Clinical officers are first point of call for patients

Kenya Union of Clinical Officers (KUCO) Chair Peterson Wachira (center) flanked by other health officials singing a solidarity song in Nakuru on July 5, 2023, after talks with them and the Nakuru county government failed over the issue of health workers employment. [Joseph Kipsang, Standard]

To many in the rural areas, they are simply daktari (doctor). This is because they are the first point of call whenever a medical emergency happens.

Clinical officers take a key position in the provision of primary healthcare services amongst Kenyans in the country with a special focus on upcountry where health service centres are few and far between.

The Kenya Union of Clinical Officers (Kuco) describes these healthcare workers as "key stakeholders in the provision of healthcare in Kenya and the region."

Kuco Secretary General George Gibore says: "Clinical officers are considered the custodians and frontline providers of primary healthcare services in Kenya. We describe them as the 'biological fathers' of primary care in the country - they have been serving in this vital role since 1928, making them one of the oldest healthcare cadres."

There are two categories of clinical officers in Kenya - holders of degrees (Bachelor of Science in Clinical Medicine) and diploma holders.

While ranking below doctors, clinical officers form the backbone of any country's primary healthcare system as the first responders to patients' needs.

"We offer over 99 per cent of the outpatient clinical services. That's why the ongoing strike by clinical officers is impacting close to 7,000 facilities across the country," Gibore explains.

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The strike has severely disrupted healthcare access for the masses who rely on clinical officers as their main medical providers.

Kenya has at least 25,000 qualified clinical officers, with the government employing about 7,800 on permanent terms; and 800 more on contract across public facilities.

Their roles cut across general practice and specialised care. "Clinical officers see all patients walking into hospitals for outpatient consultations - they are the general practitioners," says Gibore.

"Those with specialised training like orthopedics, ophthalmology, and others run their respective clinics performing procedural work like surgeries," he adds.

Beyond just urban areas, clinical officers are equally spread across rural Kenya.

"The majority of Kenyans depend directly on clinical officers for their healthcare services, right from the smallest facilities to the county and national referral hospitals," Gibore states.

In Kenya, clinical officers take the Hippocratic oath just like the physicians. This is dependent on their jurisdiction with some even belonging to national bodies.

With the strike by the officers now underway, Gibore says, "Clinical officers make the crucial decisions on patient diagnosis and treatment plans. In their absence, there is no one to formulate or implement these care pathways."

To maintain their competencies, clinical officers undergo rigorous, some even working under doctors. "The global practice is that after their theory training in college, they are put under the supervision of practicing clinicians to learn real-world decision-making on patient management," explains the Kuco Secretary General.

As outlined in the Revised Scheme of Service for Clinical Officers, their role transcends just primary care. Senior clinical officers are responsible for administration, training, and policy formulation within the healthcare sector.

The profession dates back to 1928 when the first cohorts were drawn from the then-available. They were trained at the King George VI Hospital, now Kenyatta National Hospital for one year. However, the programme was later discontinued with new students keen on clinical medicine required to pursue the course in independent colleges. Since then, more universities and colleges have emerged, which offer courses at from certificate to degree level.

When Covid-19 broke out in Kenya, clinical officers together with other medics were the first responders, with some falling victim.