This article is part of an ongoing series that highlights the successes and challenges faced by advanced medically trained clinicians (AMTCs) in developing countries.
Clinical officers (COs) have been a major force in the Kenyan healthcare system, and they have overcome many professional obstacles. Many accelerated medically trained clinicians (AMTCs) face similar barriers such as lack of government support, low pay, and lack of career advancement. Kenya has been successful at addressing these issues. The Kenyan CO is well-established, well-compensated, has autonomy, benefits from career advancement, and is one of the few AMTC professionals to serve in Doctors Without Borders.
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The Kenya Clinical Officers Association is one of the strongest AMTC professional associations in Africa and has helped COs achieve these major accomplishments. Kenyan COs were not always as well supported as they are now. They have fought many political battles to get where they are presently. I spoke with Kenneth Ireri, a Kenyan CO, and learned firsthand about the work that COs do in Kenya, the range of skills they have, and the impact that CAP260 will have on the profession. Below is a synopsis of our conversation in June 2014.
I am also including in this piece a follow-up interview with a Kenyan CO, Erick Nyaga, I met in Massachusetts who was attending the physician assistant (PA) program at Bay Path University. I had more questions about the Kenyan CO, and he was kind enough to meet with me. Below is a synopsis of our conversation.
The CO is another example of the accelerated medically trained clinician (AMTC). In Kenya the profession started in 1928 as a certificate hospital-based training program. The name of the profession had many different titles and respective education levels, and in 1988, parliament passed the document known as Act CAP 260 to standardize the CO professional title and education. In 1989, a council was created as a regulating body for the CO. Presently, there are 35 institutions and about 10,700 practicing COs in Kenya.
Mr. Ireri told me that he admits many of his patients to the hospital and follows them throughout the course of their hospital stay. Clinical officers train for extensive surgical procedures, such as hernia repair, cataract surgery, cesarean sections, and many orthopedic surgeries. Those working in outpatient clinics see up to 25 patients a day, and generally the cases range from sick visits to patients with chronic disease such as diabetes, hypertension, and HIV/AIDS. They have excellent clinical primary healthcare and interpersonal skills, which Mr. Ireri attributes to the training that these COs receive. He describes the training as practical hands-on and early clinical exposure, which helps them develop excellent communication skills.
Managing a baby with severe jaundice at the Ukunda Medical Center.
Clinical officers see the majority of patients in Kenya. They not only outnumber physicians working in Kenya, but they also tend to work in rural areas where the need is greatest. Mr. Ireri told me that the system would “grind to a halt” if it were not for the CO. Clinical officers have a lot of autonomy and have great support from the Department of Health. This, in conjunction with their very effective professional association, has allowed them to accomplish some major professional goals.
The Kenyan Clinical Officers Association is the professional organization of COs, which differs from the regulatory body, and helps promote and protect COs. This organization has been largely responsible for the advances made by Kenyan COs. Mr. Ireri told me that the initial CAP 260 was a purposefully “shallow” document to make it more palatable and to make it easier to “sail through parliament.” There was controversy about this document among COs, and some thought that it was too watered down.