Clinical Officer - Overview

Overview

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 laparatomy and Caesarean section whereas in Kenya, Tanzania and Mozambique one must undergo further specialized training in order to perform such major operations safely.

In rural and small urban health facilities, a clinical officer may be 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 basic medical cadre in the medical hierarchy but in some countries, with years of experience or 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.

A clinical officer has a broad and comprehensive training and knowledge in medicine. Unlike nurses and other health professionals who can learn to treat a specific disease (or group of diseases) and perform specific tasks and procedures, a clinical officer provides the broad range of routine medical care that you would get from a physician in general medical or specialty settings.

Countries train and utilise COs in different ways depending on their needs and resources. Against a backdrop of an acute shortage of physicians, Tanzania, Malawi and Zambia train complete physician substitutes who have advanced skills in all medical and surgical specialties including performing major surgery. They are utilised interchangeably with medical doctors.

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 technologists in Mozambique who perform major and emergency surgery across specialties). Some countries like Burkina Faso and Ghana train nurses to practice like COs.

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.