In June 2014, I was en route from South Africa back to the United States and had a four-hour layover in Rwanda. I had been in touch with Emmy Bushaija, an educator in the new Rwandan clinical officer program — the equivalent to American physician assistants — and now I had a chance to meet him.
I had offered to bring Emmy some much-needed textbooks from South Africa. Our medical library was purging its shelves of old books, and he had expressed an interest in them. I loaded up a suitcase full of book and met Emmy at the airport, where I had the privilege of speaking with him and learning about the development of the Clinical Officer program in Rwanda.
After the genocide in 1994, along with many other challenging issues, Rwanda found itself with a severe shortage of health-care providers especially in rural areas, Emmy explained. As a result, the government of Rwanda established Kigali Health Institute in 1996 to train nurses and allied health professionals. In 2010, the country conducted a needs assessment and decided to develop the Clinical Officers program as a solution to the health-care provider shortage.
Rwanda started its four-year Clinical Officer program in 2011. Graduates earn a Bachelor of Science in Clinical Medicine and Community Health. At the time, the profession was already well established in neighboring countries including Uganda, Malawi, and Kenya.
The plan, conceived of by the Rwanda Ministry of Health, aims to place newly graduated Clinical Officer students in rural health centers, where the need for health-care providers is greatest — about 90% of all Rwandans live in such areas.
Students are able to enroll in the program after they have completed high school. The Rwanda Ministry of Health pays full tuition with the agreement that new graduates will then work in rural areas for a two-year period to “pay back” the government loan. The first Clinical Officer class graduated in 2013, and the Ministry of Health is still working to find sites for these students.
Ramping up Rwanda’s health-care workforce is sometimes daunting, according to Emmy. The goal is to have two Clinical Officers at all 500 health centers in the country. Currently, Rwanda only has five educators for 162 Clinical Officer students and still needs 15 teachers to effectively educate all the students.
Health centers are the first basic level in the Rwandan health-care system. If patients need more intensive treatment, they are then referred to district hospitals.
The Rwandan vision of the Clinical Officer is that they will be proactive and fully invested in the health of communities – emphasizing disease prevention versus management.
“We want the Clinical Officer to not wait for the community to come to the health center, we want the Clinical Officer to go into the community,” Emmy explained.