kenya's public health system, a clinical officer is an alternative practitioner who is trained and authorized by law to perform any technical, administrative or legal duties that require a medical doctor. however, due to the shorter training period when compared to medical officers (i.e. 4 years instead of 6 years), a clinical officer joins the public service at a lower grade and gains seniority through experience, additional training or further education. like the term medical officer, the term clinical officer is a protected title whose use without the authority of the clinical officers council is prohibited and a punishable offense under kenyan laws. court rulings uphold that a registration certificate or a licence issued by the council automatically confers the status of a medical officer or a qualified medical practitioner to a clinician and the titles are used interchangeably in medico-legal documents because a qualified clinical officer has a recognized medical qualification and is eligible for registration as a medical practitioner under section 11(1) of the medical practitioners and dentists act in addition to being expressly authorized to practice medicine, surgery or dentistry by section 7(4) of the clinical officers actcriminal appeal 198 of 2008 - kenya lawcriminal case 6 of 2004 - kenya lawcap. 249 from the anatomy act, the legal definition of a medical officer is any public officer who is entitled to be registered as a medical practitioner if he applied under any law in the country: section 14(1) of the medical practitioners and dentists act and section 7(4) of the clinical officers act are the only two laws that can authorize one to practice medicine and render medical or dental services in the public sector if they hold a registration certificate or in the private sector if they hold a current licence as well. the public health act further defines a medical officer of health as a public officer who is responsible for health nationally (the director of medical services and the director clinical services) or regionally (the county or sub-county medical officer of health and the county or sub-county clinical officer). like his counterparts in the public service, a clinical officer in the private sector has the same practice rights and privileges as a medical officer and both are authorized to work independently and specialize in any approved branch of general or specialised medicine. the competition act no.12 of 2010 directly prohibits and addresses multi-sectoral abuse of dominance, consumer welfare, exemptions, cartels and unwarranted concentration of economic power among practitioners. a register of active clinical officers and medical institutions is available online on the clinical officers council and ministry of health websites. the clinical officers (training, registration and licensing) act no. 20 of 2017 the clinical officers (training, registration and licensing) act no.20 of 2017 is the law that governs the medical practice of a clinical officer. it establishes the clinical officers council whose functions are to: advise the government on policy matters relating to clinical medicine practice prescribe the minimum educational entry requirements for persons wishing to be trained as clinical officers approve institutions other than those established or accredited under the universities act, 2012 for the training of clinical officers establish, approve and accredit programs for continuing professional educational programs register and license clinical officers for the purposes of this act maintain a register and records of all clinical officers registered under this act cause to be published in the kenya gazette every calendar year the names of all registered clinical officers promote development and adoption of codes of practice regulate the professional conduct and ensure the maintenance and improvement of the standards of practice of clinical medicine collaborate with other medical professional associations, organisations and other relevant bodies, in the furtherance of the functions of the council and those bodies consider and deal with any other matter pertaining to clinical officers including prescribing badges, insignias or uniforms to be worn by clinical officers and carry out other functions related to the implementation of this act. training although training programmes existed as early as 1928, the first university to train clinical officers was egerton university in 1999. programs also exist at jomo kenyatta university of agriculture and technology, kenya methodist university (kemu) mt kenya university. and presbyterian university of east africa (puea)., and meru university of science and technology (must). the diploma in clinical medicine and surgery is completed in nine 15-week trimesters over three calendar years (or 135 weeks which, notably, exceeds the minimum 130 weeks of instruction required to complete us md programs). the bsc. clinical medicine and surgery is completed over 4 years. students study the biomedical and clinical sciences such as anatomy, physiology and pathology in the first year followed by the clinical subjects (medicine, surgery, pediatrics, obstetrics and gynecology) in the second year. the third and fourth year involves supervised clinical practice and internship in teaching hospitals where they rotate in all the departments, receive beside lectures, attend consultants' ward rounds, clerk patients and present medical histories, perform deliveries and first-assist in major surgery. they also attend clinical meetings and write prescriptions which at this stage must be counter-signed by a supervising clinician. there is special emphasis on primary care with modules on community health taught throughout the course. before starting their internship after the third year, clinical officers spend at least one month in a provincial rural health training centre where they immunize children, examine pregnant women and offer family planning services in mother and child health clinics. they also treat in-patients and out-patients under the guidance of qualified clinical officers and organise outreach services where they venture into remote rural villages, seeing patients and immunising children. during this time they complete a project in community diagnosis. they also learn health service management which prepares them for their management and leadership roles in health centers and other institutions. internship and registration all clinical officers must work as full-time interns for one year without pay or any form of motivation at an approved public or mission hospital before getting a licence to practice medicine, a situation that has resulted to major strikes by clinical officers in the past leading to operation standstills in public hospitals when these strikes occur. on passing the final qualifying examination, they take the hippocratic oath then apply for provisional registration by the clinical officers council, the statutory body that regulates the practice of clinical officers in the country. the internship involves supervised rotations in the major clinical departments namely casualty, medicine, paediatrics, surgery, obstetrics and gynecology. they are supervised by consultants in the respective fields. the consultants ensure that they can practice clinical medicine safely before signing them off for registration. an internship booklet signed by the consultants is required for registration. after registration one is required to apply for a licence from the coc which allows them to practice medicine, surgery and dentistry legally in the country. this licence is renewable every two years. renewal requires evidence of having attained 60 continuous professional development (cpd) points in the cpd diary by further training, research and publications, attending conferences and continuing medical education (cme) sessions or major ward rounds and outreach activities. careers progression an experienced clinical officer usually holds a senior clinical, administrative or teaching position within their organisation or establishes and manages his/her own private practice. one who holds the diploma in clinical medicine and surgery can upgrade his/her qualification to the bsc. clinical medicine and surgery or undertake postgraduate training at the university. one may also enroll for the higher diploma programme at the kenya medical training college. the higher diploma in clinical medicine and surgery requires at least three years of working experience and lasts twelve to eighteen months leading to a specialised qualification and re-designation as a specialised clinical officer in one of the medical specialties such as paediatrics, reproductive health, anaesthesia, ent, ophthalmology and cataract surgery, orthopaedics, psychiatry/clinical psychology, skin and chest diseases, epidemiology, pathology and community medicine. a specialised clinical officer provides advanced medical and surgical care including invasive procedures in their specialty such as caeserian section, cataract surgery, tonsillectomy, psychotherapy and administration of anaesthesia. malawi medical care is generally provided by clinical officers who are even capable of providing surgical care. clinical officers are trained for 4 years, (3+1 year of clinical internship at designated teaching hospitals). one meta-analysis documented that the provision of caesarean section by clinical officers does not result in a significant increase in maternal or perinatal mortality. in other, words there was no difference whether the operation was done by clinical officers or medical doctor sudan southern sudan separated from the arab north (sudan) in july 2011 after years of civil war that left much of the southern part in ruins. the healthcare system is almost non-existent. amref started training clinical officers by setting up the maridi national health training institute, name="amref"/> the graduates supplement the efforts of cos trained in neighboring countries, e.g. kenya, uganda and tanzania, most of whom work for international humanitarian agencies. since 2014, juba institute of health sciences and ayii university 2021 have now joined in production of competent cadres in the health in the republic of south sudan. tanzania in tanzania, training is under the ministry of health. there are numerous clinical officer training schools and programs last three years. internship is not required for registration. experienced clinical officers may enrol for an advanced diploma in clinical medicine which takes two years to complete. this qualification is regarded as equivalent to a first degree in medicine by universities and the ministry of health in the country. the graduates are known as assistant medical officers which no longer exist since 2017 so a clinical officer can upgrade by studying a bachelor's degree in clinical medicine in any east african country for three years or study it in tanzania for four years and graduate as a doctor equivalent to an md graduate even in salary and job opportunities or can study the medical doctor(md) which is a 5-year course plus 1 internship year making 6 years and can add 1 year to be medical bachelor and bachelor in surgery (mbbs) if interested. a further two years training from the clinical officer level leads to a specialist qualification in anaesthesia, medicine, surgery and radiology etc. kampala international university has opened a campus in dar es salaam where it is now offering its bachelor of clinical medicine and community health. uganda by 1918, uganda was training clinical officers who were called medical assistants at the time. the training is under the ministry of education and takes place in clinical officer training schools. postsecondary programs last three years, focusing on medicine and hospice care, followed by a two-year internship. kampala international university offers a bachelor of clinical medicine and community health. high school graduates take four-and-a-half years to complete this degree while practicing clinical officers take three years. zambia in zambia, clinical officers who complete a three-year diploma of science in clinical medicine course are called clinical officer -general (cog). those who complete a three-year diploma in clinical psychiatry are called clinical officer -psychiatry (cop). currently the upgrade of this diploma is a bachelor of science and holders are called medical licentiates. medical licentiates have advanced skills in medicine and surgery and may be deployed interchangeably with physicians. medical licentiates outnumber general physicians (with university degree) across all regions, with the ratio ranging from 3.8 cos per physician in lusaka to 19.3 in the northwestern provinces. they perform routine surgical and obstetric operations as well as providing clinical care in hospitals. the college of surgeons of east, central and southern africa (cosecsa) is involved in their training to increase their surgical skills through the clinical officers surgical training (cost) programme. burkina faso in burkina faso, as elsewhere in sub-saharan africa, the use of non-physician clinicians began as a temporary measure while more doctors were trained, but has become a permanent strategy in the face of a crisis in health human resources. different training alternatives have been used. two-year advanced training programs in surgery were developed for registered nurses. clinical officers (known as attachés de santé en chirurgie) were district medical officers trained with an additional six-month curriculum in emergency surgery. many studies show that trained cos provide quality medical and surgical care with outcomes similar to physicians' providing