Malawian government takes action to help retain surgically trained Clinical Officers’ in district hospitals.
Surgically trained clinical officers from across the country have been leaving their jobs in districts hospitals and moving away from practicing the profession. Lack of recognition by the and delays in promotions after obtaining a BSc in general surgery made some of them seek better job opportunities elsewhere. This has the potential of negatively impacting access to surgery in areas outside cities where majority of Malawians live.
Recognizing the importance of retention of clinical officers in district hospitals, SURG-Africa supported the annual meeting of the Surgical Association of Malawi. One of the main points discussed was how to ensure that surgically trained clinical officers stay and practice surgery in government owned district hospitals. During the meeting held in Salima last September, representatives from the Ministry of Health, surgical specialists and clinical officers had the opportunity to debate how to improve the situation.
Some clinical officers trained in surgery at BSc level expressed dissatisfaction with their professional situation. Despite obtaining a BSc in general surgery over three years ago, some of them still remain on the same salary, and feel trapped in a bureaucratic limbo due to the lack of recognition. A considerable number of the graduates have quit the civil service. This in turn made some district hospital to limit the scope of surgical procedures offered to patients. Patients and their guardians from rural areas had to travel long distances to access basic surgical care which had been previously available in these facilities.
‘There is no collaboration between the Medical Council and the Ministry of Health’, explains Aubrey Filimoni, BSc General Surgery Clinical Officer. He is one of the students who benefited from the Clinical Officers surgical training in Africa (COST-Africa), our previous project, funded by the European Union. It supported the process of opening the surgical BSc training at the University of Malawi. ‘If I qualify as clinical officer, I get a license by the Medical Council certifying that. An officer in the government by definition is an entry level for someone with a degree qualification. But, when I go to my employer, the Ministry of Health, I am called a clinical technician. There is a bit of a professional degradation’ - says Filimoni.
In order to give a deserved recognition to the clinical officers, the Medical Council has recently created a unique register for them as Clinical Associates, however the Ministry of Health clinical officers remain as technicians. This issue will have to be resolved in the future to avoid continued dissatisfaction among clinical officers.
Dr. Nedson Fosiko, Deputy Director of Clinical Services in the Ministry of Health, argued that things are moving in the right direction on the side of the government. ‘There have been inefficiencies to create new positions - he admitted. However, he was positive about reaching a solution for this situation soon. He emphasized that several clinical officers have been promoted recently, and more promotions are planned shortly.
Surgical specialists also recognise the role surgically trained COs play in the provision of surgical care. ‘We do appreciate what Clinical Officers do in surgery. They perform surgical operations in district hospitals so such patients do not have to be referred to central facilities. When referring cases, it is much better when you have surgical trained personnel at the other end of the line who can understand the language of the profession’ explains Tiyamike Chilunjika-Kapalamula, Paediatric Surgeon at Queen Elizabeth Central Hospital in Blantyre. ‘I understand that they want a new name and change their salary grade’ she adds.
With around 84% of the population living in rural areas, Malawi needs a prepared and motivated workforce that can provide surgical care to district hospitals around the country. Recent studies show that around 30% of Malawians live with a condition which is treatable with surgery, indicating extremely high demand for such care.