Health Centre Without A Doctor, A Missing Nomenclature

I have come to believe that everything that God created has a name and as He placed man in charge of creation everything that was created received a name likewise every other thing that has been made by man. Yes Physician Assistant (PA) has a name in the affirmative to the above but why is this name missing in almost all official documents within the country.

Physician Assistants provide the primary health care needs of about 70% of the rural populace including hard to reach areas which are not privileged to good roads, good communication networks, electricity etc in Ghana. Though some are found in the hospitals the majority are the ones working at the rural areas and being deprived of several opportunities, yet this profession is suffering neglect by the authorities in several things among which are the lack of condition of service, poor salary structure, no career development plan, no remuneration and even a pat at the back.

Could someone in authority explain why a profession that has been the back bone to the Country's Primary Health Care since 1969 will not have its name appearing in any official address. Physician Assistants are and have been the gate keepers of health in Ghana, manning over thousand health centres across the country and with their efforts a lot more of these health centres have been upgraded to polyclinics and district hospitals.

One may want to know whether they have the qualification to practice maybe that may contribute to the reason they are being sidelined, but even is that enough justification?

Formerly called Medical Assistants, a Physician Assistant is one who has undergone a 4 year training in medicine and dentistry with courses including Internal Medicine, Paediatrics, Obstetrics, Surgery, Public Health and other ancillary courses to equip him manage a health centre also to fit in in working at the hospitals. They are licensed by Medical and Dental Council after passing the councils examination and completing a one year internship. They are appointed as the head of the subdistrict where they are in-charge of the health centre and Community Based Health Planning and Services (CHPS) centres within their catchment area. They perform both clinical and administrative duties, as well as a 24 hour call duty.

The public knowledge about the work of a Physician Assistant is minimal and that ignorance can be attributed to the lack of mention in all forms of communication from the top level to the lowest though clients meet us everyday in most consulting rooms at the hospitals and health centres across the country. The public cannot be blamed for the ignorance of calling everyone they see in the consulting room of a health facility a doctor because of the difficulty in making a distinction between the two.

The Physician Assistant acknowledges their role in the health sector and are proud of that including being addressed as a PA. You may have come across National Health Insurance Authority's (NHIA) Medicine List document which contains Levels of Prescription of facilities stipulated as "A- CHPS, M- health centre with a midwife, B1- HEALTH CENTRE WITHOUT A DOCTOR, B2- health centre with a doctor, C- District Hospital" etc. What is wrong from mentioning the PA who occupies level B1 and this is among several other treatment been placed on the PA including restrictions on prescription of important medications for patients.

The health ministry too has been silent on the issues of the PA. Physician Assistants are always forgotten on government clearance for employment for the past years, when all the other cadres like the Doctors, General Nurses, Nurse Assistants Clinical, Community Health Nurses etc are given such quotas.

Statistics which carry doctor to patient ratio, nurse to patient ratio etc has always seen the names of the PA avoided for no other obvious reason than ......... wish readers could help me complete that sentence.

The public is being kept from knowing the immense contributions also made by the PA except to find fault. Whilst other countries like Kenya, US, Uganda etc are making the best out of Physician Assistants both in internal medicine and conducting surgeries this country is yet to realized such potential. People are developing complications everyday and others are dying because of poor road networks, lack of vehicle to convey the sick especially the pregnant women from hard to reach areas. Such is why the first point of call (health centre) being the gateway needs to be strengthened to avert such occurrences. Universal health coverage cannot be achieved without the PA providing Primary Health Care at the local level.

Authorities should remember that even though they may find themselves living and working at the cities, back at home in their villages, it is the Physician Assistants who are providing health care to their cherished mothers, fathers, sisters and brothers. Therefore it is very significant to acknowledge the role played by the Physician Assistants and give it the needed recognition, for where there is no Doctor, there is a Physician Assistant. Thanks for ending with me.

Samuel Wiafe

[email protected]

Columnist/Sen. Physician Assistant.