Transformative Education
for Health Professionals

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The United Republic of Tanzania’s Clinical Officers and Assistant Medical Officers

Prof Senga Pemba, PhD, Marie Meckel MPH, PA-C, Nadia Cobb MS, PA-C

The United Republic of Tanzania has a population of 50.76 million people with 80 % living in rural areas.  It is reported to have 2 physicians for every 100,000 people, how they are primarily in the urban areas. This shortage and maldistribution of health care providers was the incentive for expanding the skills mix through the development of regionally specific providers. Clinical Officers were introduced in the 1930’s and Assistant Medical Officers in the 1960’s to add to the health workforce and increase access to care. 

Full project description: 

To address the dire health care needs, Tanzania introduced three levels of health care providers starting in the 1930’s as a means of addressing the shortage of qualified medical doctors. The Clinical Assistant (CA), the Clinical Officer (CO) and the Assistant Medical Officer (AMO) are basically Associate Clinicians trained to provide curative and preventive services to the people. According to Human Resource for Health and Social Welfare Country Profile 2013/14, there are 1,216 Clinical Assistants, 6,164 Clinical Officers and 1,737 Assistant Medical Officers currently providing services in the country (MOH,2014).

Out of the three levels, the Clinical Assistant cadre is the lowest in the ladder and is mostly prepared for rural dispensaries. The Clinical Officer model is the most well known profession in East Africa and in other parts of Africa. It is comprised of a three-year training program, which prepares clinicians to work in rural areas especially at the health centre level. Although Clinical Officers play a huge role in the Tanzanian health system, it was soon recognized that there was a need for a more advanced health care provider that would have the clinical skills to perform emergency surgery and provide other essential services at the health center and hospital levels. This need led to the establishment of the Assistant Medical Officer cadre. They work in the district hospitals, health centres and health training institutions.

The AMO professionals have increased capacity from the Clinical Officer as they receive two-years of advanced training in curative as well as preventative medicine. The program consists of clinical rotations in key areas (medicine, surgery, child health and Obstetrics & Gynecology) and a community medicine rotation at a teaching hospital (MOH, 2008). Eligibility requirements are three years clinical work experience along with a Diploma in Clinical Medicine. The AMO perform a large percentage of surgeries outside of the major cities, with results that are comparable to physicians in term of outcomes, quality and risk indicators (McCord, 2009)

These two cadres of accelerated medically trained clinicians (non-physician) are more likely to work in rural areas where the need is the highest. There are currently 7 training institutions for AMO’s in Tanzania.

The Clinical Officer and the Assistant Medical Officer are a great solution to the rural health care needs of Tanzania and other developing countries due to the short training period and less cost of training. In other words, the establishment of these cadres in Tanzania is a direct implementation of the Task shifting/sharing approach which WHO is currently advocating for as a means of addressing the human resource crisis (WHO, 2008).

References:

  1. Global Health Observatory Data Repository. Density per 1000 Data by Country. 2014 WHO. Accessed December 2014.
  2. MOH (2008) Assistant Medical Officers training curriculum
  3.  MOHSW. (2014). Country Profile: Dar es Salaam, Ministry of Health
  4. WHO. (2008). Task shifting: rational redistribution of tasks among health workforce teams: global recommendations and guidelines. www.who.int/healthsystems/TTR-TaskShifting.pdf
  5. World Bank : http://data.worldbank.org/country/tanzania
  6. McCord, C., Mbaruku, G., Pereira, C., Nzabuhakwa, C., Bergstrom, S., The Quality Of Emergency Obstetrical Surgery By Assistant Medical Officers In Tanzanian District Hospitals, Health Affairs, 28, no.5 (2009):w876-w885 
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Case study addresses:

Quality: 
Yes
Quantity: 
Yes
Relevance: 
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Sustainability: 
Yes