New Cochrane EPOC review update: Nurses as substitutes for doctors in primary care (2)

19 July, 2018

Dear Simon and HIFA colleagues,

Thank you very much for the subjected interesting discussion. There is no doubt that Nurses are the backbone of the Primary Health Care (PHC). But what should be their role and position in PHC? the findings of the health system research and experiences should guide policy makers, planners and managers to decide. In my 15 years experiences in Health Services Development Research (HSDR), Project Of West Azerbaijan, Iran, which resulted a successful country wide PHC Network since 1971. It was obvious that without Nurses it was impossible to develop PHC Network. In contrary seven medical doctors who were with the HSDR project in Situation Analysis period and medical survey time always were negative about the PHC approach and left the project after one month when the PHC Experimental project started. But the project survived with the enthusiasm and dedication of Nurses, Nurse aids, technician of environmental health and sociologist under the leadership of a medical doctor specialist on Public Health. During the period of PHC development (trial & error), the medical doctors in their private clinics, health centers, and hospitals were the main obstacle for a real PHC development. For example the CHWs (BEHVARZ), and PHC team were promoting breast feeding, but when the child was referred to medical doctor for treatment of common diseases, the doctor would recommend powder milk instead of breast milk.

Or CHW was providing Oral Rehydration Salt (ORS), for children with diarrheal disease but the doctor was prescribing intravenous solution and some other medicines including antibiotics. When a high level technical mission from WHO/ Geneva came to visit the HSDR project and have asked me what is your most important problem for PHC development? My answer was medical doctors and curative oriented/ hospital based medical education.

In conclusion I should say that the idea could be further tested, retested and evaluated. But the most important issue is the selection criteria, curriculum and site of the training of nurses. If the nurses are going to be trained in hospital and curative minded, there is no use to be substitute for doctors in PHC. But if we train a Speciality of public health/ community oriented nurses with knowledge of Social Determinants Of Health, Equity, UHC, and SDGs approach, with compassion of nursing behavior background, no doubt could be an efficient substitute of medical doctor. The same kind of training, knowledge, and behavior for medical doctor (Family Physician), is needed if we want to keep the medical doctor as the team leader of Primary Health Care Team.

Respectfully, Dr. M.A. Barzegar, M.D., MPH.

HIFA profile: Mohammad Ali Barzegar is an initiator of Primary Health Care in Iran since 1971, and Representative of People's Health Movement (PHM) Iran. His interest include 45 years of national & international experiences on PHC, Sustainable Development and Public Health. barzgar89 AT