An updated Act CAP 260 will be presented to parliament. I asked Mr. Ireri how this version of CAP 260 will change his professional life, and he told me that it will legally protect him when he performs surgical procedures in his private clinic. Currently, only public COs receive such support. The qualifying process will also change, and COs will have the option to enroll in a program to receive their bachelor of science degree. This document will expand the surgical procedures that COs can perform. As of 2014, Mount Kenya University has already graduated 4 classes of COs with a bachelor’s degree in clinical medicine. Two other private universities and 2 public universities are already training COs at the degree level.

I asked Mr. Ireri about the education system for COs and he told me that the system has changed dramatically over the years. It is now at a place that offers COs a sense of future growth. The qualifications for COs started off as a certifying program, and now there are 2 programs: a 3-year diploma program in clinical medicine and surgery and a 4-year bachelor of clinical medicine and community health. These programs focus on community health and primary care, and students receive clinical exposure by the second year of their training.


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There is a lot of advancement professionally for COs. Professionals with a diploma can advance to a program to receive their bachelor’s degree or they can enroll in specialized programs in pediatrics, reproductive health, anesthesia, ENT, ophthalmology, cataract surgery, and orthopedics. These advanced degrees allow COs to perform advanced medical procedures such as caesarian sections, cataract surgery, and tonsillectomy, and allow them to administer anesthesia. A CO with a bachelor’s degree can also go on to medical school.  Clinical officers can also get a master’s degree in anesthesia, family medicine, and forensic pathology. They train with doctors who have a bachelor’s degree in medicine and surgery and they become specialists together. Mr. Ireri tells me that COs are currently fighting to be able to receive a master’s degree in internal medicine, surgery, obstetrics and gynecology, pediatrics, ophthalmology, and pathology.  Incidentally, the starting salary for COs with a bachelor’s degree in the government is the same as for a doctor with bachelors degree in medicine and surgery. 

The Kenyan CO has had a major impact in specialty fields and Mr. Ireri tells me that not only do COs perform the majority of eye surgeries in Kenya, but also that COs make up the majority of anesthetists in Kenya. They make up the majority of anesthetists at the Kenyatta National Hospital in Nairobi and Moi Teaching and Referral Hospital in Eldoret.


Mr. Ireri removing a plaster cast from a patient at the Ukunda Medical Center.
 

After I interviewed Mr. Ireri, I found a 20-year veteran Kenyan CO who was studying to become a PA at a Massachusetts institution. I wanted to learn more about why the Kenyan CO has done so well professionally in their country. Many African COs still remain a “hidden workforce” and I wondered what Kenyan COs have done differently.

Erick Nyaga worked as a CO in Kenya for 16 years. I asked him about why COs have done so well in Kenya. 

Mr. Nyaga said that it is well known that the CO and other AMTCs were developed around the 1920s in many countries in Africa such as Uganda, Tanzania, Malawi, and Zambia. The roots of many of these programs started in British colonies, where British colonialism led to the development of the AMTC. The British who decided to settle in Africa brought their own healthcare system with them, which left the African populations without their own healthcare system. They did have a healthcare system before colonization, but the colonization process destroyed many underlying structures, including health care.


Mr. Ireri performing a male circumcision under local anesthesia.

Kenya became independent in 1963, and the government focused on establishing many basic social health-based programs such as free universal healthcare coverage, free hospital care and support, and promotion of the CO. The government created 3 CO programs and, according to Mr. Nyaga, the government recruits and pays for students to attend CO training. The students are given housing as well. These COs work throughout the country in rural areas and urban hospital settings. This support of CO development leads to a high number of COs practicing in Kenya. The most recent figures show that there are 15,000 COs working in Kenya.

According to Mr. Nyaga, Kenya has had a long tradition of collective action, and the creation of the Kenyan Clinical Officers Association is no exception. Although it is not mandatory to join the organization, the CO profession benefits when members work as a force to promote and protect their profession.

After speaking to Mr. Ireri in 2014 and meeting Erick in 2016, I have learned a lot about the Kenyan CO. Many AMTC professions struggle for fair pay, financial support, and recognition. Many established and new AMTC programs find themselves struggling for recognition within their country. The Kenyan CO has enjoyed success, and many of the struggling programs throughout the world from Uganda, New Zealand, Australia, and Canada could learn from the political work that Kenyan COs have done to promote their profession.

Marie Meckel, PA-C, MPH, is a physician assistant who works in western Massachusetts. She spent a year in South Africa at Walter Sisulu University, where she taught clinical associates. Marie has spent the last year interviewing PAs and NPs and their international equivalents and American PAs and NPs working abroad. 

References

  1.  Egerton University. Bachelor of Science in Clinical Medicine. Accessed January 27, 2017.
  2. Mbindyo P, Blaauw D, English M. The role of clinical officers in the Kenyan health system: a question of perspective. Human Resources for Health. 2013;11:32. doi:10.1186/1478-4491-11-32
  3. World Health Organization. Kenya: WHO Statistical Profile. Accessed January 27, 2017.
  4. World Health Education Guidelines. Kenya’s Clinical Officer. Published January 13, 2015. Accessed January 27, 2017.