country's population.

Despite the impact of the profession within the Zambian health workforce, the Medical Licentiates profession still faces many challenges. This is partially because there is a significant evidence gap on the impact this cadre is having in driving health service provision. The evidence gap also hampers advocacy efforts to drive policy changes that would help the profession gain more critical recognition within the health service in Zambia, as well as regionally.

We conducted a large-scale randomized trial to measure the contribution of Medical Licentiates to the provision of surgical services in Zambia. The results showed that this cadre is the real backbone of surgery in rural areas where majority of the country's population lives. They provide good quality services, meeting the needs of patients who cannot access care in urban areas where surgical specialists live."

Dr Jakub Gajewski, RCSI Institute of Global Surgery

Building on extensive experience in surgical training, education and research partnerships in Africa, the RCSI Institute of Global Surgery works with local partners to develop sustainable surgical care systems in low and middle-income countries. The Institute has a four-fold focus: patient-centeredness, equity, creating mutually beneficial collaborations, and developing the evidence base for global surgery.

The RCSI Institute of Global Surgery has a long history of leading valuable initiatives aimed at improving surgical capacity in Zambia. In 2013, working with the Zambia Ministry, local training institutions and SolidarMed, the RCSI-led COST-Africa project helped to upgrade the programme to the level of Bachelor of Science.

Between 2017 and 2021, SURG-Africa, another RCSI-led project, continued to strengthen the surgical capacity of district level hospitals in Zambia, providing surgical training and mentorship for Medical Licentiates and other cadres practicing in rural areas of the country. Dr Jakub Gajewski led on both of these projects.