Clinical officer Information & Clinical officer Links at HealthHaven.com

In Sub-Saharan Africa, clinical officers are health care providers. After three years of training, they receive a diploma in clinical medicine, surgery and community health. Clinical officers work either independently or with a medical officer to provide healthcare services to largely rural populations. The basic training is roughly similar. However the scope of practice is as varied as there are countries in Africa because each country adapts them to local situations and needs during internship. For example in Malawi those with a basic diploma are trained to perform routine surgical and obstetric operations such as laparatomy and caeserian section whereas in Tanzania one must undergo additional training to become an Assistant Medical Officer before undertaking such responsibility.

[edit] Kenya

The training is under the Ministry of Health through the Clinical Officers Council (COC), which sets the syllabus and accredits training institutions. The Kenya Medical Training College (KMTC), also under the Ministry of Health, has campuses all over the country and trains the majority of clinical officers. St. Mary's School of Clinical Medicine-Mumias, which falls under the Roman Catholic diocese of Kakamega, was the first private institution to train clinical officers. The students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service.

Unlike other countries, clinical officers in Kenya are a constitutionally recognised profession. They are required to sign legal documents such as medical certificates, death certificates, P3 forms etc and to present medical evidence in a court of law eg in cases of rape and assault.

The Clinical Officers (Training, Registration and Licensing) Act Cap 260 of the laws of Kenya is an act of parliament that came into force in 1989 and is the legal basis for the practice of clinical officers. It establishes the Clinical Officers Council whose functions are: "(a) to assess the qualifications of clinical officers (b) to ensure the maintenance and improvement of the standards of practice by clinical officers and to supervise the professional conduct and practice of clinical officers (c) to register and license clinical officers for the purposes of this act (d) to collaborate with other bodies such as the medical practitioners and dentists board, the central board of health, the nursing council of Kenya, the pharmacy and poisons board, in the furtherance of the functions of the council and those bodies; and (e) to consider and deal with any matter pertaining to clinical officers including prescribing badges, insignia or uniforms to be worn by clinical officers."

Before this act there were many sub-cadres within the profession such as Registered clinical officer (RCO), certified clinical officer (CCO), medical assistant etc who had different kinds and levels of education. All these were abolished by the act in 1989 in favour of a uniform Clinical Officer (CO) cadre. However the title RCO has persisted even in official publications.

Although traditionally a non-university qualification, this has changed. The first university to train clinical officers was Egerton University^[1] in 1999. Other universities followed suit and currently programs exist at Jomo Kenyatta University of Agriculture and Technology^[2], Kenya Methodist University^[3] (KEMU) and Mt. Kenya University^[4]. The latter is the only one offering a four-year Bachelor of Science degree in Clinical Medicine and community health and uses a curriculum borrowed from Kampala International University which is a patner institution. The rest award a three-year diploma in Clinical Medicine and surgery. These universities follow their own curriculum jointly approved by their senates and the clinical officers council.

The training is rigorous and follows a compressed medical model. The first year is dedicated to learning the basic sciences, some experience in a diagnostic medical laboratory, nursing and clinical skills. The second year focuses on the clinical subjects whereas the third year is spent almost entirely rotating in every department of a teaching hospital where they attend ward rounds, clerk patients and present cases, perform deliveries and as first assistants in major surgical operations. they also attend clinical meetings and write prescriptions which at this stage must be countersigned by a supervising clinician.

Registration After three years of training, students sit for the national final qualifying examination (FQE) which is administered by the Clinical Officers Council. Those who trained outside the country sit a separate paper. On passing the FQE they are expected to apply for provisional registration by the Clinical Officers Council before proceeding for internship in accredited hospitals. The internship lasts one year and involves three-month supervised rotations in the major clinical departments namely casualty, medicine, paediatrics, surgery, obstetrics and gynecology.

Career advancement Qualified clinical officers with three years experience qualify to enrol for a Higher National Diploma at KMTC which leads to a specialist qualification in various specialty fields^[5]. Many clinical officers now enrol for medical degrees at various universities within and outside the country whereas others enrol for related degree courses such as sociology, psychology, statistics and public health. Some universities had in the past admitted higher diploma holders directly to Master of Public Health degree programs, but this route no longer exists and all applicants must have a bachelor's degree.

Kenyatta University introduced a four-year Medical degree in 2004 that was meant to up-grade practicing clinical officers to be doctors. However this was stopped half-way and converted to a traditional six-year medical degree due to registration issues with the Medical practitioners and dentists board. However this is set to be a non-issue as universities start to issue academic degrees to clinical officers as happens in countries that train DOs.

Kenya Clinical Officers Association (K.C.O.A) This is a professional body whose membership encompasses registered clinical officers. It is represented on the Clinical Officers Council by three of its members who must be in private practice.

[edit] Uganda

The training is under the ministry of education and takes place in clinical officer training schools. Programs last three years. Internship is not required for one to be registered.

Kampala International University offers a Bachelor of Science degree in clinical medicine and community health. High school graduates take four-and-a-half years to complete this degree while practicing clinical officers take three years.

[edit] Tanzania

Training is under the ministry of health. There are numerous clinical officer training schools and programs last three year. Internship is not required for registration.

Experienced clinical officers may enrol for an advanced diploma in clinical medicine which takes two years to complete. This qualification is regarded as equivalent to a first degree in medicine by universities in the country. The graduates are then known as Assistant Medical Officers. A further two years training leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc.

[edit] Mozambique

Tecnicos de cirurgia are experienced Clinical officers (Tecnicos de medicina) who undergo further residential training in surgery under senior surgeons lasting two years at Maputo Central Hospital and one year internship at a provincial Hospital. They are trained to carry out emergency surgery, obstetrics and traumatology and are deployed to the district hospitals where they are usually the sole surgeons [5].

[edit] Malawi

Clinical officers train for three years and undergo one year internship whereas Medical assistants train for two years and undergo one year internship. Medical assistants can then enrol for a 18 month up-grading course to become Clinical officers. The upgrading course takes place at Malamulo and Malawi College of Health Sciences[6].

In this country the Clinical officers have almost entirely replaced doctors who are in short supply or based in the urban areas. They are trained to carry out all the routine functions of a doctor at a district hospital hence are able to perform routine surgical and Obstetric Operations such as Caesarean Sections, Hysterectomies, Orthopedic care, Burr holes, Lumbar Punctures, and other important Life saving Surgical procedures.

Limited opportunities exist for career progression beyond the basic diploma. Hence most clinical officers join non-clinical degree courses in Management, Health Sciences, Education, and Biomedical Sciences. The main limitations are encountered because the country has only one medical school. Lack of sponsorship for training in neighbouring countries, lack of political will and bureocracy in the country's medical training system further compound the problem.

There is a Bachelor of Science in Mental Health Sciences at St. John of God College of Mental Health Sciences that has admitted some Clinical Officers, but the majority are still finding it hard to access bigger academic opportunities, due to the local educational system, and reasons cited above.

Despite these, some Clinical Officers in Malawi have excelled, and have attained Doctor of Medicine Degree, Masters of Sciences Degree, Doctor of Philosophy Degrees in Universities in Europe and America.

[edit] Sudan

After a devastating civil war that left much of the southern part of this country in ruins a delicate peace agreement was reached which resulted in the creation of a semi-autonomous state. The resultant impact on healthcare will be felt for years to come. Due to the shortage of health workers AMREF pioneered the training of clinical officers in this region by setting up Maridi National Health Training Institute [7].

[edit] Ethiopia

Health officers are trained in universities. All hold bachelor's degrees and therefore can progress to master's level training and education e.g. in emergency surgery.

[edit] South Africa

South Africa recently started training Clinical associates. They are to be trained for three years in district hospitals after which they will be awarded a bachelor of clinical practice degree. The first program was launched by Health Minister Tshabalala Msimang on 18 August 2008 at the Walter Sisulu University in Mthatha. Programs also exist at the University of Pretoria and will commence at the University of Witwatersrand and University of Limpopo in 2009.

[edit] International

Physician assistants in the United States train in four-year community colleges or universities or undergo a two year program if they already have a bachelors degree in a health science and hold an associate, bachelors or masters degree. Some institutions even offer a doctor of science degree in the same.

According to money magazine this is currently one of the best careers in the US.

The doctor of medicine (MD) and doctor of osteopathic medicine (DO) are the only two degrees that allow licenture as physicians in the US. The DO existed as a separate profession until, after much lobbying and resistance, they were granted the same the same practice rights and recognition as MDs. Today they all undergo similar training with DOs receiving additional training in osteopathic techniques. Outside the US physicians who hold a DO degree have varying practice rights with some countries such as the UK granting them full practice rights. In some countries they may practice with limited rights while other countries do not recognise them at all. Tanzania has adopted a similar model where Clinical officers receive additional training lasting 2 to 4 years to become Assistant Medical Officers who are regarded as equivalent to MDs by their universities.

In Australia, osteopaths belong to a separate profession which requires at least a masters degree for one to be licensed.

The United Kingdom has in recent years employed physician assistants from the United States on a trial basis as it plans to introduce this cadre into their health care system. Several universities are already offering a post-graduate diploma in Physician assistant studies. However there are already other mid-level care providers known as Emergency Care Practitioners and Operating department practitioners.

In India the Madras Medical Mission in Chennai, colloborating with Birla Institute of Technology and Frontier Lifeline has since 1992 offered a bachelor of science degree in Physician Assistant studies. The program duration is four years comprising three years classroom and laboratory coursework then one year compulsory internship. Several other universities offer similar courses in patnership with US universities. PAs in India can pursue masters and doctor of science degrees. [8], [9], [10]

Africa and the rest of the world are perhaps following a well trode path. In 1879 a group of Indians arrived in Fiji by ship having survived cholera and smallpox en route. Under Dr W. McGregor, the crew were quarantined for two months. During thing this time a group of young men were trained to vaccinate and proved very resourceful. In 1885 a group of young Fijian men started training at what became known as Suva Medical School. Three years later, in 1888, the first group of students graduated and were registered as Native Practitioners. In 1928, with help from the Rockefellar Foundation the school was expanded and renamed Central Medical School. In 1930 the graduates title was changed to Native Medical Practitioner (NMP) and in 1931 a new 4-year syllabus was implemented. In 1951 NMPs were renamed Assistant Medical Practitioners (AMPs) and in 1952 a new 5-year syllabus was commenced. By 1956 graduates renamed Assistant Medical Officer. Further renamed Primary Care Practitioners (PCPs). By 1987, the PCPs were training for three years before going back to their communities to serve one year internship before going back for another two years of study after which they were awarded a MBBS degree. In 1991 a new curriculum was implemented and the first batch of 32 PCPs enrolled in February. In 1994 the first batch of PCPs returned to their communities for their fourth year before going back to FSM for their fifth and last year. In 1998 Fiji School of Medicine became autonomous and signed a memorundum of understanding with University of South Pacific.

Malaysia started training medical assistants in the early 1900s after independence from Britain. Also known as Assistant Medical Officers, they are trained for three years and are required to register with the medical assistants board in order to practice.h

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[4] KMTC - Clinical Medicine - "Post-Basic Courses in Clinical Medicine and Surgery"

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