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Commentary

Physician assistants in Ghana

Adjase, E.T. MD, MPH

Author Information
Journal of the American Academy of Physician Assistants: April 2015 - Volume 28 - Issue 4 - p 15
doi: 10.1097/01.JAA.0000462393.36053.13
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In Ghana, physician assistant (PA) refers to three distinct groups of healthcare professionals trained in the medical model to practice medicine and dentistry: PA–Medical, also known as medical assistants; PA–Dental, also known as community oral health officers; and PA–Anesthesia, also known as nurse anesthetists.

In the past, these healthcare professionals were trained exclusively by health training institutions under the Ministry of Health with the aim to extend care to the people in areas that had few or no physicians.

The first training programs started in the mid-1960s on an ad hoc basis. By the late 1960s, a formal and more structured training program for these providers began at Kintampo in response to the acute shortage of physicians and the maldistribution of the health workforce in general. In 1969, the Ministry of Health established the Rural Health Training School at Kintampo. This school (now called the College of Health and Well-Being at Kintampo) trains professional nurses on the medical generalist model (an 18-month program) to care for rural and underserved populations. At the time, these clinicians were called health center superintendents because they were trained specifically to work in the health centers dotted across the country.

The training of the other two PA health professional groups started decades later with the same philosophy. Ghana has about 3,500 physicians and dentists, so training PAs to extend care is relevant and cost-effective. Ghana's physicians are unevenly distributed geographically and across medical disciplines and subspecialties, posing a challenge to serving its 24.2 million people.

The number of PAs in all categories has been increasing since the inception of PA training and practice in Ghana. Today, the country has about 2,500 PAs. About 90% have been licensed to practice by the Medical and Dental Council of Ghana, the regulatory body for medical and dental health professionals. Of the total number of practicing PAs, close to 72% are PAs–Medical.

In the last 4 to 5 years, the Ministry of Health has mandated the Medical and Dental Council to set standards for training and regulation of practice as well as keeping and maintaining a register of all PAs. This directive is timely as PA numbers and training institutions continue to grow.

Seven schools are training PAs in Ghana and about an equal number of institutions are applying for accreditation to start PA training programs.

PAs are well accepted in Ghana and form the bedrock for primary care throughout the country. PAs-Medical work mostly in primary care settings handling about 70% of the health needs of rural and underserved populations. They practice as generalists, triaging and managing all kinds of medical and health conditions at the health facilities and within the community.

PAs–Anesthesia and PAs-Dental practice mainly in the district and regional hospitals across the length and breadth of Ghana. Due to the inadequate numbers of anesthesiologists and dental surgeons, PAs-Anesthesia and PAs-Dental handle some of the physician responsibilities and work alongside physicians to provide the needed care.

Because the profession is growing rapidly, it appeals to many high school students with science backgrounds. Data from the admissions office of the College of Health and Well-Being at Kintampo indicate that one out of every five applicants would prefer taking the PA–Medical program.

The PA–Medical profession, male-dominated in its early days, has in the last decade become nearly 50% female. Many women who are professional nurses have been admitted into the PA-Medical and PA-Dental programs at the college. From 2010, the college has offered PA specialty and subspecialty programs, including clinical psychiatry and clinical dermatology. Because PAs have a key role to play in meeting the health-related aspects of the United Nations' Millennium Development Goals, programs that will support the attainment of these goals are indeed worthwhile.

Copyright © 2015 American Academy of Physician Assistants