Ajayi S, Zhao Y, Ibrahim N, English M
Wellcome Open Res. 2025;10
BACKGROUND: Specialist health professionals are essential for meeting the evolving health needs of Sub-Saharan Africa (SSA), especially as the burden of complex and chronic conditions rises. They contribute not only to patient care but also to teaching, research, and policy development. However, there is a significant shortfall and uneven distribution of specialists across the region, creating major challenges for health systems. This paper examines the roles, numbers, training pathways, and scope of practice of medical, nursing, and clinical specialists in four SSA countries (Kenya, Uganda, South Africa, and Nigeria), with the aim of informing more effective workforce planning. METHODS: Between September 2023 and July 2024, we conducted a document review of policies and guidelines related to specialist health professionals in Kenya, Uganda, Nigeria, and South Africa. Sources included ministries of health, regulatory bodies, academic institutions, and professional associations. We focused on the composition of the specialist workforce, training pathways, and defined roles across different health cadres. RESULTS: There is marked variation in specialist workforce composition between countries. South Africa and Kenya reported the highest numbers of medical specialists (38% and 33% of all doctors respectively), while nursing specialists were more common in South Africa (40% of all nurses) and clinical officer specialist in Kenya (10% of all clinical officers). Training pathways ranged from university-based master's programmes to national/regional fellowship systems. However, many curricula lacked essential non-clinical competencies - such as leadership, management, and communication skills - limiting specialists' effectiveness in broader health system roles. CONCLUSION: Strengthening the specialist workforce in SSA requires better alignment between training and health system needs. This includes integrating non-clinical competencies into curricula, enhancing data systems for workforce planning, and addressing gaps in distribution and capacity. Policy reforms and strong leadership are critical to building a sustainable, well-equipped specialist workforce to meet the growing healthcare challenges. We looked at the number, roles, and training of specialist health professionals - such as doctors, nurses, and clinical officers - in four countries in Sub-Saharan Africa: Kenya, Uganda, Nigeria, and South Africa. The study was needed because many people in these countries now live with long-term or complex health problems, which require care from trained specialists. However, there are not enough specialists, and they are not evenly spread across the region. We reviewed documents from health ministries, professional associations, and universities between September and December 2023. We found that the types and numbers of specialists vary widely. South Africa and Kenya have more medical specialists, while Kenya and Uganda have more nurse and clinical officer specialists. We also found that specialist training programmes often do not include important non-clinical skills, such as leadership and communication. We recommended that better workforce planning is needed, including improved data systems and policies. A key limitation is that the findings are based on available documents from four English-speaking countries and may not fully reflect all specialist training programmes or the situation in other parts of Sub-Saharan Africa. The findings can help guide future planning to strengthen health systems in the region. eng
