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Malawi’s Medical Assistants & Clinical Officers – the base of health care in Malawi

Charles Mulilima Clinical Officer, Marie Meckel, MS, PA-C, MPH, MPhil in Medical Education (in progress), Nadia Cobb, MS, PA-C

Clinical officers (CO) serve a vital and consistent role in the Malawi health care system. In 1976 the profession was developed as a short-term solution to the physician shortage crisis, and the need of a broader skills mix than the Medical Assistant could offer.  Soon the Ministry of Health recognized that this well trained cadre worked well in compliment with the Medical Assistant and was able to provide care all over the country, including in the rural and impoverished areas where there were no physicians. The CO proved to be so critical in health systems planning that the Ministry of Health decided to continue the development of the profession. 

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Since the 1890’s there has been a cadre of accelerated medically trained clinicians in Malawi, the Medical Assistant. Their training is 2 years, with a focus on primary care at the community level.  The training for the Medical Assistant was initially 3 years but in 2000 it was changed to 2 years. They are not trained in surgical aspects. Because of the physician shortage, the Clinical Officer profession was established in 1979 in response to a growing inability to meet the more complex and surgical needs of the patients in Malawi. Initially it was thought that the Clinical Officer  would be a stopgap measure until the country could produce doctors, but soon it was recognized that the Medical Assistant and Clinical Officer professions were able to cover a large spectrum of care, and thus have continued to be a vital part of the health system in Malawi. During the development of the Clinical Officer there were no medical schools in the country. Until the late 1990’s medical students were educated abroad.

In 1991 a medical school was opened in Malawi. In 1992, 12 medical school graduates continued their studies in the UK. Between 1998 and 2008 the population of Malawi grew by 30%2 and the annual output of 20 physicians was no match for the need. In 2009 the out put was about 60 per year. As Muula(2009) notes that even if the output were 100/year it would take more than 20 years to achieve 2,000. This of course does not count the brain drain, retirement and distribution (urban) inequities.

Because the Medical Assistants and Clinical Officers soon became the backbone of health care, particularly in rural and remote areas the Ministry of Health decided to develop their capacity and increase their scope of care. The regulation of practice for both the Medical Assistant and Clinical Officer fall under the Ministry of Health.

The Clinical Officers are trained in four years. They spend the first three years learning didactically and the last year is spent in clinical training. This clinical training has an extensive surgical component and Clinical Officers learn to perform cesarean sections and more advanced procedures like surgical bowel procedures. This training prepares them for their work in district hospitals and health centers. There is a career ladder option for the Medical Assistant who can become a Clinical Officer by completing a 2 year bridging course. The orthopedic, ophthalmology and anesthesia bridges are 18 months in duration.

The Ministry of Health also recognized that the Clinical Officers needed a ‘career ladder’ thus they developed a system where they had an opportunity to advance professionally and recently the system was changed from a diploma to one that offers an option of receiving a degree in specialty fields of medicine. The upgrade of the degree serves as an incentive to keep the Clinical Officer in the public system pays them more.

The Medical Assistants and Clinical Officers have an Association  who’s broad objective is to “advocate for members professional welfare so as to effectively contribute towards the delivery of equitable health services to all people”. Their vision states “Equitable and sustainable health service delivery in order to achieve the optimum level of health and well being for all in Malawi.”

With a population of 17 million and the physician ratio 0.019 /1,000 (2009) it is clear that the workforce team of Medical Assistants and Clinical Officers is a critical part of the health system. The Malawi Health Sector Strategic Plan 2011-2016 seeks to increase the number of Clinical Officers to 2,726.

Photograph: Courtesy of the Clinical Officer and Medical Assisant Association of Malawi 


  1. MD ratio: World Bank Country ///Population : The World Factbook (CIA)- est July 2014
  2. Muula, A.S., Case for Clinical Officers and Medical Assistants in Malawi, Croat Med J, 2009, Feb; 50(1):77-78  

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