Clinical officer
Encyclopedia
Clinical officers are health care provider
s who practice modern medicine. They practice independently but may be supervised by a physician in some settings.
COs are key health care providers in many countries in Sub-Saharan Africa
where they treat all diseases seen in general practice and refer those beyond their skills to physicians.
Training programs usually involve three or four years of undergraduate education
, award of a diploma or a bachelors degree and completion of an internship year. COs take the Hippocratic oath
and are registered by a statutory medical body to practice medicine.
Most curricula focus on topics relevant or applicable to clinic
al practice (actual patient care) and generally exclude non-clinical aspects of medical training. Their training is therefore shorter, requires less resources and, because of their high adaptability to local health systems, their qualifications may not be transferable to other countries - making them cost-effective clinicians who are easier to train and retain in their countries.
The general nature of their training prepares them to work at all levels of the health care system. Most work in primary care
and casualty departments in hospitals where they diagnose and treat a wide range of common diseases in all age groups; and stabilise then admit, discharge or refer emergency cases. Those who specialise in a clinical field provide advanced medical and surgical care such as administering anaesthesia, performing general or specialised surgery as well as having significant administrative duties.
Their scope of practice depends on ones training and experience, jurisdiction and workplace policies. In Malawi, for instance, all COs are trained to perform routine surgical and obstetric operations such as laparatomy and Caesarean section
but in Kenya, Tanzania and Mozambique they must undergo additional training before undertaking such responsibility.
In rural areas, where most Africans live, COs work with limited resources and must rely on their clinical skills and experience, often without much laboratory support, to make a reasonable diagnosis and provide treatment to mostly impoverished populations.
Those who work in urban centres generally have access to bigger and better equipped facilities, e.g., district, provincial and national hospitals, as well as universities and colleges, research institutions and private medical institutions. The United States' Centers for Disease Control and Prevention
projects in Africa make extensive use of COs.
Improved access to HIV/AIDS prevention and treatment services on the continent is often attributed to use of COs to provide comprehensive care to patients in areas with few or no physicians.
Similar health workers are physician assistant
s in the US, Surgical Care Practitioner
s in the UK, Assistant Physicians in Saudi Arabia, Health Extension Officer
s in Papua New Guinea, surgical technologist
s in Mozambique, and clinical associates
in South Africa.
s - and the two are utilised interchangeably.
Elsewhere, COs are more medical-oriented (like in Kenya where physicians perform most major emergency surgery and COs can only perform major surgery within a specialty e.g. cataract surgery, orthopedics and reproductive health); or more surgical-oriented (like Surgical technologist
s in Mozambique who perform major and emergency surgery across specialties).
Some countries like Burkina Faso and Ghana retrain nurses to practice like COs. Unfortunately, such nurses have been associated with high rates of adverse patient outcomes. Ghana is currently shifting away from such.
has trained COs since 1928 when she was a British colony. After independence the original certificate course was phased out and replaced with a three-year diploma in 1967. The Higher Diploma course in paediatrics, ophthalmology and other specialisations was introduced in the late 1970s and the Bachelor of Clinical Medicine and Community Health
in 2006.
COs are trained by universities, the Kenya Medical Training College (KMTC), St. Mary's School of Clinical Medicine and other private institutions.
The Ministry of Health, through the Clinical Officers Council (COC), regulates their training and practice, accredits training institutions, and approves the syllabi of the universities and colleges. The Kenya Medical Training College, 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 and St. Mary's Mission Hospital in Mumias
, owned by the Roman Catholic diocese of Kakamega
, was the first private institution to train COs in Kenya. Students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service.
legal forms, and to present medical evidence in a court of law, for instance, in cases of rape
and assault
.
The Clinical Officers (Training, Registration and Licensing) Act Cap 260 of 1988 of the laws of Kenya is the legal basis for the practice of Clinical Officers. It establishes the Clinical Officers Council whose functions are:
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 CO has persisted even in official publications.
in 1999. Other universities followed suit and currently programs exist at Jomo Kenyatta University of Agriculture and Technology
, Kenya Methodist University
(KEMU) and Mt Kenya University
. The diploma in Clinical Medicine and Surgery takes three years to complete on a trimester system. The Bachelor of Clinical Medicine and Community Health
lasts four years and is offered as a direct entry, or a top-up degree for diploma holders.
The training follows the medical model. In the first year students learn human biology through in-depth lectures in Anatomy
, Physiology
, Biochemistry
, Pathology
etc. The second year involves intensive lectures in the clinical subjects i.e. Medicine
, Surgery
, Paediatrics, and Obstetrics
and Gynecology. The last year concentrates on bedside lectures in a teaching hospital where they rotate in every department. They attend ward rounds, clerk patients and present medical histories, perform deliveries and act as first assistants in major surgery. They also attend clinical meetings and write prescriptions which at this stage must be counter-signed by a supervising clinician.
There is special emphasis on primary care
with modules on community health
taught throughout the course. In the third year students must spend at least one month in a Provincial Rural Health Training Centre where they immunise children, examine pregnant women and offer family planning services in mother and child health clinics. They treat in-patients and out-patients under the guidance of qualified Clinical officers. They also organise outreach services where they venture into remote rural villages, seeing patients and immunising children. During this time they complete a project in community diagnosis.
They also learn Health Service Management
which prepares them for their management and leadership roles in health centres and other institutions.
then apply for provisional registration by the Clinical Officers Council, the professional body representing clinical officers in the country. The internship involves three-month supervised rotations in the major clinical departments namely casualty
, medicine
, paediatrics, surgery
, obstetrics
and gynecology. They are supervised by consultants in the respective fields, who must grade their performance. Those whose performance is inadequate are given another three months to repeat the failed rotation.
, anaesthesia, ENT, ophthalmology
and cataract surgery, orthopaedics skin and chest diseases, epidemiology
, Community health
or medical education. They are then able to provide advanced medical and surgical care including invasive procedures in their specialisation such as caeserian section, cataract surgery, tonsillectomy and administering anaesthesia.
Many COs hold advanced degrees and diplomas in Biochemistry
, Microbiology
, Counselling psychology, Management
, Statistics
, Sociology
, Public Health
, etc. A good number go on to medical school
.
, the training is under the Ministry of Education and takes place in clinical officer training schools. Postsecondary programs last three years, focusing on medicine and hospice care, followed by a two-year internship.
Kampala International University
offers a Bachelor of 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.
, training is under the Ministry of Health. There are numerous clinical officer training schools and programs last three years. 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 and the Ministry of Health in the country. The graduates are known as Assistant Medical Officer
s. A further two years training leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc.
Kampala International University
has opened a campus in Dar es Salaam
where it is now offering its Bachelor of Clinical Medicine and Community Health
.
The graduates supplement the efforts of COs trained in neighboring countries, e.g. Kenya, Uganda and Tanzania, most of who work for international humanitarian agencies.
was initially a “health officer” training institution. The training of health officers started at Gonder University in 1954 due to the shortage of physicians. Health officers hold bachelors degrees and undergo a three-year training program plus one-year internship. Those who complete the masters degree provide advanced care e.g. emergency surgery.
, where physicians are in short supply and concentrated in the urban areas, clinical officers perform the vast majority of major surgical procedures in district and central hospitals. Clinical officers train for three years and undergo one year internship in order to be able to carry out all the routine functions of a doctor, including minor surgery, obstetric operations such as Caesarean section
s, orthopedic care, dermatology and ophthalmology.
Medical assistants can enrol for an 18 month upgrading course to become specialised clinical officers; the upgrading course takes place at Malamulo and Malawi College of Health Sciences.
, tecnicos de cirurgia, or surgical technologist
s, are experienced Clinical Officers who undergo further residential training in surgery under the supervision of senior surgeons lasting two years at Maputo Central Hospital, and a 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 surgical care providers.
, “Medical Assistants” (MAs) have traditionally been experienced nurses who have undergone a one-year post-basic course to become MAs. High school graduates can now attend a three-year diploma course to become MAs.
which associated them with higher maternal and neonatal mortality when they performed caeserian sections.
, the Tubman National Institute of Medical Arts (TNIMA) was established in 1945. In 1965, the physician assistant (PA) programme was established as a joint venture between the Liberian government, WHO
and UNICEF. Initially it was a one-year course, but currently it is a three-year diploma course accredited by the Liberia National Physician Assistant Association (LINPAA) and the Liberia Medical and Dental Association Board. In order to legally practice medicine as a PA one must sit and pass a state exam administered by the medical board.
trains clinical associates
for three years and awards them the Bachelor of Clinical Medical Practice
degree. The first program was launched by the late Health Minister Tshabalala Msimang on 18 August 2008 at the Walter Sisulu University in Mthatha. The first class graduated in December 2010. Programs also exist at the University of Pretoria
and the University of the Witwatersrand
.
s in the United States train for at least two years at the postsecondary level and can hold an associate, bachelors or masters degree. Some institutions 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 profession is represented by the American Academy of Physician Assistants
.
has in recent years employed physician assistant
s 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 Practitioner
s and Operating department practitioner
s.
offers a one-and-a-half-year Master of Physician Assistant Studies to those with a bachelors degree. Those with a post-secondary healthcare qualification such as registered nurses and paramedics can access the programme via a Graduate Certificate in Physician Assistant Studies; as long as they have at least five years full-time working experience.
to rural populations where they are also known as barefoot doctors
. They typically have about one year of training; those who sit and pass government examinations qualify to be rural doctors. Those who fail become community health worker
s. However, there is a government move to have all rural doctors complete three years training.
by ship having survived cholera
and smallpox
en route. During a period of crew quarantine, a small group was trained in vaccination
. The experience was considered so successful that a few years later, in 1885, a group of young Fijian men started a three-year training program at the Suva Medical School, now known as the Fiji School of Medicine
. The title given to the professional practice has had many names over the years, including Native Medical Practitioner, Assistant Medical Practitioner, Assistant Medical Officer
, and Primary Care Practitioner (PCP). By 1987, the PCPs were training for three years before going back to their communities to serve one-year internship, followed by another two years of study after which they were awarded a MBBS
degree.
, 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.
As of 2009, the Indian government plans to introduce a three-and-a-half-year Bachelor of Rural Medicine and Surgery (BRMS) degree to train doctors who will work in remote Indian villages. On graduation they will undergo a one year internship period at a regional hospital before being licensed. Those with five years experience will qualify for post-graduate studies on equal standing with their MBBS counterparts.
s, they are trained for three years in an undergraduate academic program recognized by the Malaysian Qualifications Agency
in order to practice. They are mainly deployed in public hospital
s, parastatal institutions (e.g. military, prisons), rural health centres, aged care centres, or private specialist hospitals.
Health care provider
A health care provider is an individual or an institution that provides preventive, curative, promotional or rehabilitative health care services in a systematic way to individuals, families or communities....
s who practice modern medicine. They practice independently but may be supervised by a physician in some settings.
COs are key health care providers in many countries in Sub-Saharan Africa
Sub-Saharan Africa
Sub-Saharan Africa as a geographical term refers to the area of the African continent which lies south of the Sahara. A political definition of Sub-Saharan Africa, instead, covers all African countries which are fully or partially located south of the Sahara...
where they treat all diseases seen in general practice and refer those beyond their skills to physicians.
Training programs usually involve three or four years of undergraduate education
Undergraduate education
Undergraduate education is an education level taken prior to gaining a first degree . Hence, in many subjects in many educational systems, undergraduate education is post-secondary education up to the level of a bachelor's degree, such as in the United States, where a university entry level is...
, award of a diploma or a bachelors degree and completion of an internship year. COs take the Hippocratic oath
Hippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
and are registered by a statutory medical body to practice medicine.
Most curricula focus on topics relevant or applicable to clinic
Clinic
A clinic is a health care facility that is primarily devoted to the care of outpatients...
al practice (actual patient care) and generally exclude non-clinical aspects of medical training. Their training is therefore shorter, requires less resources and, because of their high adaptability to local health systems, their qualifications may not be transferable to other countries - making them cost-effective clinicians who are easier to train and retain in their countries.
The general nature of their training prepares them to work at all levels of the health care system. Most work in primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
and casualty departments in hospitals where they diagnose and treat a wide range of common diseases in all age groups; and stabilise then admit, discharge or refer emergency cases. Those who specialise in a clinical field provide advanced medical and surgical care such as administering anaesthesia, performing general or specialised surgery as well as having significant administrative duties.
Their scope of practice depends on ones training and experience, jurisdiction and workplace policies. In Malawi, for instance, all COs are trained to perform routine surgical and obstetric operations such as laparatomy and Caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
but in Kenya, Tanzania and Mozambique they must undergo additional training before undertaking such responsibility.
In rural areas, where most Africans live, COs work with limited resources and must rely on their clinical skills and experience, often without much laboratory support, to make a reasonable diagnosis and provide treatment to mostly impoverished populations.
Those who work in urban centres generally have access to bigger and better equipped facilities, e.g., district, provincial and national hospitals, as well as universities and colleges, research institutions and private medical institutions. The United States' Centers for Disease Control and Prevention
Centers for Disease Control and Prevention
The Centers for Disease Control and Prevention are a United States federal agency under the Department of Health and Human Services headquartered in Druid Hills, unincorporated DeKalb County, Georgia, in Greater Atlanta...
projects in Africa make extensive use of COs.
Improved access to HIV/AIDS prevention and treatment services on the continent is often attributed to use of COs to provide comprehensive care to patients in areas with few or no physicians.
Similar health workers are physician assistant
Physician assistant
A physician assistant/associate ' is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.-General description:...
s in the US, Surgical Care Practitioner
Surgical Care Practitioner
Surgical Care Practitioners are allied health workers in the UK who are trained to carry out surgical procedures....
s in the UK, Assistant Physicians in Saudi Arabia, Health Extension Officer
Health Extension Officer
Health Extension Officers, also known as Health Extension Workers , are a category of health care providers found in some countries including Papua New Guinea and Ethiopia...
s in Papua New Guinea, surgical technologist
Surgical technologist
A surgical technologist, also called "scrub tech," "surgical technician," or "operating room technician", is an allied health professional working as a part of the team delivering surgical care in some countries. They possess knowledge and skills in sterile and aseptic techniques...
s in Mozambique, and clinical associates
Clinical associates
Clinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician....
in South Africa.
Overview
Countries train and utilise COs in different ways. Tanzania, Malawi and Zambia train complete physician substitutes who have advanced skills in all medical and surgical specialties including performing major surgery - just like MDMD
- Science :* Doctor of Medicine, from the Latin Medicinæ Doctor * Macular degeneration, a condition characterized by progressive thinning and atrophy of the macula area of the retina* Mahalanobis distance, a distance measure introduced by P. C...
s - and the two are utilised interchangeably.
Elsewhere, COs are more medical-oriented (like in Kenya where physicians perform most major emergency surgery and COs can only perform major surgery within a specialty e.g. cataract surgery, orthopedics and reproductive health); or more surgical-oriented (like Surgical technologist
Surgical technologist
A surgical technologist, also called "scrub tech," "surgical technician," or "operating room technician", is an allied health professional working as a part of the team delivering surgical care in some countries. They possess knowledge and skills in sterile and aseptic techniques...
s in Mozambique who perform major and emergency surgery across specialties).
Some countries like Burkina Faso and Ghana retrain nurses to practice like COs. Unfortunately, such nurses have been associated with high rates of adverse patient outcomes. Ghana is currently shifting away from such.
Kenya
KenyaKenya
Kenya , officially known as the Republic of Kenya, is a country in East Africa that lies on the equator, with the Indian Ocean to its south-east...
has trained COs since 1928 when she was a British colony. After independence the original certificate course was phased out and replaced with a three-year diploma in 1967. The Higher Diploma course in paediatrics, ophthalmology and other specialisations was introduced in the late 1970s and the Bachelor of Clinical Medicine and Community Health
Bachelor of Clinical Medicine and Community Health
The Bachelor of Clinical Medicine and Surgery is an academic degree awarded to Clinical officers by universities in East Africa. It is currently offered by Mount Kenya University and Kampala International University....
in 2006.
COs are trained by universities, the Kenya Medical Training College (KMTC), St. Mary's School of Clinical Medicine and other private institutions.
The Ministry of Health, through the Clinical Officers Council (COC), regulates their training and practice, accredits training institutions, and approves the syllabi of the universities and colleges. The Kenya Medical Training College, 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 and St. Mary's Mission Hospital in Mumias
Mumias
Mumias is a town in the Western Province of Kenya. The town has an urban population of 32.965 Mumias is the center of the Mumias Division of the Butere/Mumias District. The town is linked by road to Kakamega , Busia , Bungoma , Butere . The village of Buchinga is located between Mumias and...
, owned by the Roman Catholic diocese of Kakamega
Kakamega
Kakamega is a town in western Kenya lying about 30 km north of the Equator. It is the headquarters of . The town has a population of 73,607 ....
, was the first private institution to train COs in Kenya. Students sit the same examination as their counterparts at the KMTC and are examined by consultants from the public service.
The Clinical Officers (Training, Registration and Licensing) Act Cap 260
Clinical officers are legally recognized as qualified medical practitioners. They are required to see, examine and treat patients, sign legal documents such as medical certificates, death certificates and P3P3
-Aviation:* P-3 Hawk, an American fighter aircraft of the 1920s* P-3 Orion, an American maritime patrol aircraft* Piaggio P.3, an Italian night bomber prototype of the 1920s* Pilatus P-3, a Swiss military training aircraft of the 1950s...
legal forms, and to present medical evidence in a court of law, for instance, in cases of rape
Rape
Rape is a type of sexual assault usually involving sexual intercourse, which is initiated by one or more persons against another person without that person's consent. The act may be carried out by physical force, coercion, abuse of authority or with a person who is incapable of valid consent. The...
and assault
Assault
In law, assault is a crime causing a victim to fear violence. The term is often confused with battery, which involves physical contact. The specific meaning of assault varies between countries, but can refer to an act that causes another to apprehend immediate and personal violence, or in the more...
.
The Clinical Officers (Training, Registration and Licensing) Act Cap 260 of 1988 of the laws of Kenya is the legal basis for the practice of Clinical Officers. It establishes the Clinical Officers Council whose functions are:
- To assess the qualifications of Clinical officers
- 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
- To register and license clinical officers for the purposes of this act
- 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
- 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 CO has persisted even in official publications.
Training
The first university to train clinical officers was Egerton UniversityEgerton University
Egerton University is a public university; the main campus is in Njoro, near the city of Nakuru, Kenya. The chancellor is Ambassador Bethuel K Kiplagat and the vice chancellor is Professor J. K. Tuitoek.-History:...
in 1999. Other universities followed suit and currently programs exist at Jomo Kenyatta University of Agriculture and Technology
Jomo Kenyatta University of Agriculture and Technology
Jomo Kenyatta University of Agriculture and Technology is a public university near Nairobi, Kenya. It is situated in Juja, 36 kilometres North East of Nairobi, along Nairobi-Thika Highway. It offers courses in Engineering, Science, Architecture and Building sciences...
, Kenya Methodist University
Kenya Methodist University
The Kenya Methodist University is a Chartered private University founded by the Methodist Church in Kenya. It is situated within woodland on the North Eastern slopes of Mount Kenya, five kilometers from Meru Town...
(KEMU) and Mt Kenya University
Mt Kenya University
Mt Kenya University is a private university in Thika Kenya.The idea behind the establishment of the University dates back to 1996 when the precursor of the University, the Thika Institute of Technology was founded as a Computer Outreach Program...
. The diploma in Clinical Medicine and Surgery takes three years to complete on a trimester system. The Bachelor of Clinical Medicine and Community Health
Bachelor of Clinical Medicine and Community Health
The Bachelor of Clinical Medicine and Surgery is an academic degree awarded to Clinical officers by universities in East Africa. It is currently offered by Mount Kenya University and Kampala International University....
lasts four years and is offered as a direct entry, or a top-up degree for diploma holders.
The training follows the medical model. In the first year students learn human biology through in-depth lectures in Anatomy
Anatomy
Anatomy is a branch of biology and medicine that is the consideration of the structure of living things. It is a general term that includes human anatomy, animal anatomy , and plant anatomy...
, Physiology
Physiology
Physiology is the science of the function of living systems. This includes how organisms, organ systems, organs, cells, and bio-molecules carry out the chemical or physical functions that exist in a living system. The highest honor awarded in physiology is the Nobel Prize in Physiology or...
, Biochemistry
Biochemistry
Biochemistry, sometimes called biological chemistry, is the study of chemical processes in living organisms, including, but not limited to, living matter. Biochemistry governs all living organisms and living processes...
, Pathology
Pathology
Pathology is the precise study and diagnosis of disease. The word pathology is from Ancient Greek , pathos, "feeling, suffering"; and , -logia, "the study of". Pathologization, to pathologize, refers to the process of defining a condition or behavior as pathological, e.g. pathological gambling....
etc. The second year involves intensive lectures in the clinical subjects i.e. Medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, Surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, Paediatrics, and Obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
and Gynecology. The last year concentrates on bedside lectures in a teaching hospital where they rotate in every department. They attend ward rounds, clerk patients and present medical histories, perform deliveries and act as first assistants in major surgery. They also attend clinical meetings and write prescriptions which at this stage must be counter-signed by a supervising clinician.
There is special emphasis on primary care
Primary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
with modules on community health
Community health
Community health, a field of public health, is a discipline that concerns itself with the study and betterment of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared...
taught throughout the course. In the third year students must spend at least one month in a Provincial Rural Health Training Centre where they immunise children, examine pregnant women and offer family planning services in mother and child health clinics. They treat in-patients and out-patients under the guidance of qualified Clinical officers. They also organise outreach services where they venture into remote rural villages, seeing patients and immunising children. During this time they complete a project in community diagnosis.
They also learn Health Service Management
Health Service Management
Health Service Management is the branch of management that is concerned with the planning, organising, staffing, directing, controlling and cordinating the delivery of healthcare services within a health facility....
which prepares them for their management and leadership roles in health centres and other institutions.
Internship and registration
All clinical officers must work as full-time interns for one year at an approved public or mission hospital before getting a license to practice medicine. On passing the final qualifying examination, they take the hippocratic oathHippocratic Oath
The Hippocratic Oath is an oath historically taken by physicians and other healthcare professionals swearing to practice medicine ethically. It is widely believed to have been written by Hippocrates, often regarded as the father of western medicine, or by one of his students. The oath is written in...
then apply for provisional registration by the Clinical Officers Council, the professional body representing clinical officers in the country. The internship involves three-month supervised rotations in the major clinical departments namely casualty
Emergency department
An emergency department , also known as accident & emergency , emergency room , emergency ward , or casualty department is a medical treatment facility specialising in acute care of patients who present without prior appointment, either by their own means or by ambulance...
, medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
, paediatrics, surgery
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
, obstetrics
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
and gynecology. They are supervised by consultants in the respective fields, who must grade their performance. Those whose performance is inadequate are given another three months to repeat the failed rotation.
Advancement
The Kenya Medical Training College offers post-basic courses to COs with three years experience. These last twelve to eighteen months leading to a specialised qualification in paediatrics, reproductive healthReproductive health
Within the framework of the World Health Organization's definition of health as a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity, reproductive health, or sexual health/hygiene, addresses the reproductive processes, functions and system...
, anaesthesia, ENT, ophthalmology
Ophthalmology
Ophthalmology is the branch of medicine that deals with the anatomy, physiology and diseases of the eye. An ophthalmologist is a specialist in medical and surgical eye problems...
and cataract surgery, orthopaedics skin and chest diseases, epidemiology
Epidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
, Community health
Community health
Community health, a field of public health, is a discipline that concerns itself with the study and betterment of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared...
or medical education. They are then able to provide advanced medical and surgical care including invasive procedures in their specialisation such as caeserian section, cataract surgery, tonsillectomy and administering anaesthesia.
Many COs hold advanced degrees and diplomas in Biochemistry
Biochemistry
Biochemistry, sometimes called biological chemistry, is the study of chemical processes in living organisms, including, but not limited to, living matter. Biochemistry governs all living organisms and living processes...
, Microbiology
Microbiology
Microbiology is the study of microorganisms, which are defined as any microscopic organism that comprises either a single cell , cell clusters or no cell at all . This includes eukaryotes, such as fungi and protists, and prokaryotes...
, Counselling psychology, Management
Management
Management in all business and organizational activities is the act of getting people together to accomplish desired goals and objectives using available resources efficiently and effectively...
, Statistics
Statistics
Statistics is the study of the collection, organization, analysis, and interpretation of data. It deals with all aspects of this, including the planning of data collection in terms of the design of surveys and experiments....
, Sociology
Sociology
Sociology is the study of society. It is a social science—a term with which it is sometimes synonymous—which uses various methods of empirical investigation and critical analysis to develop a body of knowledge about human social activity...
, Public Health
Public health
Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals" . It is concerned with threats to health based on population health...
, etc. A good number go on to medical school
Medical school
A medical school is a tertiary educational institution—or part of such an institution—that teaches medicine. Degree programs offered at medical schools often include Doctor of Osteopathic Medicine, Bachelor/Doctor of Medicine, Doctor of Philosophy, master's degree, or other post-secondary...
.
Famous clinical officers
- Karisa Maitha, the late former member of parliament for Kisauni and foreign affairs minister
- Ole Kiu, former Chief Clinical Officer, Ministry of Health
- Mohamed Abdi Haji Mohamed, Member of Parliament for Mandera West.
Uganda
In UgandaUganda
Uganda , officially the Republic of Uganda, is a landlocked country in East Africa. Uganda is also known as the "Pearl of Africa". It is bordered on the east by Kenya, on the north by South Sudan, on the west by the Democratic Republic of the Congo, on the southwest by Rwanda, and on the south by...
, the training is under the Ministry of Education and takes place in clinical officer training schools. Postsecondary programs last three years, focusing on medicine and hospice care, followed by a two-year internship.
Kampala International University
Kampala International University
Kampala International University is a private multi-campus university in Uganda.-Location:Kampala International University has its main campus at Kansanga, a location in the southeastern part of Kampala, Uganda's capital and largest city. The coordinates of the university's main campus are:00 17...
offers a Bachelor of Clinical Medicine and Community Health
Bachelor of Clinical Medicine and Community Health
The Bachelor of Clinical Medicine and Surgery is an academic degree awarded to Clinical officers by universities in East Africa. It is currently offered by Mount Kenya University and Kampala International University....
. High school graduates take four-and-a-half years to complete this degree while practicing clinical officers take three years.
Tanzania
In TanzaniaTanzania
The United Republic of Tanzania is a country in East Africa bordered by Kenya and Uganda to the north, Rwanda, Burundi, and the Democratic Republic of the Congo to the west, and Zambia, Malawi, and Mozambique to the south. The country's eastern borders lie on the Indian Ocean.Tanzania is a state...
, training is under the Ministry of Health. There are numerous clinical officer training schools and programs last three years. 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 and the Ministry of Health in the country. The graduates are known as Assistant Medical Officer
Assistant Medical Officer
Assistant Medical Officers are health care providers in countries like Tanzania and Malaysia. They work independently or with limited supervision of a physician to provide healthcare services to largely underserved populations....
s. A further two years training leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc.
Kampala International University
Kampala International University
Kampala International University is a private multi-campus university in Uganda.-Location:Kampala International University has its main campus at Kansanga, a location in the southeastern part of Kampala, Uganda's capital and largest city. The coordinates of the university's main campus are:00 17...
has opened a campus in Dar es Salaam
Dar es Salaam
Dar es Salaam , formerly Mzizima, is the largest city in Tanzania. It is also the country's richest city and a regionally important economic centre. Dar es Salaam is actually an administrative province within Tanzania, and consists of three local government areas or administrative districts: ...
where it is now offering its Bachelor of Clinical Medicine and Community Health
Bachelor of Clinical Medicine and Community Health
The Bachelor of Clinical Medicine and Surgery is an academic degree awarded to Clinical officers by universities in East Africa. It is currently offered by Mount Kenya University and Kampala International University....
.
Sudan
Southern Sudan separated from the Arab North (Sudan) in July 2011 after years of civil war that left much of the southern part in ruins. The healthcare system is almost non-existent. AMREF started training clinical officers by setting up the Maridi National Health Training Institute.The graduates supplement the efforts of COs trained in neighboring countries, e.g. Kenya, Uganda and Tanzania, most of who work for international humanitarian agencies.
Ethiopia
The first medical school in EthiopiaEthiopia
Ethiopia , officially known as the Federal Democratic Republic of Ethiopia, is a country located in the Horn of Africa. It is the second-most populous nation in Africa, with over 82 million inhabitants, and the tenth-largest by area, occupying 1,100,000 km2...
was initially a “health officer” training institution. The training of health officers started at Gonder University in 1954 due to the shortage of physicians. Health officers hold bachelors degrees and undergo a three-year training program plus one-year internship. Those who complete the masters degree provide advanced care e.g. emergency surgery.
Zambia
Medical licentiates are qualified clinical officers who undergo advanced training in clinical medicine and surgery for two more years. They are awarded an advanced diploma in general medicine. They perform routine surgical and obstetric operations as well as providing expert clinical care in hospitals.Malawi
In MalawiMalawi
The Republic of Malawi is a landlocked country in southeast Africa that was formerly known as Nyasaland. It is bordered by Zambia to the northwest, Tanzania to the northeast, and Mozambique on the east, south and west. The country is separated from Tanzania and Mozambique by Lake Malawi. Its size...
, where physicians are in short supply and concentrated in the urban areas, clinical officers perform the vast majority of major surgical procedures in district and central hospitals. Clinical officers train for three years and undergo one year internship in order to be able to carry out all the routine functions of a doctor, including minor surgery, obstetric operations such as Caesarean section
Caesarean section
A Caesarean section, is a surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies, or, rarely, to remove a dead fetus...
s, orthopedic care, dermatology and ophthalmology.
Medical assistants can enrol for an 18 month upgrading course to become specialised clinical officers; the upgrading course takes place at Malamulo and Malawi College of Health Sciences.
Mozambique
In MozambiqueMozambique
Mozambique, officially the Republic of Mozambique , is a country in southeastern Africa bordered by the Indian Ocean to the east, Tanzania to the north, Malawi and Zambia to the northwest, Zimbabwe to the west and Swaziland and South Africa to the southwest...
, tecnicos de cirurgia, or surgical technologist
Surgical technologist
A surgical technologist, also called "scrub tech," "surgical technician," or "operating room technician", is an allied health professional working as a part of the team delivering surgical care in some countries. They possess knowledge and skills in sterile and aseptic techniques...
s, are experienced Clinical Officers who undergo further residential training in surgery under the supervision of senior surgeons lasting two years at Maputo Central Hospital, and a 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 surgical care providers.
Ghana
In GhanaGhana
Ghana , officially the Republic of Ghana, is a country located in West Africa. It is bordered by Côte d'Ivoire to the west, Burkina Faso to the north, Togo to the east, and the Gulf of Guinea to the south...
, “Medical Assistants” (MAs) have traditionally been experienced nurses who have undergone a one-year post-basic course to become MAs. High school graduates can now attend a three-year diploma course to become MAs.
Burkina Faso
Many studies show that trained COs provide quality medical and surgical care with outcomes similar to physicians' providing similar care in the same setting. However, nurses re-trained to become COs are associated with more adverse outcomes as shown in a study done in Burkina FasoBurkina Faso
Burkina Faso – also known by its short-form name Burkina – is a landlocked country in west Africa. It is surrounded by six countries: Mali to the north, Niger to the east, Benin to the southeast, Togo and Ghana to the south, and Côte d'Ivoire to the southwest.Its size is with an estimated...
which associated them with higher maternal and neonatal mortality when they performed caeserian sections.
Liberia
In LiberiaLiberia
Liberia , officially the Republic of Liberia, is a country in West Africa. It is bordered by Sierra Leone on the west, Guinea on the north and Côte d'Ivoire on the east. Liberia's coastline is composed of mostly mangrove forests while the more sparsely populated inland consists of forests that open...
, the Tubman National Institute of Medical Arts (TNIMA) was established in 1945. In 1965, the physician assistant (PA) programme was established as a joint venture between the Liberian government, WHO
Who
Who may refer to:* Who , an English-language pronoun* who , a Unix command* Who?, one of the Five Ws in journalism- Art and entertainment :* Who? , a 1958 novel by Algis Budrys...
and UNICEF. Initially it was a one-year course, but currently it is a three-year diploma course accredited by the Liberia National Physician Assistant Association (LINPAA) and the Liberia Medical and Dental Association Board. In order to legally practice medicine as a PA one must sit and pass a state exam administered by the medical board.
South Africa
South AfricaSouth Africa
The Republic of South Africa is a country in southern Africa. Located at the southern tip of Africa, it is divided into nine provinces, with of coastline on the Atlantic and Indian oceans...
trains clinical associates
Clinical associates
Clinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician....
for three years and awards them the Bachelor of Clinical Medical Practice
Bachelor of Clinical Medical Practice
The Bachelor of Clinical Medical Practice is a three-year degree awarded to Clinical associates by universities in South africa.It is shorter than the Bachelor of Clinical Medicine and Community Health degree awarded to Clinical officers in East Africa but similar to the three-year diploma....
degree. The first program was launched by the late Health Minister Tshabalala Msimang on 18 August 2008 at the Walter Sisulu University in Mthatha. The first class graduated in December 2010. Programs also exist at the University of Pretoria
University of Pretoria
The University of Pretoria is a multi campus public research university located in Pretoria, the administrative and de facto capital of South Africa...
and the University of the Witwatersrand
University of the Witwatersrand
The University of the Witwatersrand, Johannesburg is a South African university situated in the northern areas of central Johannesburg. It is more commonly known as Wits University...
.
United States
Physician assistantPhysician assistant
A physician assistant/associate ' is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.-General description:...
s in the United States train for at least two years at the postsecondary level and can hold an associate, bachelors or masters degree. Some institutions offer a Doctor of Science
Doctor of Science
Doctor of Science , usually abbreviated Sc.D., D.Sc., S.D. or Dr.Sc., is an academic research degree awarded in a number of countries throughout the world. In some countries Doctor of Science is the name used for the standard doctorate in the sciences, elsewhere the Sc.D...
degree in the same. According to Money magazine, this is currently one of the best careers in the US. The profession is represented by the American Academy of Physician Assistants
American Academy of Physician Assistants
The American Academy of Physician Assistants is the largest professional organization of physician assistants in the United States of America. It was founded in 1968 and currently has approximately 39,000 members in all 50 states, District of Columbia, US Virgin Islands and Northern Marianas...
.
United Kingdom
The United KingdomUnited Kingdom
The United Kingdom of Great Britain and Northern IrelandIn the United Kingdom and Dependencies, other languages have been officially recognised as legitimate autochthonous languages under the European Charter for Regional or Minority Languages...
has in recent years employed physician assistant
Physician assistant
A physician assistant/associate ' is a healthcare professional trained and licensed to practice medicine with limited supervision by a physician.-General description:...
s 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 Practitioner
Emergency Care Practitioner
An Emergency Care Practitioner may come from either a paramedic, nursing or allied health professional background and most have additional academic qualifications, usually at university, with enhanced skills in medical assessment and extra clinical skills over and above those of a standard...
s and Operating department practitioner
Operating department practitioner
Operating department practitioners are a type of health care provider involved with the overall planning and delivery of a patient's perioperative care. They are mainly employed in surgical operating departments but can be found in other clinical areas including Accident & Emergency , Intensive...
s.
Australia
The University of QueenslandUniversity of Queensland
The University of Queensland, also known as UQ, is a public university located in state of Queensland, Australia. Founded in 1909, it is the oldest and largest university in Queensland and the fifth oldest in the nation...
offers a one-and-a-half-year Master of Physician Assistant Studies to those with a bachelors degree. Those with a post-secondary healthcare qualification such as registered nurses and paramedics can access the programme via a Graduate Certificate in Physician Assistant Studies; as long as they have at least five years full-time working experience.
China
China has about 880,000 Rural Doctors and 110,000 assistant doctors who provide primary carePrimary care
Primary care is the term for the health services by providers who act as the principal point of consultation for patients within a health care system...
to rural populations where they are also known as barefoot doctors
Barefoot doctors
Barefoot doctors are farmers who received minimal basic medical and paramedical training and worked in rural villages in the People's Republic of China. Their purpose was to bring health care to rural areas where urban-trained doctors would not settle...
. They typically have about one year of training; those who sit and pass government examinations qualify to be rural doctors. Those who fail become community health worker
Community health worker
Community health workers are members of a community who are chosen by community members or organizations to provide basic health and medical care to their community...
s. However, there is a government move to have all rural doctors complete three years training.
Fiji
Africa and the rest of the world are perhaps following a well trode path. In 1879, a group of Indians arrived in FijiFiji
Fiji , officially the Republic of Fiji , is an island nation in Melanesia in the South Pacific Ocean about northeast of New Zealand's North Island...
by ship having survived cholera
Cholera
Cholera is an infection of the small intestine that is caused by the bacterium Vibrio cholerae. The main symptoms are profuse watery diarrhea and vomiting. Transmission occurs primarily by drinking or eating water or food that has been contaminated by the diarrhea of an infected person or the feces...
and smallpox
Smallpox
Smallpox was an infectious disease unique to humans, caused by either of two virus variants, Variola major and Variola minor. The disease is also known by the Latin names Variola or Variola vera, which is a derivative of the Latin varius, meaning "spotted", or varus, meaning "pimple"...
en route. During a period of crew quarantine, a small group was trained in vaccination
Vaccination
Vaccination is the administration of antigenic material to stimulate the immune system of an individual to develop adaptive immunity to a disease. Vaccines can prevent or ameliorate the effects of infection by many pathogens...
. The experience was considered so successful that a few years later, in 1885, a group of young Fijian men started a three-year training program at the Suva Medical School, now known as the Fiji School of Medicine
Fiji School of Medicine
The Fiji School of Medicine is a tertiary institution based in Suva, Fiji. Originally established in 1885 as the Suva Medical School. After merger with leading institutions in 2010, FSM is now called called College of Medicine, Nursing & Health Sciences under Fiji National University. It striving...
. The title given to the professional practice has had many names over the years, including Native Medical Practitioner, Assistant Medical Practitioner, Assistant Medical Officer
Assistant Medical Officer
Assistant Medical Officers are health care providers in countries like Tanzania and Malaysia. They work independently or with limited supervision of a physician to provide healthcare services to largely underserved populations....
, and Primary Care Practitioner (PCP). By 1987, the PCPs were training for three years before going back to their communities to serve one-year internship, followed by another two years of study after which they were awarded a MBBS
MBBS
MBBS was a popular BBS system in the Nordic countries during the mid-1990s. It was created by a team of Oslo-based enthusiasts, led by Mike Robertson. As many BBS systems of that era, it was only available for the DOS platform. Since one process could only handle one node, multitaskers such as...
degree.
India
In IndiaIndia
India , officially the Republic of India , is a country in South Asia. It is the seventh-largest country by geographical area, the second-most populous country with over 1.2 billion people, and the most populous democracy in the world...
, the Madras Medical Mission
Madras Medical Mission
The Madras Medical Mission is a hospital located in Chennai. The first unit of the hospital was set up in 1987. The hospital houses 207 beds including 76 intensive care beds.- External links :*...
in Chennai, colloborating with Birla Institute of Technology
Birla Institute of Technology
Birla Institute of Technology, Mesra , is an autonomous engineering and technology oriented institute of higher education located in Ranchi, Jharkhand, India...
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.
As of 2009, the Indian government plans to introduce a three-and-a-half-year Bachelor of Rural Medicine and Surgery (BRMS) degree to train doctors who will work in remote Indian villages. On graduation they will undergo a one year internship period at a regional hospital before being licensed. Those with five years experience will qualify for post-graduate studies on equal standing with their MBBS counterparts.
Malaysia
Malaysia started training medical assistants in the early 1900s after independence from Britain. Also known as Assistant Medical OfficerAssistant Medical Officer
Assistant Medical Officers are health care providers in countries like Tanzania and Malaysia. They work independently or with limited supervision of a physician to provide healthcare services to largely underserved populations....
s, they are trained for three years in an undergraduate academic program recognized by the Malaysian Qualifications Agency
Malaysian Qualifications Agency
The Malaysian Qualifications Agency or the MQA is a statutory body in Malaysia set up under the Malaysian Qualifications Act 2007 to accredit academic programs provided by educational institutions providing post secondary or higher education and facilitate the accreditation and articulation of...
in order to practice. They are mainly deployed in public hospital
Hospital
A hospital is a health care institution providing patient treatment by specialized staff and equipment. Hospitals often, but not always, provide for inpatient care or longer-term patient stays....
s, parastatal institutions (e.g. military, prisons), rural health centres, aged care centres, or private specialist hospitals.
See also
- Allied health professionsAllied health professionsAllied health professions are clinical health care professions distinct from dentistry, nursing and medicine. One estimate reported allied health professionals make up 60 percent of the total health workforce...
- Healthcare in KenyaHealthcare in KenyaKenya’s health care system is structured in a step-wise manner so that complicated cases are referred to a higher level. Gaps in the system are filled by private and church run units...
- Assistant Medical OfficerAssistant Medical OfficerAssistant Medical Officers are health care providers in countries like Tanzania and Malaysia. They work independently or with limited supervision of a physician to provide healthcare services to largely underserved populations....
s - Surgical technologistSurgical technologistA surgical technologist, also called "scrub tech," "surgical technician," or "operating room technician", is an allied health professional working as a part of the team delivering surgical care in some countries. They possess knowledge and skills in sterile and aseptic techniques...
s - Clinical associatesClinical associatesClinical associates are a category of healthcare providers found in South Africa. They assess patients, make diagnoses, prescribe treatment and perform minor surgery under the supervision of a physician....
in South Africa - FeldsherFeldsherFeldsher is the name of a health care professional who provides various medical services in Russia and other countries of the former Soviet Union, mainly in rural areas...
in countries of the former Soviet Union
External links
- Clinical officers - Ministry of Health, Kenya
- Kenya Medical Training College - Clinical Medicine Department
- Kilimanjaro Christian Medical College- Tanzania
- Egerton University (Kenya) - Diploma in Clinical Medicine and Surgery
- Kenya Methodist University - Department of Clinical Medicine
- Mt. Kenya University
- Malawi College of Health Sciences
- Maridi National Health Training Institute- Maridi
- Indian Association of Physician Assistants
- The Clinical Officers Council