Abstract:
Background: Despite 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).
Methods: Qualitative 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.
Results: The 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.
Conclusions: Even 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.
