Are Medical Clinical Officers / Allied Health Professionals still part of the Health Systems?
(The Unsung Heroes in the Health Sector Awards)
PREAMBLE
The healthcare industry is an aggregation and integration of sectors within the economic system that provides goods and services to treat patients with Curative, Preventive, Rehabilitative, and Palliative Care. These are registered, licensed and regulated during practice under different councils including but not limited to Uganda Medical and Dental Practitioners Council (UMDPC), Allied Health Professionals’ Council (AHPC), Uganda Nurses and Midwives Council (UNMC), for the case of Uganda, whereas; a separate Clinical Officers’ Council (KCOC) exits at the neighborhood in Kenya. 57 Allied health professions are dully recognized globally and aim to prevent, diagnose and treat a range of illnesses and often work within a multidisciplinary health team to provide the best patient outcomes. And thus Allied Health is a term used to describe the broad range of health professionals who are not Medical officers or nurses/Midwives as well as pharmacists.
BACKGROUND HEALTH SERVICE DELIVERY AND RECOGNITION
Worldwide, health workers have been rewarded and continuously appreciated especially during pandemics like COVID-19 as well as the daily dedication to save lives and promote health; through tokens, promotions, awards among other as organized by the government through the ministries concerned with such services. The HRH Audit Report, 2019/2020, MoH, a robust and well performing health care workforce was critical for the attainment of the Health Sector Development Plan II goal; to accelerate Universal Health Coverage (UHC), with a focus on Primary Health Care (PHC) and improve population health, safety & management by 2025. Furthermore, MoH Report to Parliament, October, 2021 clarified that the overall goal of the Health Sector is the attainment of the UHC by 2030 in line with the Sustainable Development Goal (SDG) 3.
The Heroes in Health Awards (HIHA) is a Public-Private Partnership project instituted in 2019 by the MOH with the support of Xtraordinary Media. HIHA was basically instituted as an inaugural rewards initiative to recognize outstanding individuals, entities, organizations, services, products, and programs. The members of the public nominates and vote their heroes. The aim is to shine light on their outstanding contributions; individual, community, nonprofit, public and private players in the health sector in line with innovation, better It is similarly an annual event to boost morale and give homage to the dedicated and talented foot soldiers, practitioners, academicians, organizations and other sector partners who dedicate their careers, time, life and resources to providing exemplary care, innovation and service to Ugandans countrywide.
HEALTH SERVICE DELIVERY, ROLES & RESPONSIBILITIES AND RECOGNITION OF AHPs IN UGANDA HEALTH SECTOR
In Uganda, AHPC among other councils, is a fully acknowledged body established by an ACT of Parliament, (AHPC ACT Cap 268 of 1996). And registers, licenses and regulates ~35 professions, front liners, practitioners, academicians; most of whom, run the sectors to provide exemplary care, innovation and service to Ugandans countrywide. Currently, there are about 26,685 Allied Health Professionals (AHPs) of which; 11,795 are Medical Clinical Officers, 8,845 Laboratory Cadres, 3,021 Public Health Related Cadres, 368 Radiographers, 375 Physiotherapy based cadres among others (AHPC website). Relatedly, there are over 2,645 Clinical Officers working in local government health care facilities (HC III to DHO level), 2,674 laboratory cadres, 14,690 Nurses, 5,780 Midwives, 48 radiographers, 164 Pharmacy cadres, and 674 Medical doctors among others. Furthermore, there were 511 Clinical Officers working in PNFP health facilities. The HRH Audit Report, 2021, MoH stipulates that Clinical Officers, Laboratory cadres, among other Allied Health Professionals, are deployed & work from HC3 to the National Referral Hospitals. Clinical Officers, Laboratory cadres, Nurses & Midwives are the backbone of PHC as community level implementers. This makes the Medical Clinical Officers the highest (about 44.6%) category of cadre among the allied health professionals in Uganda. Some of the Medical Clinical Officers have gone ahead to improve their knowledge and skills in different health specialties like ENT, Psychiatry, Dermatology, Anesthesia, Ophthalmology, and
Public Health among others, in their quest to serve the public better.
At Public facilities
According to the Uganda National Health Facility Master List, 2018, there was a total of 6,929 health facilities across the country. Out of these, 1,569 (22.62%) were HC3s, 222 (3.2%) HC4s, 163 (2.35%) GHs. Almost all HC3s were/are headed by Clinical Officers, as facility managers & clinicians, with Nurses, Midwives & Laboratory cadres as the main health care technical staff running the facilities. The Medical Clinical Officers among other AHPs are currently deployed at different levels of Uganda’s health care system, and they perform different roles for instance, it is estimated that at least 2,676 (39%) of all the health facilities in Uganda are headed or directly supervised by Medical Clinical Officers (46% of AHPs). Similarly, these are known for running most of the outpatient departments in health Centre IVs, district hospitals and regional hospitals. They are also known for supporting most of the health programs that have become successful in Uganda. These programs include malaria control, HIV prevention and control (UNAIDS 95, 95, 95), safe male circumcision (SMC), and tuberculosis/leprosy control, among others.
At Private Clinics
Uganda has ~1,578 private clinics and it’s estimated that ~70% of the facilities are owned or supervised by Medical Clinical Officers among other AHPs. This is a great contribution to increasing access to health care services (UHC) in Uganda, especially in the rural settings where ~83% of the country’s population and ~80% of the morbidities are found.
In summary, the AHPs as a whole have been at the forefront during several epidemics and in the current COVID-19 pandemic. The MCOs may have not been in the intensive care units in the hospitals, but Anesthetists, medical Laboratory scientists, Imaging, Environmental among others were/are, and whoever comes to the ICU most likely first went to the nearby lower-level facilities or to the outpatient’s department of the hospital and should have interfaced with a Clinical Officer or another AHP at that level.
Degree Holder AHPs such as Bachelor of Clinical Medicine and Community Health etc. Based on the changing nature of health care needs and demands, disease patterns as put forth by the HSC report and Public service reports of 2017, 2018/2019; it was vital to improve the knowledge and skills of AHPs. ~ 300 BCMCH have graduated with a Bachelor of Clinical Medicine and Community Health. It’s hoped that people in the communities especially those in rural setting are benefiting from better services provided by this more technical cadre of MCOs and same for other upgraded AHPs. Furthermore, the changes in the health industry and emphasis on cost-efficient solutions to health care delivery will continue to encourage expansion of the allied health workforce. The WHO by 2006 estimated that there was a worldwide shortage of about 2 million AHPs needed in order to meet global health goals, and it is a round this time that Bachelor of Clinical medicine and Community Health (BCMCH), BMLS, BSN and BSc Midwifery among others were implemented in the Sector.
In recognition of the growth of the number and diversity of allied health professionals in recent years, the 2008 version of the International Standard Classification of Occupations increased the number of groups dedicated to AHPs. Depending on the presumed skill level, they are either identified as “health professionals” or “health associate professionals”. For example, the categories included “paramedical practitioners” grouping professions such as medical clinical officers (Diploma to Degree (BCMCH), clinical associates, physician assistants, and assistant medical officers as well as for community health workers; dietitians and nutritionists; audiologists and speech therapists; and others.
CPD Platform
It is clear that a reliable and sustainable continuous professional development (CPD), platform is vital to enable professionals improve their skills in especially the critical areas, including emergency medicine, dermatology, and non-communicable diseases etc. The MCOs Professionals- Uganda (MCOPU, The National Association of Clinical Officers) has partnered with World AMTC Network (WAN), and University of Utah to establish the platform that enables professionals to enroll for selected courses in the medical sector. This will be developed further to allow learning exchange. Given the above its very clear that the Medical Clinical Officers have and continue to play a critical role in Uganda’s health sector. It’s imperative to support the development of the professionals and support them to perform better as Uganda strives to achieve UHC.
However, in Uganda, we have in the recent years/months witnessed a trend in our health sector where some medical/health care professionals have been sidelined, for reasons which remain obscure. This has been evident in a number of areas, with selective cadre specific motivational privileges including recruitments, job distribution, remuneration, scholarships, career progression, and promotion.
The most recent awards (HIHA) held on 12th November, 2021 where a number of professional categories were rewarded including doctor of the year (for Medical Officers, at various ranks/seniority), Pharmacist of the year (for Pharmacists), Nurse of the year (for Nurses), Midwife of the year (for Midwives) and other general categories. Nonetheless, there was absolutely no profession specific recognition for Medical Clinical Officers, and all their counterparts/colleagues regulated by the Allied Health Professionals Council. This coupled with the ongoing unfair & profession selective health worker recruitments, job allocation, cadre selective & discriminative remuneration, career progression/ advancement restrictions against mainly the Allied Health Professionals greatly undermines teamwork and team spirit, creates unnecessary disharmony between various cadres.
It is worth noting that health professionals were/are unjustly & unjustifiably categorized in two salary classes; Med 1 (for Medical Officers, Dental Surgeons & Pharmacists), currently earning a gross monthly salary of ugx. 3M (Uganda shillings Three Million) at entry level whereas all their graduate counterparts, including Nurses, Midwives & Allied Health cadres are classified as Med 2, earning a gross pay of ugx. 2.2M (Uganda shillings Two Million two hundred thousand). Relatedly, most Allied Health cadres are yet to have their respective professional Schemes of Service & scope of practice approved & implemented by the ministry of health & ministry of Public service, to incorporate their respective new cadres especially graduates.
Similarly, the Graduate MCOs’ medical internship Program (one of their key training requirements before Licensure for Professional Practice) is also yet to be approved & implemented by the ministry of health; though, despite various engagements between Bachelor of Clinical Medicine & Community Health (BCMCH) graduates, Allied Health Professionals Council & ministry of health (including top Senior Management), and Parliament. This has rendered almost all graduates unsure about their career despite the fact that majority are government student loan scheme beneficiaries, with statutory obligations to repay student loans.
RECOMMENDATIONS TO STAKEHOLDERS; MOH, PUBLIC SERVICE, LOCAL GOVERNMENT, MINISTRY OF FP & ECONOMIC DEVELOPMENT AMONG OTHERS. Ideally, a holistic/quality patient care is achieved through teamwork; comprising of a team of various medical/health care professionals including a Medical Officer, a Medical Clinical Officer, a Laboratory cadre, a Nurse, a Midwife, a Radiographer, a Pharmacist, a Nutritionist, a Counselor, a Physiotherapist, among others. Each professional’s contribution is unique & equally necessary, for the recovery of the patient. For instance, the Medical Officer and/or Medical Clinical Officer assesses the patient, sends him/her to the Laboratory cadre and/or Radiographer, for more investigations (to confirm the validity of his/her working/differential diagnosis), after confirming the diagnosis (Final/definitive diagnosis), the former prescribes the treatment (in conjunction with all team members) for the patient, the nurse/midwife then administers the treatment. All this, confirms that everyone’s input is unique & equally important/necessary hence should be equally appreciated. This includes equal/equitable motivation among others. Thus; –
1. The HIHA ought to embrace advancements, and organizers may consider possibly an award per profession for equity and representativeness, as we promote teamwork in UHC and health delivery. 2. Scope of practice and scheme of services for the Nurses, Midwives, Lab, Nutritionists, MCOs among other AHPs’ cadres in the sector ought to be approved, and implemented.
3. Standardization of healthcare practitioners ought to be a priority including at least a one (1)-year medical internship approval and implementation for the degree holder AHPs such as the BCMCH Graduates. 4. The concerned stakeholders ought to implement the presidential directives by paying well the Interns and promoting same salary for equal academic level not discriminative Med1, Med2 systems. 5. Equitable representation of professions/cadres (such as MCOs) at all levels of the health systems; district level (ADHO), MOH Headquarters (Commissioner & Ass. Commissioner AHPs, Community Health etc)
Together we can do more in Health sector and service delivery to realize vision 2040, NDP III, Global Goals. Thank you.
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