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Rural Health Issues: Clinical Officers in Malawi.

Medpharm Publications
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  • Biology
  • Ecology
  • Medicine
  • Pharmacology


SA Fam Pract 2004;46(2)32 Clinical Officers in Malawi Malawi had 123 doctors serving a population in excess of 10 million in 2002-2003 (doctor: population ratio of 1: 89,962)1. Four out of 26 health districts had no doctors whilst a further 6 had only one doctor. Malawi has responded to this problem by training and relying on the clinical officer cadre since 1980, when the first group of clinical officers commenced service delivery. Clinical officers are largely respon- sible for the provision of clinical care at district hospital level and play a very important role in the larger central hospitals. Often clinical officers will be supported by doctors but they have shown themselves able to func- tion well without medical officer sup- port. Their duties include OPD care, emergency care, ward management of hospitalized patients and surgical care. Clinical officers carry out a range of surgical procedures including, amongst others, caesarean sections, hernia repairs, management of ectopic pregnancies and fracture manage- ment. With the advent of the provision of anti-retroviral agents (ARVs) to pub- lic sector patients it is clear that the clinical officers will be leading the teams responsible for delivery of ARVs in many health districts. Clinical officers undergo a four year training which includes anatomy, physiology, pharmacology, paediat- rics, medicine, surgery, obstetrics and gynaecology. A separate cadre, med- ical assistants (two years of training), are allowed to upgrade to the clinical officer level after some years of prac- tise – they are then trained specifically as anaesthetists and orthopaedic of- ficers. Many clinical officers have moved beyond the clinical care sector to lead district health management teams (as district health officers) and to support many of the important programmes in Malawi such as TB Control, Malaria Control, IMCI and others. Here they are active as programme managers and as researchers. It is clear that clinical care at hos- pital level in Malawi

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