A clinical officer (CO) is a licensed practitioner of medicine in East Africa and parts of Southern Africa who is trained and authorized to perform general or specialized medical duties such as diagnosis and treatment of disease and injury, ordering and interpreting medical tests, performing routine medical and surgical procedures, and referring patients to other practitioners.
Unlike nurses and physician assistants, a clinical officer is an independent practitioner who is trained in the medical model to practice the full scope of medicine and provides routine care in general medicine or within a medical specialty such as anesthesia and carries out treatment that is outside the nurses' scope. A clinical officer usually oversees a health center or a district hospital and is part of the medical team in bigger hospitals where one may head a department or work under a senior clinical officer or a physician.AMREF. Clinical Officers. Accessed 6 April 2011.
History In her books, "Beyond the State: The Colonial Medical Service in British Africa" and "Indian Doctors in Kenya, 1895 - 1940: The Forgotten History", the author Anna Greenwood notes that before 1923 there were twice as many Indian doctors as there were European doctors working in the Colonial Medical Service. The Indian doctors had migrated to British Africa along with the coolies who came to work on the Uganda Railway. The Indian doctors faced discrimination and were not appointed to nor paid at the same rank as medical officers (European doctors). Instead, they were designated as Assistant or Sub-assistant surgeons despite having attended similar 3 - 4 year Indian medical schools that were recognized by the General Medical Council in the UK and performing clinical and administrative duties that were largely identical to those of the European doctors. From the mid-1920s the Indians were removed from the colonial service as they were not deemed to be the proper face of the imperial services in Africa. The Indian Assistant and Sub-Assistant Surgeons were thus replaced with similarly qualified Africans who came to be known as clinical officers when the authorizing legislation was passed in 1988 abolishing the Assistant and Sub-Assistant Surgeon and similar positions.
Overview To practice medicine and surgery or dentistry as a clinical officer one requires at least four years of full-time medical training, supervised clinical practice and internship at an accredited medical training institution and hospitals and registration with the relevant medical board in their country. After a prescribed number of years in active practice, one may complete a further one or two-year residency programme in order to specialize in any approved branch of clinical medicine and surgery such as anesthesia or pediatrics, or get an advanced medical qualification from the university. There are no pathways (post-basic or post-graduate entry-level conversion programs) for nurses and other health workers hence it takes at least eight years of specialised medical training and experience for a clinical officer to graduate with a post-basic qualification. "Clinical officer" in some countries such as Tanzania and Zambia refers to a different cadre of health workers, comparable to "medical assistants" in Malawi, who have less than three years of training but who may upgrade to a similar level by becoming Assistant Medical Officers (AMOs) or Medical Licentiates (MLs)."medical assistants/Sub Assistant Community Medical Officer" in Bangladesh, a Four Year medical diploma course conducting state medical faculty of Bangladesh under ministry of Health and family welfare.
A clinician can specialize in any other field that is deemed appropriate by them and not just clinical medicine. China also has masters of clinical medicine. In countries like Tanzania, UK, and other countries, clinical medicine is regarded as a medical course and graduates are allowed to apply to masters of medicine specialties.
No significant difference has been demonstrated in studies comparing treatment decisions, patient outcomes, quality of care provided and level of knowledge about diseases between a clinical officer and a medical officer (a non-specialist physician) except in countries where nurses were mistakenly assessed as clinical officers. However, because of the nature of practice, populations served and resources at ones disposal, a clinical officer is less likely to administer expensive treatment, prescribe expensive (but not necessarily better) drugs or engage in futile care.
The success of HIV/AIDS prevention and treatment initiatives in Africa is mostly attributed to use of clinical officers to diagnose the disease and provide comprehensive medical care. Access to emergency obstetric care through greater deployment of the clinical officer is one way of attaining the Millennium Development Goals 4 (reducing child mortality) and 5 (improving maternal health).University of Birmingham. Major analysis shows value of non-physician clinicians for maternal health in sub-Saharan Africa. Posted on 20 May 2011.
Worldwide, patients are seen by many other practitioners other than the traditional doctor such as: Osteopathic physicians, Podiatrists, Optometrists and Anesthesiologist assistants in the United States Emergency and Clinical Officer Pakistan Physician Assistants in the United States, United Kingdom, Netherlands, Liberia and Ghana Assistant Doctors in China, Surgical Care and Emergency Care Practitioners in the UK, Assistant Physicians in Saudi Arabia, Health Extension Officers in Papua New Guinea medical assistants/Sub Assistant Community Medical Officer in Bangladesh Medical Assistants in Fiji Assistant Medical Officers in Malaysia Surgical Technologists in Mozambique Clinical Associates in South Africa.World Health Organization. Classifying health workers. Geneva, WHO, 2010.
Scope of practice A clinical officer takes the Hippocratic oath and, depending on jurisdiction, may be registered by the same statutory board as physicians (in the southern countries such as Zambia and Malawi) or a separate board (in the eastern countries such as Kenya and Uganda). The broad nature of medical training prepares one to work at all levels of the health care system. Most work in primary care health centres and clinics, and casualty departments in hospitals where one will diagnose and treat all common diseases, including serious and life-threatening ones, in all age groups; and stabilise then admit, discharge or refer emergency cases. In smaller hospitals one may work as a hospitalist and one who has specialized in a clinical field provides advanced medical and surgical care and treatment such as administering anesthesia, performing general or specialised surgery, supervising other health workers and other administrative duties.
A clinical officer's scope of practice depends on one's training and experience, jurisdiction and workplace policies. In Malawi, for instance, a clinical officer performs all routine surgical and obstetric operations such as exploratory laparatomy, emergency orthopaedics and Caesarean section. However, in Kenya, Tanzania and Mozambique one has to undergo further specialized training in order to perform such major operations safely.
In rural and small urban health facilities a clinical officer is usually the highest medical care provider and works with minimal resources, relying on the traditional medical history and physical examination, often with little or no laboratory facilities, to make a diagnosis and provide treatment. In bigger and better equipped facilities a clinical officer generally acquires superior knowledge, experience and skills and provides high quality and a wider range of services in district, provincial and national hospitals, universities and colleges, research institutions and private medical facilities.
A clinical officer is usually the lowest entry-level cadre in the medical hierarchy but with years of experience and/or further training one can rise to the same or a higher grade than a physician. In most countries, however, wages are usually low compared to training and responsibilities and career progression is usually restricted by awarding terminal degrees and diplomas, training students who have not attained the minimum university entry grade and, in some countries, not awarding any degree or recognition for advanced training. In such countries, this usually results in a demotivated and low quality workforce and resulting poor health indicators.
The United States' Centers for Disease Control and Prevention and other international health and research institutions make extensive use of COs in their projects in Africa and clinical officers have been the backbone of HIV care and treatment enabling the rollout of ARVS to even the most rural hard to reach areas in Africa.
Research done by the University of Birmingham and published in the British Medical Journal concluded that the effectiveness and safety of caeserian sections carried out by clinical officers did not differ significantly compared with doctors. Better health outcomes including lower maternal mortality rates were observed where COs had completed further specialised training particularly in anaesthesia.
In the multi-country study, poor outcomes were observed in Burkina Faso and Zaire - the only countries where the procedure was performed by trained nurses. Higher rates of wound infection and Wound dehiscence in these countries was thought to be due to the nurses' poor surgical technique and need for enhanced training. ≠
Kenya Kenya has a comprehensive framework of parallel laws and regulations that govern the medical practice of medical officers and clinical officers. The supreme health policy and medical authorities in the republic are the cabinet secretary of health and the director of medical services who oversee the registration and licensing of medical institutions and the training, registration and licensing of medical practitioners through the Medical Practitioners and Dentists Board and the Clinical Officers Council.
As a British colony in 1928, Kenya started training a select group of natives to practice medicine and care for the local population who were increasingly accepting and seeking western medicine. After independence from Britain in 1963, medical training in Kenya initially adopted the four-year medical school system used in the US rather than the six-year UK model. This was heavily influenced by the Kennedy Airlift which followed initial funding by the African-American Students Foundation (AASF) in 1959 and led to hundreds of young Kenyan students getting scholarships to study in American institutions: These students came back to Kenya after their studies and joined the civil service in the early post-independence Kenya. It was also around this time that the first DOs were accepted as medical officers by the US civil service and by 1967 the structure and duration of medical training in Kenya was similar to the US MD training. When the University of Nairobi split from the University of East Africa and became the first university in Kenya in 1970, it continued to teach the six-year British degree which led to the creation of two statutory bodies: the Kenya Medical Practitioners and Dentists Board in 1978 which had jurisdiction over medical officers and physicians, and the Clinical Officers Council in 1989 which had jurisdiction over clinical officers. Instead of residency for the clinical officer, the higher diploma in paediatrics, ophthalmology and other specializations was introduced in the late 1970s as a post-basic course for those who had worked for three or more years and, after ten years of service, one became a Senior Clinical Officer and qualified for a licence to practice under his own name as a private medical practitioner. The BSc. Clinical Medicine and Surgery degree was later introduced in 2006.