Abstract
BackgroundDespite the increasing interest in using non-physician clinicians in many low-income countries, little is known about the roles they play in typical health system settings. Prior research has concentrated on evaluating their technical competencies compared to those of doctors. This work explored perceptions of the roles of Kenyan non-physician clinicians (Clinical Officers (COs).MethodsQualitative methods including in-depth interviews (with COs, nurses, doctors, hospital management, and policymakers, among others), participant observation and document analysis were used. A nomothetic-idiographic framework was used to examine tensions between institutions and individuals within them. A comparative approach was used to examine institutional versus individual notions of CO roles, how these roles play out in government and faith-based hospital (FBH) settings as well as differences arising from three specific work settings for COs within hospitals.ResultsThe main finding was the discrepancy between policy documents that outline a broad role for COs that covers both technical and managerial roles, while respondents articulated a narrow technical role that focused on patient care and management. Respondents described a variety of images of COs, ranging from ‘filter’ to ‘primary healthcare physician’, when asked about CO roles. COs argued for a defined role associated with primary healthcare, feeling constrained by their technical role. FBH settings were found to additionally clarify CO roles when compared with public hospitals. Tensions between formal prescriptions of CO roles and actual practice were reported and coalesced around lack of recognition over COs work, role conflict among specialist COs, and role ambiguity.ConclusionsEven though COs are important service providers their role is not clearly understood, which has resulted in role conflict. It is suggested that their role be redefined, moving from that of ‘substitute clinician’ to professional ‘primary care clinician’, with this being supported by the health system.
Highlights
Recent research has shown that non-physician clinicians (NPCs), a form of mid-level worker, may be a viable solution to bringing physician-type services closer to people that need them while long-term solutions to recruiting and retaining qualified health professionals especially in rural areas are sought [1,2,3,4,5,6]
This is seen to have resulted in a neglect of other aspects of Clinical Officers (COs) roles that include health education and promotion in the community, which perhaps would serve to reduce the number of patients visiting hospitals with preventable illnesses
This is despite the fact that their training and scope of service allows for much broader roles than are currently enacted
Summary
Recent research has shown that non-physician clinicians (NPCs), a form of mid-level worker, may be a viable solution to bringing physician-type services closer to people that need them while long-term solutions to recruiting and retaining qualified health professionals especially in rural areas are sought [1,2,3,4,5,6]. Available literature on COs suggests that they play distinct and important roles in the day-to-day delivery of health services [8,9]. What their roles are and how these are perceived by COs and others is rarely described. To understand the role issues facing COs, we draw on work describing professional tensions between doctors and nurses. This work explored perceptions of the roles of Kenyan non-physician clinicians (Clinical Officers (COs)
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