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UGANDA

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Cadre name:

Medical Clinical Officers
established 1918

originally called Medical Assistants

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Provider Density

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Clinical Officer Stats

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Primary Care vs Specialties

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Scope of Practice

MEDICAL CLINICAL OFFICERS 
 

A Medical Clinical Officer is a qualified and licensed/authorized to perform general or 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 facilities. The training covers all foundational (basic, biomedical) and clinical sciences. In Uganda training takes four and half years with an award of a Bachelor of Clinical Medicine and Community Health.

Clinical Medicine is a field that deals primarily with study and practice of medicine based on the on the assessment and management of the patients’ conditions. 
 

DEGREE HOLDER
 

DIPLOMA HOLDER
 

1. Assess
2. Investigate
3. Diagnose
4. Treat 
5. Prevent diseases 
6. Carry out minor Surgery

ACTIVITIES
 

ACTIVITIES
 

i. General management of patients in Internal Medicine, Pediatrics, Surgery, Obstetrics/Gynecology and community Health

i. General management of patients in medicine, pediatrics, surgery, obstetrics/gynecology, and public health

a. Taking medical history
b. Performing general examination
c. Requesting for clinical investigation
d. Interpreting various test results, for example X- ray, lab, and ultrasound scan results.
e. Prescribing appropriate medicines/ medical interventions
f. Offering appropriate counseling and health education to clients
g. Referring  appropriately 



ii. Obstetric/gynecological assessment & management
 



a. Providing prenatal, antenatal, intranatal and postnatal care
b. Providing Family planning services
c. Providing emergency obstetric care including caesarian section
d. Managing common ectopic pregnancy 
e. Providing post abortion care including Evacuation/Dilatation and Curettage.
f. Making appropriate referrals

 

ii. Obstetric/gynecological assessment & management

a. Providing prenatal, antenatal, intranatal, and postnatal care
b. Providing Family planning services
c. Providing post abortion care including Evacuation/Dilatation and Curettage.
d. Making appropriate referrals

a. Taking medical history
b. Performing general examination
c. Requesting for various medical tests
d. Interpreting various tests results, for example X- ray, lab, and ultrasound scan results.
e. Prescribing appropriate medicines/ medical interventions
f. Offering appropriate counseling and health education to clients
g. Referring  appropriately 

​​
 


 

iv. Preventive healthcate

iii. Assessment & management of general surgical conditions
 

a. Carrying out male circumcision
b. Performing Surgical toilet & suture
c. Removing uncomplicated foreign body 
e. Carrying out Emergency relief of  urine retention
e. Excising superficial abnormal lumps and growth.
f. Digital amputations
g. Referring where applicable.
h. Carrying out Incision & Drainage

iii. Assessment & management of general surgical conditions

a. Carrying out Incision & Drainage
b. Carrying out male circumcision
c. Performing Surgical toilet & suture
d. Removing uncomplicated foreign body 

e. Carrying out Emergency relief of urine retention
f. Referring where applicable

iv. Preventive healthcate

a. Carrying out community diagnosis
b. Participating in disease surveillance
c. Designing and implementing appropriate community interventions
d. Conducting appropriate research

a. Carrying out community diagnosis
b. Participating in disease surveillance
c. Designing and implementing appropriate community interventions
d. Conducting appropriate research

v. Management functions

v. Management functions

a. Planning, implementing, monitoring and evaluation of the use of health service resources    
b. Managing health care finances
c. Provision of leadership in health care delivery
d. Mentoring staff and trainees 

a. Planning, implementing, monitoring and evaluation of the use of health service resources    
b. Managing health care finances
c. Provision of leadership in health care delivery
d. Mentoring staff and trainees 

vi. Medico-legal issues

vi. Medico-legal issues

a. Attending to medical legal issues pertaining to their scope of practice and generate reports

a. Attending to medical legal issues pertaining to their scope of practice and generate reports

Source:  George William Barigye |  DCMCH, BPH, MPH, PhD candidate | President Medical Clinical Officers of Uganda
           Alex Kachwano BCMCH, MPH (in pursuit) | Leader/Representative BCMCH Graduates | Deputy Secretary General Medical Clinical Officers Professionals, Uganda
 

1. Assess
2. Investigate
3. Diagnose
4. Treat 
5. Prevent diseases 
6. Carry out minor Surgery

Age Distribution

Data on this particular realm does not currently exist, or is in the process of being gathered and verified.

Read more about our data gathering practices here.

Gender Split

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Rural Practice Data

Distribution of AMTCs in hospitals (urban) versus rural areas

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Source:  George William Barigye |  DCMCH, BPH, MPH, PhD candidate |
President Medical Clinical Officers of Uganda
 

Training

Average number of Clinical Officers trained
by institutions annually

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Sources:  Namugosa Annet Caara | Senior clinical officer DCM, BCMCH | Secretary General Medical Clinical Officers Professionals Uganda
           Alex Kachwano BCMCH, MPH (in pursuit) | Leader/Representative BCMCH Graduates | Deputy Secretary General Medical Clinical Officers Professionals, Uganda

Degree 
Bachelor of Clinical Medicine and Community Health training extends over a period of at least 186 weeks divided into 4 ½ academic years of each for regular students with total of 219 CUs.
There is compulsory community health attachment during third year of the academic study for all students which covers 8 weeks for community diagnosis and 4 weeks of Health Service Management. The entire program entails 59 course units, of which 09 are basic and the remaining  50 are core. The BCMCH accredited curriculum in Uganda mandates the graduates to further undergo a one year National Internship training prior to Licensing. 


Diploma 
The Diploma in Clinical Medicine and Community Health is completed over six semesters in three calendar years. Each semester is comprised of seventeen weeks in which a total of 38 courses (134 credits) are completed. The first year focuses on biomedical sciences, second year on pathological sciences, and the final year on clinical subjects. During the clinical year, students are assigned to 
specific sites and attend ward rounds. They present medical cases to collaborative medical teams, writing prescriptions that are counter-signed by supervising clinicians, and may opt to do a  specialty rotation in ENT, ophthalmology, psychiatry, dermatology, or dentistry if desired. 


Graduates per year 
200 Graduates allowed by NCHE on accreditation and same number goes for a one year internship. 


An average of 670 Clinical Officers are trained by institutions annually. 
 

History

Colonial Era 
The origin of Clinical Officers is traced to the initiatives by Dr. Albert Cook who in 1917 started the first Medical Training School in Uganda for Dressers and Dispensers to facilitate his medical work. It was this medical training which gave rise to the establishment of health training institutions for medical practitioners in Uganda. By 1918, under the Ministry of Health, Uganda was training medical practitioners who were called Medical Assistants at the time.  
In 1946, the Uganda protectorate government identified training in health as one of the avenues to absorb the returnees from the 2nd World War and to care and promote their health. It was this year when the current Masaka School of Comprehensive Nursing was established to train ex-service men and offer some medical skills. Ex-service men with good formal education were trained for 2 years to become Medical Assistants (as named then). Other Ex-service men with little formal education were trained for one year to qualify as nursing orderlies. The need for Medical Assistants and Nursing orderlies kept on increasing and Masaka Campus could not cope up with the demand. The Government then decided to transfer the training of Medical Assistants to Mbale and left Masaka to  continue training nurses. 
In view of the need for a Hospital in the Training of Medical Assistants (as called then), the current Mbale COHES which was initially training Environmental Health Assistants and Inspectors was later in 1950 converted to train Medical Assistants because of its vicinity to Mbale Hospital. The School was under the Ministry of Health and together with Mbale School of Hygiene; they were being  supervised by the Medical Superintendent of Mbale Hospital.  


Post-Colonial Era 

In 1960, the administration of the Medical Assistant Training School of Mbale was handed over to a Ugandan after a White Nurse Tutor drafted a curriculum in 1970 which was officiated by 1975.  Later in 1996; the name/qualification title was changed and modified; evolving from Medical  Assistant to Clinical Officer after adding Community Health to Clinical Medicine Training and  Practice to cater for Public Health priorities as put forth in the 1978 in Karzakistan and later the 1990s MDGs Development which called for Community based interventions including community participation in health promotion, care and especially preventive medicine. similarly, BCMCH  development was brought on board to supplement the MDGs which ended in 2015 and currently  the BCMCH suits the UN SDGs pursuit by being further trained to cater for the Community through research based interventions, breakout investigations including pandemics, such as the current Covid-19, measles, rubella, as well as the endemic conditions like TB, malaria, among others like zoonoses such as Anthrax.

Today 
In 2006, Uganda became one of the pioneers in career progression and professional development of Medical Clinical Officers from Diploma (DCM) to Degree (BCMCH) level, which is in efforts to retool and improve skill sets of the professionals in the ever changing and challenging medical field in order to meet basic, emergency, and specialized healthcare needs of our evolving society. This was equally intended to match desired regional and international labor market skills sets and competence levels, like our counterparts in Kenya, Malawi, Zambia, Ethiopia, Ghana, Tanzania, Rwanda, and USA where training of these cadres is streamlined to Masters (specialization) and PhD. In the East African Community, BCMCH is currently offered by Mount Kenya University, Egerton University, Great Lakes University of Kisumu, and Kabarak University in Kenya, University of Rwanda, and Kampala International University Western Campus in Bushenyi-Ishaka and KIU-Tanzania Campus.  



 
Sources: 

               Namugosa Annet Caara | Senior clinical officer DCM, BCMCH | Secretary General Medical Clinical Officers Professionals Uganda
           Alex Kachwano BCMCH, MPH (in pursuit) | Leader/Representative BCMCH Graduates | Deputy Secretary General Medical Clinical Officers Professionals, Uganda
 

Regulation & Accreditation

Source:  Namugosa Annet Caara | Senior clinical officer DCM, BCMCH | Secretary General Medical Clinical Officers Professionals Uganda
For any university to start teaching a BCMCH program, it must be approved by the National  Council for Higher Education (NCHE). Diploma programs in alternative tertiary institutions  must seek their approval by the Ministry of Education (MOE) through the Business Technical  Vocational Education and Training (BTVET) department.


 
 

Health Workforce Indicators Collected In-Country

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Healthcare System Structure 

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* Medical Clinical Officers exist in other levels across the healthcare system, but their impact is felt most within the levels represented here.

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The contribution of Medical Clinical Officers to Uganda’s health service delivery:

In Uganda, Medical Clinical Officers trace their origins to around 1918 when Dr. Albert Cook started training Africans to become skilled medical workers. In 1929, the Ugandan government recognized the importance of Clinical Officer s and created official schools and the training curriculum which has evolved to date.

Currently Allied Health Professionals Council has registered approximately 11,795 people under the medical Clinical Officers’ Board. This makes the Medical Clinical Officers the highest (44.6%) category of cadre among the allied health professionals in Uganda.
Some of the Medical Clinical Officers have gone ahead to improve their knowledge and skills in different health specialties like ENT, Psychiatry, Dermatology, Anesthesia, Ophthalmology, and Public Health among others, in their quest to serve the public better.

The Medical Clinical Officers are currently deployed at different levels of Uganda’s health care system, and they perform different roles:

 
• Regional Referral Hospitals
Medical Clinical Officers manage most of the outpatients’ departments of regional and district hospitals and in most cases, they are the first persons to interface with patients as they report to the hospitals for services. Here, they can manage most of the patients’ conditions and refer some to other medical cadres in the hospitals. They also work in some special clinics for example, antiretroviral therapy (ART) to manage HIV/AIDS related conditions, ear nose, and throat (ENT),  mental health, and eye care clinic, among others. You will, therefore, find around 20-30 Medical Clinical Officers at each regional hospital.

​• 
District hospitals

Each district is expected to have a district hospital. Like at referral hospitals, the Medical Clinical Officers manage outpatients’ departments of the district hospitals. Here, they can manage most of the patients’ conditions and refer some to other medical cadres in the hospitals. They also work in special clinics for example, antiretroviral Therapy (ART), ear nose and throat (ENT), mental health, and eye care clinic, among others. You will, therefore, find around 10-20 medical clinical officers at each hospital.
 
• Health Centre IV
These are in different counties throughout the country. At this level, Medical Clinical Officers pray a vital role in managing outpatients and inpatient departments of the facility. They also work in the special clinics for example, antiretroviral therapy (ART), ear nose and throat (ENT), mental health, and eye care clinic, among others where they exist. You will, therefore, find around 3-5 clinical officers at each facility.

• Health Centre III
These are in each subcounty throughout the country, and mostly in remote areas of the country where the majorly of the population of Uganda live. Medical Clinical Officers are in charges of  the health centre IIIs , and therefore manage all patients’ conditions, and provide appropriate referrals for some patients. You will find an average of 2 clinical officers at this level of health facility.

• District Health Office
Though currently there is no position of a Clinical Officer  at district level, it’s not uncommon to find clinical officers assigned by the district health officer to run some programs, and therefore deployed as disease surveillance focal persons, malaria focal person, HIV focal person, among others. Therefore, you will find 2-3 medical clinical officers at each district.

• Non-Governmental Organizations (NGOs)
Uganda has several NGOs that are running several health programs that supplement government efforts in the areas of HIV prevention and control, malaria control, tuberculosis control, sexual and reproductive health, among others. Medical Clinical Officers play critical roles in the NGOs, either as program leaders or direct service providers. You will, therefore, find 20-30 medical clinical officers employed by each of the NGOs that are implementing health programs.

• Private Clinics
Uganda has approximately 1,578 private clinics and it’s estimated that approximately 70% of the facilities are owned or supervised by Medical Clinical Officers. This a great contribution to increasing access to health care services in Uganda, especially in the rural settings.

It’s estimated that at least 2,676 (39%)  of all the health facilities in Uganda are headed or directly supervised by Medical Clinical Officers. In addition to this, the Medical Clinical Officers are known for running most of the outpatient departments in health centre IVs, district hospitals and regional hospitals.
They are also known for supporting most of the health programs that have become successful in Uganda. These programs include malaria control, HIV prevention and control, safe male circumcision (SMC), and tuberculosis/leprosy control, among others.

The Medical Clinical officers have been at the forefront during several epidemics and in the current COVID-19 pandemic . The Clinical Officers may have not been in the intensive care units in the hospitals, but remember, whoever comes to the intensive care most likely first went to the nearby lower-level facilities or to the outpatient’s department of the hospital and should have interfaced with a Clinical Officer.

In order to remain competitive and more relevant in provision of better services, the Medical Clinical Officers professional has had the following initiatives:


• Establishment of Bachelor of Clinical Medicine and Community Health
Given the changing nature of health care needs, it was very important to improve the knowledge and skills of the professionals. Approximately 230 people have graduated with a Bachelor of Clinical Medicine and Community Health. It’s hoped that the people in the communities especially those who live in the rural setting will benefit from better services provided by this more technical cadre of Clinical Officers.

• Establishment of CPD Platform
Establishment of reliable and sustainable continuous professional development( CPD) platform to enable the professionals improve their skills in some critical areas, including dermatology, and non-communicable diseases, among others. The Medical Clinical Officers Professionals- Uganda (association of Clinical Officers) has partnered with the World AMTC Network (WAN), and University of Utah to establish the platform that enables professionals to enroll for selected courses in the medical sector. This will be developed further to allow learning exchange.
Given the above its very clear that the Medical Clinical Officers have and continue to play a critical role in Uganda’s health sector. It's imperative to support the development of the professionals and support them to perform better as Uganda strives to achieve universal health coverage.




Sources: The Republic of Uganda Ministry of Health Master Facility List, 2018
                George William Barigye |  DCMCH, BPH, MPH, PhD candidate | President Medical Clinical Officers of Uganda
 

Leadership Bodies

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Allied Health Professionals Council Uganda

1. Supervising the registration and licensing of Allied Health Professionals
and publication of the registered Professionals in the gazette
2. Regulating the conduct of Allied health Professionals and exercising
disciplinary control over them 
3. Approving the qualifications awarded by the different institutes in
respect of the different categories of Allied Health Professionals

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Uganda National Council for Higher Education

For any university to start teaching a BCMCH program, it must be approved by the National  Council for Higher Education (NCHE). Diploma programs in alternative tertiary institutions  must seek their approval by the Ministry of Education (MOE) through the Business Technical  Vocational Education and Training (BTVET) department.

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Medical Clinical Officers Professionals Uganda Association (MCOP-U)

MCOP-U is an association of health professionals that have a background training in Clinical Medicine and Community Health. It’s fully registered and legally recognized under the companies Act No.01 of 2012. The main aim of this association is to unite all Medical Clinical Officers of Uganda and further any activities that uphold professionalism and high quality clinical care in Uganda.
Medical Clinical Officers are part of the medical professionals regulated by Allied Health Professionals’ Council (AHPC), under the Allied Health Professionals Council (Act Cap. 268) Section 54. 

Roles of MCOP U Association
1. Is to unite all medical clinical officers  professional in Uganda (Ophthalmic, Anaesthesia, ENT, Psychiatry and General) and further any activities that uphold professionalism. AHPC ACT 268
2. To enhance the Capacity of Medical Clinical officers and build institutional Capacity within MCOP-U for effective health service delivery in Uganda
3. To promote access to strategic information and knowledge management among the professionals for improved, efficient and effective health care delivery.
4.To promote advocacy and representation of the Medical Clinical Officers’ Professionals with regard to laws, regulations, policies and practices affecting their work 
5. To enhance Association, partnership building and coordination among Medical clinical officers Professionals and other actors for effective and sustained Health care delivery
6. To increase access to resources by MCOP-U through mobilization, grant making and management

 

Current Challenges

∙ Lack of regionally sustainable conferences, Workshops, Research, CMEs and/or CPD organization 
∙ The possibility of a paid internship program remains uncertain
∙ The cadre remains recently excluded at the ministry of Public service appointments
∙ There is no standard assessment procedure including but not limited to assessment schedule by time, content areas, as well as results communication

Source:  Alex Kachwano BCMCH, MPH (in pursuit) | Leader/Representative BCMCH Graduates | Deputy Secretary General Medical Clinical Officers Professionals, Uganda
 

Resources & Links

Source:  Alex Kachwano BCMCH, MPH (in pursuit) | Leader/Representative BCMCH Graduates | Deputy Secretary General Medical Clinical Officers Professionals, Uganda

Data sources reviewed for overall page content:

+AHPC ACT
+MCO Scope of Practice
+Evolution of Uganda health sector by Prof. Dr. Mbonye
+Curricular approval documents and documentations
+Uganda Allied Health Professionals Council, data base
+Consultations on various web and senior cadres