This article is part of an ongoing series that highlights the successes and challenges faced by advanced medically trained clinicians (AMTCs) in developing countries.

I was eager to talk to James Ofono about the history of clinical officers in Uganda. I had met Mr Ofono when I worked at Walter Sisulu University in Eastern Cape in South Africa. He has worked as one of the educators there for many years. He has been instrumental in the growth and development of the clinical associate program in Eastern Cape. When I thought about the development of the physician assistant and nurse practitioner professions, I immediately assumed that the United States was one of the first countries to develop these health care professions. However, after meeting Mr Ofono, I realized that Uganda has a rich history of not only developing this unique cadre of healthcare professionals, but also implementing them into their healthcare system.

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After reading about the development of the clinical officer in Africa, I learned that British colonizers were a major force in developing this profession. The British had their own healthcare system in many of the countries they colonized, and African populations did not have access to this system.  Although the British essentially prevented access to their medical care, this resulted in the development of the non-doctor healthcare providers in many of these countries.

As NPs and PAs, we are aware that our professions have had long and often difficult journeys from being barely understood by the medical community to one of the fastest-growing and most respected professions in the United States. Likewise, the Ugandan clinical officer has had a long and arduous path, and the current profession greatly benefited from this journey.

Mr Ofono, a clinical officer in Uganda, works as a lecturer in the clinical associate program at Walter Sisulu University in South Africa. When asked about his profession’s role in the country, he said, “It’s very popular and very well respected.” The profession is so popular that schools receive thousands of applicants each year for a small number of available spots. While there is federal financial aid to help students fund their education, Mr Ofono notes that “the population has outrun government resources.” Now, financial aid is awarded to students with the highest grades.

Although Mr Ofono believes the future of clinical officers is bright, Uganda faces many challenges in delivering quality health care to its residents. Most developing countries share similar struggles such as poverty, limited access to clean water, urban air pollution, and infectious diseases like malaria, but Uganda is also experiencing explosive population growth. Fifteen of the world’s youngest populations are in Africa, and Uganda has the 2nd youngest population in the world, with half of the country’s population younger than 15.7 years old. Uganda’s population has been growing at an annual rate of 3.2%, which is the 9th fastest in the world. From 2002 to 2012, Uganda grew from a nation of 24 million to 34 million – and most of that growth is happening in rural areas, where access to health care can be challenging. Mr Ofono estimates that 80% of the population lives in these rural areas, and he emphasized that clinical officer training is focusing on serving these areas.

The evolution and education of clinical officers in Uganda

The clinical officer program started in 1918, which makes it one of the oldest programs in the world. However, as Mr Ofono points out, there is no real documentation to support this. The initial title of this profession was medical assistant, and it was changed to clinical officer in 1996. Mr Ofono tells us that Sir Albert Cook, CMG, OBE, MD, and his wife, a nurse, were Christian missionaries living in Uganda in 1918. They recognized that there was a need to train laypeople in treating patients. In 1929 the Ugandan government recognized the importance of this healthcare profession and created an official training school for clinical officers.

An official curriculum was established in 1975 for the clinical officer program, which was a major achievement for Uganda. In 1995, public health was incorporated into the clinical officer curriculum, and the profession was clearly recognized as a means of addressing the public health needs of Uganda. Students spent 10 weeks working in rural communities where they learned environmental health, rural health concerns, irrigation, hygiene, and basic public health issues. 

The education of the clinical officer is quite different from how NPs or PAs are educated in the United States. There are 2 tracks for the clinical officer. The 1st track is for students who matriculate, followed by 2 years of basic science. The 2nd track is for healthcare professionals such as orthopedic technicians or nurses. Students from both graduate as clinical officers, but what is unique is that the program has different tracks for different learners.

Another feature of the clinical officer program is the educational model. The program is 3 years, but it is unique in that students spend time in both the classroom and in the clinical setting throughout their studies. The 1st-year students spend 40% of their time in clinical settings and 60% of their time in lectures. As the years progress, they spend less time in the classroom, so that by their last year they spend 80% of their time in a clinical setting.