Clinical Associates’ experiences, challenges and needs of working in emergency centres in South Africa
1
1 Department of family medicine, University of Witwatersrand, Johannesburg, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A3478
ABSTRACT
BACKGROUND:
The global health workforce shortage critically impacts South African emergency centres (ECs), contributing to severe overcrowding and staff burnout. To mitigate doctor shortages and strengthen district health systems, the Clinical Associate (Clin-A) profession was established to facilitate task-shifting, aligning with Sustainable Development Goal 3. Although not originally intended for specialised emergency care, Clin-As increasingly staff these types of units. However, their professional experiences and integration within the specific context of the EC remains insufficiently explored.
METHODS:
A descriptive exploratory qualitative study design was employed. Qualified Clin-As with a minimum of six months experience in public or private emergency centres were recruited using purposive sampling. Data were collected through individual, semi-structured interviews and analysed using Braun and Clarke’s (2006) six-phase thematic analysis
RESULTS:
11 participants were interviewed, with the majority (n = 8) employed in the private sector and the remainder (n = 3) in the public sector. The analysis revealed three main themes: “Building competence through practice”, “The identity battle”, and “The invisible ceiling: regulatory and economic dead ends”. Findings indicated that participants perceived a gap in their undergraduate emergency training, which they bridged through self-directed and experiential learning. This developed sense of clinical competence often contrasted with their professional title, creating hierarchical tensions. The most significant challenge reported was the regulatory requirement for mandatory career-long supervision; this was viewed as limiting, fuelling frustration and dissatisfaction with remuneration and intention to seek non-clinical roles.
CONCLUSIONS:
The findings of this study suggest that while Clin-As working in ECs perceive themselves as proficient and essential to service delivery, the current systemic and regulatory frameworks pose a substantial risk to retention. It is suggested that policy reform addressing the misalignment between experienced Clin-As’ scope of practice and restrictive supervision regulations is be considered to safeguard the workforce and enhance task-sharing efficiency.
The global health workforce shortage critically impacts South African emergency centres (ECs), contributing to severe overcrowding and staff burnout. To mitigate doctor shortages and strengthen district health systems, the Clinical Associate (Clin-A) profession was established to facilitate task-shifting, aligning with Sustainable Development Goal 3. Although not originally intended for specialised emergency care, Clin-As increasingly staff these types of units. However, their professional experiences and integration within the specific context of the EC remains insufficiently explored.
METHODS:
A descriptive exploratory qualitative study design was employed. Qualified Clin-As with a minimum of six months experience in public or private emergency centres were recruited using purposive sampling. Data were collected through individual, semi-structured interviews and analysed using Braun and Clarke’s (2006) six-phase thematic analysis
RESULTS:
11 participants were interviewed, with the majority (n = 8) employed in the private sector and the remainder (n = 3) in the public sector. The analysis revealed three main themes: “Building competence through practice”, “The identity battle”, and “The invisible ceiling: regulatory and economic dead ends”. Findings indicated that participants perceived a gap in their undergraduate emergency training, which they bridged through self-directed and experiential learning. This developed sense of clinical competence often contrasted with their professional title, creating hierarchical tensions. The most significant challenge reported was the regulatory requirement for mandatory career-long supervision; this was viewed as limiting, fuelling frustration and dissatisfaction with remuneration and intention to seek non-clinical roles.
CONCLUSIONS:
The findings of this study suggest that while Clin-As working in ECs perceive themselves as proficient and essential to service delivery, the current systemic and regulatory frameworks pose a substantial risk to retention. It is suggested that policy reform addressing the misalignment between experienced Clin-As’ scope of practice and restrictive supervision regulations is be considered to safeguard the workforce and enhance task-sharing efficiency.
| eISSN: | 2654-1459 |
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