Stakeholders' views on the utility and employment strategies of clinical associates.

Background: Clinical associates (ClinAs) were introduced into the South African healthcare system to increase the numbers of skilled health professionals. Little is known on how they are viewed. This study explored stakeholder views on the utility and employment strategies of ClinAs in the public sector.

Methods: A mixed-methods design was used. An online survey was used to collect data from operational stakeholders, while online interviews explored strategic stakeholders' views.

Results: Forty-five operational stakeholders participated. The view of ClinAs' contribution to the joint management of four common health conditions was strong (91% - 96%). The poorest agreement was their perceived contribution to maternal health (38%). There was a strong agreement (mean = 6.13, s.d.: 0.94) that conditions of ClinAs practice are met. Clinical associates were viewed as being able to work with others (mean = 6.11, s.d.: 0.98) and contribute to service improvement (mean = 6.47, s.d.: 0.62). There was a low agreement regarding the positive impact of recruitment (mean = 2.93, s.d.: 1.99) and retention strategies on ClinAs (mean = 2.75, s.d.: 1.51). The six key strategic stakeholders ascribed the slow progress made in career development, career progression, post creation and professional autonomy to the uncertainty regarding the scope of practice and perceived lack of support.

Conclusion: The utility of ClinAs to provide health services in the public sector is clear, and their contribution is valued. The lack of progress around many of the human resource issues is a constraint that needs a champion if this cadre is to fully realise their potential.Contribution: Clinical associates are valued at service delivery level, but appear overlooked higher up.