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As a result of increased demand for health care services in the developed and developing countries due to rise in population, the supply of physicians and doctors is becoming limited. The shifting of physicians and doctors to nurses in the primary health care as offered a solution to curb the limited number of the personnel. This program is basically referred to as doctor-nurse substitution. The reason behind this program is provide quality health care and in-turn reduces the workload of the physicians as well as reducing the cost.

However, the strategy may be curtailed and subsequently fail to be fully realized. The obvious reason being poor primary medical care delivery. This could lead to improper treatment or even lead to death of patients due to inadequate care. In such cases the substitutes need training to improve their skills on the new roles. However the strategy can be reversed by the countries experiencing the shortage of medical personnel by reducing the number of doctors migrating to other countries in search for better pay. This mostly happens in sub-Saharan countries (AMREF, 2011).

The doctor-nurse substitution problem can be fixed by establishing integrated programs to solve the problem. The programs that will hinder the advancement of the proposed plan of nurse-doctor substitution include the following:

1.      The government initiative to increase remuneration of qualified personnel. This will limit the number of doctors wanting to go other countries such as developing countries for better salaries.

2.      The discouraging of indirect substitution. This is because this kind of substitution does not involve some training as opposed to nurse-doctor substitution where nurses are first trained. This goes along way in assuring the public of better service delivery.

3.      The use of direct substitution. This is a case where less qualified and specialized medical personnel are substituted with doctors. In some African countries like Kenya, Uganda and Tanzania, clinical officers are more specialized and better placed as substitutes than nurses. Other African countries such as Malawi, Ghana and Mozambique, Medical assistants are more specialized than nurses.

4.      Improved living and working conditions of medical personnel can motivate them to working in there mother countries and hence increased number of personnel (Nursing advocacy, 2005).

5.      Compensation of educational expenses in cases of emigration by government. This initiative could lead to raising the morale of doctors of working in there countries of origin.

6.      Giving of additional benefits to expatriate doctors by the government after they go back to their countries. This will give confidence to other medical doctors already working in other countries to return to their countries.

7.       Bridging the gap between medical professionals. Making of policies by the government that augments sustainability between highly qualified professionals and the less qualified professionals. This will help to harmonize the professional differences and create a better working environment (Bourgain, Pierettiy, & Zou, 2009).

The implementation of the above proposals can to a greater extent reduce the mass departure of highly competent and specialized medical professionals to other countries in search for better remuneration.  It has been found out that direct substitution also helps to contain the problem since medical professionals hailing from particular countries will only be confined to their countries due to their specific qualifications which are of less consideration basing on international standards, and cannot seek employment in other countries (Laurant et al., 2007).

This paper gives suggestions which if implemented by the country experiencing shortage of medical personnel will see the number of medical personnel working in their mother country improving. However, these suggestions are barriers, pitfalls or obstacles that hinder the implementation of the proposed project/plan doctor-nurse substitution.

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