Who are Clinical officers and their role in provision of healthcare

A clinical officer (CO) is a gazetted officer who is qualified and licensed to practice medicine.
In her books, "Beyond the State: The Colonial Medical Service in British Africa" and "Indian Doctors in Kenya, 1895 - 1940: The Forgotten History", the author Anna

In Kenya, the origin of the clinical officer can be traced back to around 1888 when Sir William Mackinnon, 1st Baronet founded the Imperial British East Africa Company. The company was granted royal charter by Queen Victoria and was used by the Government of the United Kingdom to establish its influence in the East Africa Protectorate (present day Kenya). As the influence grew a healthcare system developed to meet the medical needs of the colony. In 1901 Kenyatta National Hospital was established as the Native Civil Hospital and later renamed the King George VI Hospital after King George VI of the United Kingdom. In 1958 the European Hospital(present-day Nairobi Hospital) was established in the same area to serve the European settlers. The need for qualified medical staff who would provide preventivepromotivecurative and rehabilitativeservices in hospitals and communities led to the establishment of the first formal training programme for clinical officers at Kenyatta National Hospital in 1928. The programme initially admitted experienced nurses and took them through a one-year certificate course which prepared them for advanced practice. The nursing track was discontinued and new students had to complete a medical course and sit and pass continuous assessment tests and final qualifying examinations which covered the biomedical sciencesmedicinesurgerypaediatricsobstetrics and gynecologycommunity health and health service management. The training expanded after Kenya's independence in 1962 through to 1970 when the newly created University of Nairobi started its own medical school and also used Kenyatta National Hospital as its teaching hospital. Legislation to regulate medical practice by clinical officers was passed in 1988 thus creating the Clinical Officers Council in 1989. In 1990 the Kenya Medical Training College was established by the government with campuses in all major towns and in 1996 the Roman Catholic Diocese of Kakamega established St. Mary's School of Clinical Medicine at St. Mary's Hospital in Mumias which become the second and third institutions to offer the training in Kenya. By this time clinical officers had to complete an accredited four-year programme of study, practicals and internship in clinical medicine and surgery and have their names entered in the clinical officers register which was cleaned annually and taken to the government printer to be published in the Kenya Gazette. Private practice by clinical officers who had left government service after working for a minimum of 10 years was now allowed. Undergraduate degrees in clinical medicine were first offered by Egerton University and other universities as from 2006 and in 2012 the Commission for University Education Act No. 42 of 2012 removed the accreditation role from all regulatory bodies such as the Clinical Officers Council (COC) and the Kenya Medical Practitioners and Dentists Council (KMPDC) making the Commission for University Education (CUE) the only authorized accrediting body for all university degrees in Kenya including the degree in clinical medicine. In 2017 the old legislation was repealed and the Clinical Officers Council reconstituted by the Clinical Officers (Training, Registration and Licensing) Act No. 20 of 2017 which requires each clinical officer, clinic or medical centre to be registered by the council and to maintain a current practice license and a current practising certificate in order to operate legally within the scope of medicinedentistryorthopedics or health work. A clinical officer may, with respect to patients - examine, diagnose, order laboratory and imaging investigations, prescribe treatment and perform procedures as per their scope of training. Clinical officers are members of the Kenya Clinical Officers Association and the Kenya Union of Clinical Officers. In June 2020 the Public Service Commissionapproved the Revised Scheme of Service for Clinical Personnel which was issued by the State Department for Public Service to define the clinical officer's career structure, job description, standards for recruitment, training and advancement, and career planning and succession management within the civil service. The scheme is administered by the Ministry of Healththrough the Cabinet Secretary and the Principal Secretary in conjunction with the Public Service Commission and the County Chief Officer for Health in each of the 47 Counties of Kenya.

Clinical officer is a professional designation established by the government through the Clinical Officers Council (COC) which has jurisdiction and responsibility for the clinical officer's trainingregistration and licensing and each officer must (1) study clinical medicine and surgery or clinical medicine and community health for three or four years (2) graduate from a government-accredited medical training college (3) sit and pass a government licensing examination (4) complete an internship year at a teaching hospital (5) be registered as a clinical officer (6) have a medical practice licence (7) complete a three-year period of clinical supervision under a senior clinical officer or a senior medical officer (8) have a practising certificateif they have a private practice which allows one to provide general medical services on their own directly to the public (9) undergo one or two additional years of specialized training (optional) and (10) become a trainer. Clinical Officer (CO) is a protected professional title and its use by unregistered persons is prohibited by law and punishable by up to five years in jail with or without a fine. Globally, the title may not have legal restrictions and can refer to a job grade rather than a medical qualification such as junior assistive clinical staff (e.g. in Zambia and Tanzania), licensed medical professionals (e.g. in Kenya and Malawi) or high-level corporate officers, directors, and managers (e.g. Chief Clinical Officersin Europe and the United States).

A clinical officer observes, interviews and examinessick and healthy individuals in all specialties to determine and document their health status and applies relevant pathologicalradiologicalpsychiatricand community health techniques, procedures and findings needed to classify diseases and related health problems and to establish a provisional or final diagnosis upon which to prescribe, initiate, carry out or terminate treatment or therapy based on their specialized knowledge, skills and experience in clinical pharmacology, use of clinical guidelinesbest practices and disease patterns as well as individual patient and community characteristics while being actively pharmacovigilant to prevent, identify, minimize and manage drug reactions, drug errors, side effects and poisoningoverdiagnosisoverscreeningovertreatment and futile care. A clinical officer performs general and specialized medical duties such as diagnosis and treatment of disease and injury, ordering and interpreting medical tests, performing routine medical and surgical procedures, referring patients to other practitioners and managing health departments, institutions, projects and systems.

Clinical officers, medical officers and medical practitioners are the only officers who are gazettedand licensed to practice medicine in Kenya. They work under oath and generate credible health dataand information within communities and health institutions and cascade the same to the county and national governments, government agencies and third parties through standard recording and reporting tools from the Ministry of Health which are used to capture data on disease outbreaks, physical injuries and deformities, mental illness, drug resistance, disability, nutritional disorders, births and deaths among others.

Sally Sally Gakuo

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