Clinical officers petition Ruto over rule that bars 26,000 medics from key SHA approvals

Clinical officers have petitioned President William Ruto over a new rule that will exclude the 26,000 medics from pre-approving key medical procedures in the Social Health Authority (SHA) plan, which they say could disrupt services in more than 1,000 facilities currently run by the professionals.

The medics, who have also separately petitioned Health Cabinet Secretary Deborah Barasa and the SHA leadership, argue that the rule is discriminatory and could penalise patients seeking services under the new health plan, which emphasises referrals before moving on to the next stage of treatment.

Under the auspices of the Clinical Officers Union, the Clinical Officers Council and the Kenya Clinical Officers Association, the medics wrote to the President on December 4, Ms Barasa on December 3 and the Social Health Authority on November 30 to protest against the new rule.

The petition accuses the SHA of excluding over 1,000 health facilities registered by clinical officers from empanelment and contracting.

These facilities, many of which serve marginalised and underserved areas, were previously accredited under the now-defunct National Health Insurance Fund (NHIF).

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The clinical officers also claim that they have been deprived of the right to pre-authorise specialised procedures, despite playing a critical role in the delivery of health services at all levels of care in Kenya.

Mr Peterson Wachira, the chairman of the Kenya Union of Clinical Officers, said the new Social Health Authority (SHA) system was forcing clinical officers to use medical officer licences to pre-authorise procedures in their facilities or obtain licences from the Kenya Medical Practitioners and Dentists Council (KMPDC), which is predominantly an organisation for medical doctors.

“Clinical officers are in charge of most of the country’s Level 2 and 3 facilities, where no medical officers are present, and are pivotal in running outpatient services in Levels 4, 5, and 6. Why would you expect that when they want to prescribe a procedure to a patient they must use a doctor's licence for the system to accept but when they use their licence, it is rejected? This is discrimination and we will not allow that. We are equally trained to offer these services and we are demanding to offer them,” Mr Wachira said.

According to the Clinical Officers Council, Kenya's healthcare landscape is supported by over 26,000 clinical officers compared to over 6,000 licensed doctors according to the Kenya Medical Practitioners and Dentists Council (KMPDC).

According to the Council's data, the officers provide over 98 percent of the anaesthetic services in the country, with a number of them working in ophthalmology, cataract, oncology, and ear, nose and throat departments.

Mr Wachira said the SHA management requires clinical officers to register their facilities with the KMPDC – a regulatory body meant only for doctors and dentists.

This forces clinical officers into double taxation and licensing, adding unnecessary financial burdens, he said.

“This policy denies clinical officers the ability to pre-authorise diagnostics and procedures under the SHA system, even though they perform many specialised procedures. As a result, many Kenyans face delays or outright denial of critical care,” the chairman said.

But Medical Services Principal Secretary Harry Kimtai disputes this, saying the ministry has not restricted clinical officers from conducting any preauthorisation. However, he said, under the SHA Act, it is the KMPDC that has been given the mandate to licence health facilities.

“We have requested that they forward the names of all facilities and registered officers licensed by the Clinical Officers Council to the KMPDC. This information is necessary for us to understand which officer is responsible for which procedure and what each facility does. Without these details in the system, it is challenging to open access to every cadre,” Mr Kimtai said.

“We want them to align their efforts so that, during the audit, we can identify who was responsible for what procedure and at which facility.”

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Initially, he said, the portal was accessible to all cadres for pre-authorisation procedures, but was closed after it was found that requests were being made by people not authorised to carry out certain procedures.

“We respect every profession; this is not discrimination, as they claim. They simply need to align, and submit the names of the facilities and the officers. The KMPDC will conduct inspections, and provide licensing, and then their data will be entered into the system. This will enable them to perform all the procedures they are mandated to do under the supervision of the SHA,” Mr Kimtai said.

But Mr Wachira insists that the KMPDC route was still a roadblock and one that is tantamount to excluding them altogether.

“We have specialised clinical officers who even manage advanced clinics alongside consultants, ensuring healthcare reaches the grassroots and underserved populations. Why are we being subjected to such discrimination? Does this mean that we are lesser healthcare workers?” asked Mr Wachira.

The Social Health Act Regulations states that, "The Authority shall empanel all licensed and certified healthcare providers and health facilities in the list submitted to the Authority from time to time by the relevant bodies responsible for accreditation."

Mr Wachira said, “We have realised that this is a greater and coordinated scheme to extort money from the affected health workers through a cartel involving operatives from SHA and KMPDC. This cartel is not new and the same old conniving tactics were used in 2018 to extort our members and was only addressed after we raised the issue.”

He added, “Clinical officers operate the majority of private health facilities in Kenya. Denying them empanelment threatens to shutter these centres, leaving vulnerable populations without care. With private facilities excluded, public hospitals face overwhelming patient loads, leading to longer wait times, reduced care quality, and avoidable deaths.”

In Kenya, clinical officers provide care in the most remote and rural hospitals.

A position between a doctor and an assistant, it was developed as a short-term solution to the shortage of qualified doctors.

Although initially a stop-gap measure, the ministry decided to develop and increase the capacity and skills of clinical officers, as the health system could not function without them.

Clinical officers are trained in a four-year programme. The first three years are spent learning theory and practical skills in central and district hospitals, and the last year is a clinical training year.

The clinical training has a strong surgical component and clinical officers learn to perform most minor and major surgical procedures, including caesarean sections and bowel surgery.

This prepares them to work in rural and district hospitals and health centres. At the end of their training, clinical officers are awarded a Diploma in Clinical Medicine.

The role of the clinical officer can be varied and extensive depending on the location. They may be responsible for supervising staff, running clinics, ordering medication, performing surgery, recording data and managing correspondence.

Clinical officers can also specialise with diplomas in orthopaedics, anaesthesia, ophthalmology, psychiatry, dermatology and psychiatry. It is also possible to complete a three-year Bachelor of Science programme in medicine, paediatrics, general surgery, obstetrics and gynaecology, anaesthesia and orthopaedics.

After a minimum of four years, a clinical officer can progress to senior clinical officer, then to chief clinical officer and finally to chief superintendent clinical officer. At these grades, additional roles and responsibilities in health service delivery are expected.

Doctors spend six years in medical school. After graduation, they complete a mandatory 13-month supervised internship in approved training centres.

The medical intern rotates in critical areas of internal medicine, surgery, paediatrics and child health, obstetrics and gynaecology, psychiatry and community health.

A dental intern rotates in critical areas of oral and maxillofacial surgery, prosthodontics and conservative dentistry, periodontics, paediatric dentistry and orthodontics, and community dentistry. By the end of the course, the trainee is expected to have acquired the practical knowledge necessary to practice.

Aspiring specialists can then embark on at least four years of specialist postgraduate training.