Shifting Tasks to Save Lives: Clinical Officers in Southern Sudan
Southern Sudan emerged from two decades of civil war in 2005 to find its health system in tatters. 
The country’s health indicators are some of the worst in the world. Maternal mortality is estimated at 1 in every 50 live births and 1 in every 4 children will die before reaching their fifth birthday.
Southern Sudan also faces a dire shortage of health care workers – there are an estimated 100 doctors for a population of more than 10 million people.
Following the signing of the Comprehensive Peace Agreement that granted Southern Sudan semi-autonomy in 2005, AMREF, at the request of the Government of Southern Sudan developed standardized curricula to train urgently needed health workers.
Task Shifting
Task shifting is defined by the World Health Organization as the rational re-distribution of tasks among health workforce teams.
Specific tasks are moved, where appropriate, from highly qualified health workers to health workers who have fewer qualifications in order to make more efficient use of the available human resources for health.
In Southern Sudan, task shifting represents the key to overcoming the severe shortage of eligible workforce for training in the various disciplines of medicine and public health.
This shortage demands that the few trainable candidates be equipped with a multiplicity of skills that will enable them to provide comprehensive and integrated health services at all levels.
Clinical Officers: South Sudan’s Doctors
The AMREF run National Health Training Institute in Maridi Southern Sudan, relies on the principals of task shifting to train clinical officers. Clincical officers, previously known as medical assistants, are a cadre of middle-level health professionals, falling between physicians and nurses. They can perform 70 per cent of the work a physician does at one fifth of the cost of training a doctor in half the time.
Clinical officers are trained in preventive, curative and emergency health services using the primary health care approach. The three-year course prepares students to develop critical thinking, clinical reasoning and problem-solving skills in managing patients and providing services at different levels of the health delivery system.
The Maridi institute has trained 350 clinical officers since 1998 representing nearly 99 per cent of the clinical officers working in all of Southern Sudan.
In the context of Southern Sudan, task shifting represents the key to overcoming the severe shortage of eligible health workers.
It is estimated that Southern Sudan still needs 1,500 clinical officers to meet the health needs. By focusing on innovative and locally relevant strategies – AMREF is leading the way to ensuring this happens.
Meet Janet – AMREF Trained Clinical Officer
By nine o’clock every morning, the Tali Primary Health Care Centre in Terekeka County South Sudan is teeming with patients.
This is the largest health centre in Tali. The nearest referral hospital is in the town of Lui, a five-hour drive away.
Every day 100-150 patients are seen at the Tali health centre, numbers that would normally be seen at a regional rural hospital rather than the smaller primary health centre.
On a chilly October morning, Janet, a clinical officer, is on duty in the consultation room. Most of the men and women in the waiting room are accompanied by children. On most mornings, Janet attends to infants and children under five, the majority of whom complain of difficulty in breathing, coughs, fever, vomiting or diarrhea. These are typical signs of malaria or respiratory tract infections, Janet explains, the two main cause of death in children under five in Tali.
From the theatre, Janet proceeds to the maternity wing, where a mother with a retained placenta is waiting for her.
Most women in Southern Sudan prefer to deliver at home, Janet explains. Many do not even come for antenatal services either, because the health centres are too far from their homes. Culture also demands that they give birth at home with the help of traditional birth attendants.
On questioning the patient, Janet discovers that she had malaria and anemia during her pregnancy, which caused her to have weak contractions during labour. She takes the mother into the labour ward, where she expertly removes the placenta. She will keep the patient under close observation before discharging her.
Janet was trained as a clinical officer at the AMREF-managed National Health Training Institute (NHTI) in Maridi, she can easily perform many tasks that are often reserved for doctors.
“We have no doctor here, and the nearest hospital is in Lui, which is 400 miles away. I appreciate the broad range of knowledge and skills that I gained in Maridi because they have enabled me to handle a wide range of diseases and illnesses,” says Janice.
Having been accepted as the ‘doctors’ of Southern Sudan, clinical officers like Janet have the challenging mandate of providing quality services at different levels of the country’s struggling health system, which is characterized by severe shortages of medical supplies and health workers.
Learn more about AMREF’s work in Southern Sudan
Meet AMREF trained Clinical Officer Sgt. Kuol
Research Report: Doctors of Southern Sudan
Return to the Rx Africa: Prescriptions for Better Health
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