MeLD Track

With an estimated population of 16.2 million, with 60.5% living in rural areas, Zambia faces a critical health workforce shortage. The country deploys non-physician clinicians, known locally as 'medical licentiates', as the main surgical workforce at the district level, filling a major gap due to shortages or absence of doctors. Medical licentiates have been trained in Zambia for over 20 years and, in that time, more than 600 qualified practitioners have been delivering life-saving medical and surgical procedures to the country's population.

In collaboration with the RCSI Institute of Global Surgery, Heidelberg Institute for Global Health, SolidarMed, and the Surgical Society of Zambia, the Medical Licentiate Development Tracker (MeLD Track) is a research project generating important evidence. The goal is to inform policy makers at the highest levels of the Zambian government to help drive decisions that will underpin health systems strengthening efforts, and improve health service provision to Zambians.

The assessment of the contribution of Medical Licentiates to the provision of surgical services in Zambia shows that this cadre is the real backbone of surgery in rural areas where the majority of the country’s population lives, and they provide good quality services, meeting the needs of patients who cannot access care in urban areas where surgical specialists live.

Despite the impact of the profession within the Zambian health workforce, Medical Licentiates still face many challenges. This is partially because there is a considerable evidence gap on the impact this cadre is having in driving health service provision. The evidence gap also hampers advocacy efforts to drive policy changes that would help the profession gain more critical recognition within the health service in Zambia, as well as regionally. 


The overarching aim of the study is to highlight the contribution medical licentiates make towards health care delivery in Zambia and to identify challenges and barriers this cadre faces. More specifically the study has the following objectives:

  • To determine the number of qualified MLs in Zambia
  • To determine the number of clinically and surgically active medical licentiates
  • To measure the contribution of MLs in delivery of health services
  • To determine ML attrition rates
  • To identify and document factors responsible for attrition and career trajectories of medical licentiates

The RCSI team