You are unfit for CS deliveries; doctors tell clinical officers

Clinical officers hold a newly born baby after a CS procedure. [Getty Images]

A section of doctors has opposed clinical officers performing caesarean sections citing inadequate surgical training.

Led by obstetricians and gynaecologists the doctors warn that allowing clinical officers and other health workers to conduct C-sections without the requisite surgical training, accreditation, and oversight poses a direct threat to the lives of mothers and newborns.

In a joint statement, the Kenya Medical Association (KMA) and the Kenya Obstetrical and Gynaecological Society (KOGS) raised concerns over the increasing number of clinical officers and other health cadres performing these procedures independently.

“Maternal mortality and morbidity remain a national concern, and the inappropriate delegation of surgical responsibilities risks worsening this crisis,” the statement reads in part.

Data from the Ministry of Health and the Kenya National Bureau of Statistics indicates that 17 per cent of all deliveries in Kenya are conducted through C-sections.

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Each year, at least 6,300 women die due to pregnancy and childbirth-related complications, while 35,000 newborns lose their lives due to birth-related complications.

While acknowledging the critical role that all healthcare providers play in service delivery, doctors emphasise that obstetric and gynaecological surgeries require highly specialised training, rigorous competency assessments, and adherence to global safety standards.

The doctors stressed that the scope of practice for different medical cadres is clearly defined in law and enforced through professional regulatory bodies.

Any expansion of these roles, they argue, must be guided by scientific evidence, structured training, and regulatory frameworks—not workforce shortages or political lobbying.

KMA and KOGS urged the Ministry of Health, Parliament, and other stakeholders to uphold professional standards by ensuring that any modifications to healthcare practice are evidence-based and competency-driven.

They further called for clear policies that define healthcare workers' roles within their regulated scope of practice to enhance patient safety and outcomes.

Amid concerns over specialist shortages, the associations urged the government to invest in training more medical specialists and officers to meet the growing demand for surgical services.

Additionally, the doctors insisted that all surgical procedures should only be performed by legally recognized, adequately trained professionals.

They suggested that clinical officers interested in performing surgeries, including C-sections, should undergo formal medical training in accredited institutions.

They asked that any proposed changes in medical practice must involve substantive engagement with professional bodies, medical regulatory authorities, and the wider healthcare community.

Their calls have been backed by the World Medical Association (WMA) which noted that compromising critical standards endangers lives, threatens maternal and neonatal health, and risks undoing hard-earned progress in patient safety.

“Maternal and neonatal health are fundamental components of the broader public health framework, and any action that endangers their safety has far-reaching consequences,” said WMA in a statement.

According to WMA, the expertise required to perform complex surgeries extends beyond general clinical knowledge, involving years of rigorous, specialized training, continuous competency evaluations, and adherence to best practice standards to ensure the safety of both mother and newborn.

But in a quick rejoinder, the Kenya Union of Clinical Officers (KUCO) dismissed the claims saying their scope of training includes performing C-Section because it is a life-saving procedure.

Secretary General George Gibore said not all clinical officers perform surgeries and C-Section, but only those trained in reproductive health.

Gibore maintained that clinical officers are highly trained, with some holding masters with vast knowledge in surgery.

“C-section is not a procedure you just want to do because of leisure. Not all clinical officers perform the procedure. It is only reproductive health clinical officers and degree trained. Clinical officers do not perform procedures, they only do so during training because they might be required to save lives,” said Gibore in defense.

The dispute on whether to allow clinical officers to perform procedures he said came up in 2007, and the Director General of Health by then allowed them to practice.

Currently, the clinical officers' representative said at least 70 per cent of procedures done nationally are conducted by clinical offers.

“Why are they bringing this discussion now yet the same clinical officers perform 70 per cent of the procedures? Doctors are feeling that their space is threatened,” said Gibore.

He said the Social Health Authority (SHA) has given liberty to patients to choose who to do the procedure because they are not confined to hospitals, an issue doctors are against.

“Apart from C-Section, we have more procedures that clinical officers do to save lives. The discussion is not about qualification, ability to do it, or competency, but resources. People are fighting for resources,” said Gibore.

Gibore said instead of blanket accusations, doctors should share any cases of malpractice and medical negligence.

“Let us compare the scope of training, is it worth it? Doctors have more cases of negligence and malpractice occurring during surgery in courts and medical council,” he said.