KENYA

During colonial times:
The training of clinical officers in Kenya started in 1927 at then King George Hospital, now Kenyatta Hospital. It was a hands-on basic that took a duration of 2 years. They graduated as Certified Clinical Officer (CCO).This continued until around 1952 during the state of emergency

Emergency need to train Clinical Officers:
Between 1952 and 1964, many British doctors left the country for fear of reprisal by the Kenyan natives. These was an acute shortage of health care workers/ Because of this there was accelerated training of Clinical Officers to fill in the gap. These Clinical Officers qualified as Clinical Assistants (CA). The training started formally and a syllabus was drawn. In 1962 there was already a movement by the few Clinical Officers to agitate for recognition and unsupervised practice by Clinical Officers. The training was temporarily stopped by the government through the pressure of the few doctors that were there. It was said that nobody else should use a stethoscope other than a doctor. This caused a crisis in the health sector and the program was restarted in 1967. The training continued until 1969 when the role of Clinical Officers in service provision was fully recognized. A curriculum was drawn and the duration was extended to three years to enable them broaden the scope and masters the skills in order to manage health institutions. They qualified as Registered Clinical Officers in 1971(RCO)

Training of Clinical Officer Specialists ( higher national diploma)-- 17 programs to date:
After appreciating the good work done by Clinical Officers, the Ministry of Health found it fit to train Clinical Officers at a higher national diploma (Clinical Officer Specialists). There was a big problem of tuberculosis and leprosy. So the first HND was Clinical Officer TB and Leprosy (COTULEP), many others were started later including: dermato-veneriology, chest medicine, paediatrics, family medicine, ENT, anaesthesia, reproductive health, mental health, oncology, orthopaedics, nephrology, emergency and critical care, cardiopulmonary perfusion, audiology, ophthalmology, epidemiology, and medical education. Due to the need to equip Clinical Officers with more competencies to handle primary health care competently, a four year program was started in 2004. Students graduate with a degree in clinical medicine.
 

Journey to accreditation and self-regulation (1981-1989)
The Kenya Clinical Officers Association was formed in 1962 and registered in 1981. The objective was to bring all Clinical Officers together, forge for recognition through an act of Parliament, fight for the welfare of Clinical Officers, and have a scheme of service. The Clinical Officers were limited in the types and range of drugs to prescribe. This was very frustrating as they were to wait for the few doctors available to countersign the prescriptions before giving to the patient. The association tried in all ways but the road was blocked. The Clinical Officers raised funds to get a lawyer to represent in court to have an act of Parliament. 
One day as the then president was on his way in a county side, he developed severe malaria. The only health facility nearby was a health centre run by a certified Clinical Officer. He was managed so well and after sometime he summoned the “doctor” who had treated him to statehouse. It turned out that he was a Clinical Officer and not a doctor. He was immediately appointed the Chief Clinical Officer in Kenya. The court ruled in favor of Clinical Officers bringing to fore Cap 260 laws of Kenya. The Clinical Officer’s Council was formed in 1988 and started operating in 1989. The council was charged with training registration and licensing of Clinical Officers.  The act has since been repealed to Clinical Officers Act no 20 of 2017. The new act gives more power to Clinical Officers. There is no limitation in drug prescription, ordering and interpreting lab results, and it allows Clinical Officers to perform invasive procedures (surgeries).
Currently there are 66 training institutions for Clinical Officers including Government, faith-based, private, and 12 universities. So far 2656 Clinical Officers with higher national diploma have been trained, and 715 degree Clinical Officers have also been trained. There are 23,000 Clinical Officers registered by the COC today.

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Compiled by David Njeru, 2021