REPUBLIC OF KENYA

MINISTRY OF HEALTH

REVISED SCHEME OF SERVICE FOR MEDICAL OFFICERS

REVISED DECEMBER 2011

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Incorporating: Key Result Areas Standards of Performance Expanded Skills / Competencies

1. AIM AND OBJECTIVES 1.1 To provide for a well-defined career progression structure that will attract, motivate retain suitably qualified medical officers in the civil service. and

1.2 To provide for clearly defined job descriptions and specifications with clear delineation of duties and responsibilities at all levels within the career structure, to enable officers understand the requirements and demands of their job. 1.3 To establish standards / criteria for recruitment, rational deployment, promotion, training and advancement to higher grades within the career structure on the basis of qualifications, knowledge / experience, work performance and results. 1.4 To ensure appropriate career planning and succession management

2. ADMINSTRATION AND TRAINING SCOPE OF THE SCHEME 2.1 Responsibility for administration The Scheme will be administered by the Principal Secretary of the Ministry of Health in consultation with the Principal Secretary, Ministry of State for Public Service and the Public Service Commission. The Principal Secretary will ensure that the provisions of the scheme are strictly observed and that serving officers are encouraged and given equal opportunities in deployment, promotion and succession.

2.2 Training scope The Principal Secretary will also ensure that the provisions of the scheme on development are implemented, training opportunities with the attendant resources looked for, and that serving officers are encouraged and given equal opportunity to acquire additional professional knowledge, skills, competences, attitudes and expertise necessary for both efficient and effective performance of their duties and advancement within the Scheme of Service.
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3. THE FUNCTIONS, DUTIES AND RESPONSIBILITIES OF A MEDICAL OFFICER For purposes of the scheme: 3.1 The professional qualification and career progression of medical officers have four functional clinical levels, namely: the medical officer intern, general medical officer, medical specialist / consultant and medical sub-specialist; 3.2 Medical Officers also can progress and mature into health administration to become Departmental In-Charges and/or Facility In-Charges at facility level, Medical Superintendents / Chief Executive Officers of county hospitals at hospital level / County Directors of Health at county level, Chief Executive Officers of National Referral Institutions (hospitals and institutes), Divisional Heads, Departmental Heads at headquarter level; Directors of Health, heading directorates, e.g of Mental Health and Substance, Communicable Disease Control, Noncomunicable Disease Control, Family Health, Standards and Regulatory Services, National Health Services, Pharmaceutical Services), and Director-General at the highest level.

3.3 Medical Officers functions, duties and responsibilities therefore include: 3.3.1 General diagnosis, care, treatment and rehabilitation of patients disease conditions, 3.3.2 Specialized clinical care, 3.3.3 Community diagnosis, care and treatment, 3.3.4 Disease prevention, surveillance and control, 3.3.5 Emergency response and clinical care, 3.3.6 Medical examinations, writing medical reports and medical board proceedings, 3.3.7 Disaster preparedness and management, 3.3.8 Health education and promotion, 3.3.9 Hospital / Facility administration, 3.3.10 Teaching and mentorship of human resources for health at various levels, 3.3.11 Health information, data management and operational research, 3.3.12 Setting of Health Standards, guidelines and protocols and Service Regulation, 3.3.13 Leadership and Management at various levels within the Health sector, 3.3.14 Forensic and medico-legal services,
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3.3.15 Health Policy formulation, legislation and coordination 3.3.16 And in International Health Relations

3.4 Deployment areas for Medical Officers: 3.4.1 In Level II (health centre), III (county hospital), and IV (national referral health institutions) 3.4.2 In County and National Health Institutions, 3.4.3 In sub-regional, regional and international health offices.

4. GRADING STRUCTURE AND SCOPE 4.1 Grading structure The scheme of service establishes eight (8) grades of medical officers and one (1) executive appointment which will be designated and graded as follows; however, the entry points for basic and post-graduate degree holders and subsequent upward movement where deserving will take into cognizance their longer duration of training and extraneousness of duty.

Designation 1. 2. 3. 4. 5. 6. 7. 8. 9. Medical Officer II (Intern) Medical Officer I Senior Medical Officer Ass Dir of Med Serv / Med Specialist II Sen Ass Dir of Medical Serv/ Medical Specialist I Dpty Dir of Med Serv / Deputy Chief Medical Specialist Sen Dpy Dir of Med Serv / Sen Dpy Chief Medical Specialist Dir of Med Serv / Chief Medical Specialist Director-General of Health

J/G -N -P -Q -R -S -T -U -V -W

4.2 Conversion to the New Grading Structure Serving officers will adopt the new grading structure as follows:

Present Designation JG
1. Medical Officer II (Intern) L

JG
Medical Officer II (Intern)

New

Designation
N

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2. Medical Officer I 3. Senior Medical Officer 4. Ass Dir of Med Serv / Medical Spec II 5. Snr Ass Dir of Med Serv / Med Specialist I 6. Dpy Dir of Med Serv / Dep Chief Med Specialist 7. Snr Dpy Dir of Med Serv / Chief Med Specialist 8. Director of Medical Services 9. ----------------------------------------------------------------

M N P Q R S T

Medical Officer I Senior Medical Officer Ass Dir of Med Serv / Med Specialist II Snr Ass Dir of Med Serv / Med Specialist I Dpy Dir of Med Serv / Dpy Chf Med Specialist Snr Dpy Dir of Med Serv / Snr Dpy Chf Med Specialist Dir of Med Serv / Chief Med Specialist Director-General of Health

P Q R S T U V W

Notes: The grades of Medical Officers in Job Groups N, P, Q, R will form a common establishment for the purpose of this scheme; movement to higher grades then becomes competitive. 4.3 Serving officers Serving officers will adopt and convert as appropriate to the designations and grading structure provided in the scheme of service though they may not be in possession of the requisite minimum qualifications and/ or experience prescribed. For advancement to higher grades however, officers must be in possession of the prescribed minimum qualification and experience required for appointment to the grade.

5. PROVISION OF POSTS A scheme of service does not constitute authority for creation or upgrading of post(s).Any additional post(s) required under the new grading structure must be included in the Ministrys establishment proposals for consideration and approval by the Principal Secretary, Ministry of State for Public Service.

6. ENTRY INTO THE SCHEME OF SERVICE 6.1 Direct Appointment Direct appointment will normally be made to the grade of Medical Officer (Intern), Job Group N. In exceptional circumstances, however, direct appointment may be made beyond this grade by the Public Service Commission on the recommendation of the Principal Secretary, Ministry of Health and in consultation with the Principal Secretary, Ministry of State for Public
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Service, provided the candidate is in possession of the minimum qualifications and experience required for appointment to the grade.

6.2 Incremental Credit Incremental credits for approved experience acquired after obtaining the prescribed minimum qualifications may be awarded at the rate of one increment for each completed year of approved experience, provided that the maximum of the scale is not exceeded. In awarding incremental credit(s), any period of service or experience stipulated as a basic requirement for appointment to a particular grade will be excluded.

7. ADVANCEMENT WITHIN THE SCHEME OF SERVICE The scheme of service sets out the minimum qualifications and / or experience required for advancement from one grade to another. It is emphasized, however, that these are minimum requirements entitling an officer to be considered for appointment to the next grade. In addition, advancement from one grade to another will depend on: (a) Existence of a vacancy in the authorized establishment; (b) Merit and ability as evidenced in work performance and results; (c) Recommendation by the Director-General of Health and Principal Secretary, Ministry of Health; (d) And approval by Public Service Commission.

8. RECOGNIZED QUALIFICATION The following are the recognized qualifications for the purpose of this Scheme of Service:8.1 Bachelor of Medicine and Bachelor of Surgery (M.B;Ch.B.) degree or its equivalent degree from a university or institution recognized in Kenya; 8.2 Master of Medicine (M.MED.) degree in any specified field in health (e.g. Peadiatrics, Obstetrics & Gynecology, etc) or its equivalent degree from a university or institution recognized in Kenya; 8.3 Post-graduate Certificate or Diploma, Masters degree or Doctorate in any subspecialty (e.g. Orthopedics, Neurosurgery, Nephrology, Cardiology, Tropical Medicine, Urogynecology, Health Systems Management, International Public Health, etc) whose training duration is three (3) months or more and is recognized by the Medical Practitioners and Dentists Board;

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8.4 A leadership or managerial course lasting not less than four (4) weeks from a institution recognized in Kenya, e.g. Strategic Leadership Development; 8.5 Such other equivalent qualifications as may be recognized by the Medical Practitioners and Dentists Board and / or Ministry of State for Public Service.

9. IMPLEMENTATION OF THE SCHEME The Scheme of Service will become operational with effect from July 1, 2012. The Principal Secretary of the Ministry of Health shall be the administrator and, on implementation, all serving officers will automatically become members of the Scheme.

10. JOB AND APPOINTMENT SPECIFICATIONS 10.1 Medical Officer II (intern), Job Group N (a) Job Summary This is the entry grade into this cadre under the scheme of service. During this one (1) year period of internship or pre-registration training, the newly qualified Medical Officer Intern will work under supervision of recognized Specialists / Consultants and is expected to cover various disciplines of medical care including but not limited to Internal Medicine, Psychiatry, Pediatrics, Obstetrics & Gynecology, General Surgery, Orthopedics, (and, where possible, ENT surgery and Ophthalmology, etc).

Key Result Areas (KRA) KRA 1: Diagnosis, Care and Treatment of Patients 1. Clerk, examine, investigate, care and monitor treatment of disease conditions for both outpatients and inpatients in the various disciplines; 2. Respond to all calls of duty, whether emergency or otherwise; 3. Observe timeliness in service delivery at all times; 4. Provide counseling to both patients and their relatives; 5. Generate patients records and information on their health status. 6. Attend all clinical meetings. Standards of Performance
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1. Duty Rota Adhere to all duty rosters made. 2. Major Ward Rounds, Theatre Days and Clinical Meetings Specialists to countercheck participation of the officers during these sessions. 3. Internship Logbook All surgical procedures to be recorded in the logbook. 4. Patients Medical Records Maintain proper legible patients records in their cards and files. 5. Validation Confirmation during supervision and countersigning of the officers logbook wherever necessary. 6. Frequency As prescribed by the Consultants in their various clinical areas. KRA 2: Medicines, Medical Equipment / Instruments Management 1. Identify and report, in collaboration with all relevant health workers, medicines, medical equipment / instruments at the duty station; 2. Use medicines, equipment / instruments rationally. Standards of Performance 1. Medicines, Medical equipment / instruments register : Ensure it is always up-to-date. 2. Validation: Register to be countersigned by the supervisor monthly. KRA 3: Provision of Health Education 1. Provide education for prevention of disease and promotion of health; 2. Participate in outreach health activities. Standards of Performance 1. Logbook: Maintain the logbook sections for health education and outreach activities; 2. Validation: All sessions held and activities carried out must be countersigned by the immediate supervisors for confirmation at the end of the rotation. 3. Frequency: All interns must undertake the above activities monthly. KRA 4: Registration 1. Ensure properly filled and countersigned logbook of all activities undertaken throughout the internship period. the status of

Standards of Performance 1. Logbook: Logbook properly signed 2. Internship Forms: Forms properly signed and forwarded to the Medical Practitioners and Dentists Board (MPDB) for registration upon satisfaction of the supervisors.
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3. Validation: Due registration of the Medical Officer in the MPDBs register and the Kenya Gazette. (b) Requirements for Appointment For appointment to the grade of Medical Officer (intern), candidates must have: (i) Academic Qualification: A Bachelor of Medicine and Bachelor of Surgery (M.B;Ch.B.) degree or its equivalent degree from a university or institution recognized in Kenya; (ii) Initiative: Ability to work under pressure and with supervision. (iii) Conduct: Respect for seniors, colleagues, patients and others. (iv) Advancement to the higher grade : This will depend on the officers personal and professional conduct and, upon satisfaction of the supervisors, registration of the Medical Officer by the Medical Practitioners and Dentists Board and publication in the Kenya Gazette.

10.2 Medical Officer (MO) I, Job Group P (a) Job Summary Work at this level involves management of a wide range of services in Level II (health centers), III (hospitals) and IV health facilities (national health institutions) in communities and the courts. (i) In Level III and IV Hospitals where interns exist : Besides Second-On-Call duties, Medical Officers should conduct (minor) teaching ward rounds (with interns), perform certain specified emergency surgeries, (both minor and major) and should be available whenever called, to physically review the patients and instruct, in writing, all his recommendations. He should supervise and mentor interns. He should also assist the specialist in all wards, theatres, and clinics. MOs should also undertake medico-legal duties (which include filling of P.3 forms, performance of post mortems, undertaking of medical examinations, writing medical reports and medical board proceedings, court attendances, etc) and outreach services . (ii) In Level III and IV Hospitals where there are no interns : In these smaller hospitals, Medical Officers are expected to undertake First/Second-On-Call duties: he should clerk, investigate, and manage patients accordingly, should conduct, at least, 1 clinic day and 1 theatre day every week for all follow-ups and surgical cases that he can manage on his own, the rest are referred. If the M.O. in such a hospital is the in-charge and in the absence of a Senior Medical Officer (under special circumstances), he is expected to offer good leadership and manage all other health workers, arrange and chair, regularly, teaching clinical and administrative meetings and ensure all data and information is collected, transmitted and utilized to benefit the customer and service provider as is necessary. (i) Key Result Areas in Level III and IV Hospitals where Interns exist
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KRA 1: Second-on-Call Duties on Patient Care 1. Respond to all calls of duty by the intern doctor or nurse on-duty, whether emergency or otherwise, as quickly as possible; 2. Physically review all patients and instruct, in writing, all the recommendations; 3. Assist the consultant in all wards, theatres, and clinics 4. Observe timeliness in service delivery at all times. Standards of Performance 1. Duty Rotas Adhere to all duty rotas made. 2. Validation Every review of a patient must be recorded in the patients card or file for counterchecking by the specialist whenever necessary. KRA 2: Minor Teaching Ward Rounds and Theatre Work 1. Conduct teaching ward rounds with the interns and students rotating in the clinical area whenever the specialist is not there. 2. Undertake certain specified emergency surgeries, minor or major, with the assistance of the intern doctor(s) or student(s). Standards of Performance 1. Inpatient files and Theatre books : All work done must be entered in the patients files and the operations book in theatre. KRA 3: Medico-legal Duties 1. Fill P.3 forms; 2. Perform post mortems (PMs) and duly fill PM forms; 3. Undertake medical examinations and certify physical fitness; 4. Attend to court cases. Standards of Performance 1. P.3 Register - Maintain the register for recording all P.3 forms filled; 2. PM Register - Maintain the register for all postmortems done; 3. Medical Examinations Register - Maintain the register for recording all medical examinations undertaken be the medical officer; 4. Register for all Court Summons Maintain the register of all police bonds and court orders delivered and duly signed. 5. Validation All P.3 forms filled, PMs done, Medical Examinations and Court Summons attended to be recorded accordingly and counterchecked by the Medical Superintendent of the hospital. KRA 4: Provision of Health Education 1. Provide education for prevention of disease and promotion of health;
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2. Participate in outreach health activities. Standards of Performance 1. Outreach Activities Register: Maintain the register for health education and outreach activities; 2. Validation: All sessions held and activities carried out must be countersigned by the Medical Superintendent of the hospital. 3. Frequency: All Medical Officers must undertake the above activities monthly and/or whenever they are required to. (ii) Key Result Areas in Level IV Hospitals where there are no Interns KRA 1: First-On-Call duties on Patient Care 1. Respond to all calls of duty by the clinical officer or nurse on-duty, whether emergency or otherwise, as quickly as possible if living in the hospital compound, or perhaps within 20-30 minutes if living outside the hospital; 2. Physically review all patients and instruct, in writing, all the recommendations on patient care and treatment; 3. Conduct 1 clinic day and 1 theatre day every week for all follow-ups and new cases that he can manage on his own, the rest are referred; 4. Observe timeliness in service delivery at all times. Standards of Performance 1. Duty Rotas Adhere to all duty rotas made. 2. Inpatient files and Theatre books : All work done must be entered in the patients files and the operations book in theatre. 3. Validation Every review of a patient must be recorded in the patients card or file for safe custody and counterchecking whenever necessary; timeliness will be assessed during supportive supervision by the Medical Superintendent. KRA 2: Hospital Administration 1. Offer good leadership and manage all other health workers in the hospital if the M.O. in such a Level IV hospital is the in-charge and in the absence of a more senior Medical Officer (under special circumstances); 2. Arrange and chair, regularly, teaching clinical and administrative meetings Standards of Performance 1. 2. 3. 4. 5. Performance Contract Scoring Sheets - These must be filled regularly Hospital Reforms Scoring Sheets - These must be filled regularly Annual Work Plans These must be adhered to as planned FIF Summary Sheets - These must be filled regularly Validation The above documents must be kept safely for validation during supportive supervision.
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6. Frequency Reports must be submitted monthly / quarterly, whichever is applicable. KRA 3: Health Records and Information Management 1. Ensure safe custody of all health records and information generated in the hospital. 2. Ensure all data and information so collected is transmitted and utilized to benefit policy formulation and planning, the service providers and customers as is necessary. Standards of Performance 1. Monthly, Quarterly and Annual Reports Ensure these reports are submitted by the 5 th day of every month, quarter and new year. 2. Validation All records must be counterchecked by the County Director of Health and upon submission, by the Chief Health Records and Information Officer at the Headquarters. 3. Frequency Reports must be made monthly, quarterly and annually, whichever is applicable depending on the type of report. (b) Requirements for Appointment The Medical Officer enters Job Group P if: (i) Experience: He satisfies the consultants at the end of internship and gets registered by the Medical Practitioners Board and is recommended by a Director of Medical Services and PS / Ministry of Health and approved by the PS / Directorate of Personnel Management and the Public Service Commission. (ii) Capability: He has shown merit and ability as reflected in work performance results. (iii) Initiative: Ability to work without supervision (iv) Conduct: Respect for gender and diversity. (v) Advancement to the higher grade : will depend on personal and professional conduct, must have served for at least two (2) years, and is retained as a general medical practitioner by the Medical Practitioners and Dentists Board. 10.3 Senior Medical Officer (SMO), Job Group Q (a) Job Summary Work at this level involves all the duties of a Medical Officer and additional responsibility in teaching, consultation, and surgery in Level III, IV and V health facilities and administration in all Level III and some Level IV hospitals only. The officer is more experienced and skilled, is introduced to results-based management and performance contracting, health systems management, quality of care, regulation of standards and program management; he is therefore a leader and manager in his own right. In addition, responsibilities include organizing, planning, monitoring and control of all resources at hospital and program level, including finances, infrastructure, commodities, human resource and data & information.

Key Result Areas (KRA)

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KRA 1: Clinical and Administrative Duties 1. All the duties of a Medical Officer; 2. Additional responsibility in teaching, consultation, and surgery in Level III, IV and V health facilities, and administration in all Level III and some Level IV hospitals only; 3. Organizing, planning, monitoring and control of all resources at hospital and program level, including finances, infrastructure, commodities, human resource and health records and information. Standards of Performance 1. Monthly, Quarterly and Annual Reports Ensure these reports are submitted by the 5 th day of every month, quarter and new year. 2. Validation All records must be counterchecked by the County Director of Health and upon submission, by the Chief Health Records & Information Officer at the Headquarters; all hospital units must be functional all the time. 3. Frequency Reports must be made monthly, quarterly and annually, whichever is applicable depending on the type of report. (b) Requirements for Appointment. For appointment to the grade of Senior Medical Officer, the officer must: (i) Experience: Have served as Medical Officer for, at least, two (2) years; with demonstrable skills and experience in the various clinical areas; (ii) Capability: Have demonstrated ability, initiative and professional competence in work performance and results; (iii) Initiative: Be innovative and able to work without supervision; (iv) Advancement to the higher grade: This will depend on personal and professional conduct, must have served for at least two (2) years in the current grade, and is retained as a medical practitioner by the Medical Practitioners and Dentists Board. 10.4 Assistant Director of Medical Services / Medical Specialist II, Job Group R (a) Job Summary As an Assistant Director of Medical Services / Medical Specialist II , one undertakes all duties of a Senior Medical Officer as prescribed above. However, he is more skilled and experienced to perform more administrative functions in larger Level IV hospitals. As a Medical Specialist in Internal Medicine, Obstetrics & Gynecology, General Surgery, ENT Surgery, Ophthalmology, Psychiatry, Anaesthesia, Paediatrics, Pathology, Radiology, Public Health, or other speciality recognized by the Board, one undertakes clinical and administrative duties and provision of specialized services in his own speciality and guides and teaches young Medical Officers and technical support cadres in the management of various conditions in his discipline. He also assists the senior specialist if present in his field. If alone, the Medical Specialist is also the one responsible for the management of departmental stores including
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essential medicines and/or plant and equipment. He is expected to support the Medical Superintendent / Administrator in all various levels of administration. Key Result Areas (KRA) KRA 1: Clinical and Administrative Duties 1. All duties of a Senior Medical Officer as prescribed above 2. Guidance and teaching of young Medical Officers and technical support cadres in the management of various conditions in his discipline and assists the senior specialist if present in his field 3. Management of departmental stores including medicines and/or plant and equipment 4. Support to the Medical Superintendent in all various levels of administration.

Standards of Performance 1. Ward Rounds, Theatres, and Clinics : Record all clinical notes on patients disease conditions in the files and cards; 2. Departmental Inventory: Maintain all inventories of departmental stores including medicines and/or plant and equipment; 3. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital. 4. Validation and Frequency: All patients notes, hospital reports, inventories and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required; all hospital units must be functional all the time.

(b) Requirements for Appointment For appointment to this grade, the officer must: Either: (i) Experience: Have served in the grade of Senior Medical Officer for at least five (5) years; with demonstrable skills and experience in the various specialized clinical areas; (ii) Capability: Have demonstrated ability, initiative and professional competence in work performance and results in his own field; Or: (i) Academic Qualification: Have obtained a Master of Medicine (M.MED.) degree in any specified field (e.g. Paediatrics, Obstetrics & Gynecology, etc as indicated earlier) or its equivalent degree from a recognized university or institution in Kenya; (iii) Training: Skill to design, carry out and evaluate training;
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(iv)

Research: Skill to design and carry out operational research, analyze and utilize research findings in planning activities to improve service delivery. (v) Advancement to the higher grade will depend on personal and professional conduct, must have served for at least two (2) years in the current grade, is recognized and retained as a specialist in his own field by the Medical Practitioners and Dentists Board.

10.5 Sen Assist Dir of Med Services / Medical Specialist I, Job Grp S (a) Job Summary Either Duties and responsibilities at this level will be similar to those of Assistant Director of Medical Services / Medical Specialist II and will cover divisions / departments / sections at facility level, district, province or national level in the specialized area of clinical practice. The officer will be expected to provide the necessary guidance, training and development of professional and technical staff in clinical practice in his own area and support services in other areas, as a clinician; Or The officer, upon induction, can also be confirmed in appointment to a position of administration, namely: head of department, the Medical Superintendent, District Medical Services Officer or District Medical Officer of Health at district level. He can assist at county level and / or program level. Responsibilities may involve activities such as planning and management of national healthcare programs at the implementation level directed towards the improvement of health services in the country; or developing intervention activities or programs for the training of other health cadres in the field of community health and health management, as an administrator.

Either Key Result Areas for Clinicians KRA 1: Clinical and Administrative Duties 1. All duties of a Medical Specialist as prescribed above; 2. Provision of the necessary guidance, training and development of professional and technical staff in clinical practice in his own area and support services in other areas. 3. Management of departmental stores including medicines and/or plant and equipment 4. Support to the Medical Superintendent in all various levels of administration. Standards of Performance

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1. Ward Rounds, Theatres, and Clinics : Record all clinical notes on patients disease conditions in the files and cards; 2. Departmental Inventory: Maintain all inventories of departmental stores, and / or plant and equipment; 3. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital. 4. Register for Outreach Services: Ensure briefs on all outreach activities and services are entered in the register and lessons learned are addressed accordingly; 5. Validation and Frequency: All patients notes, hospital reports, inventories and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required; too, all hospital units must be functional all the time.

Or Key Result Areas for Administrators KRA 1: Health Administration at District Level 1. As Medical Superintendent / District Medical Services Officer 1.1. Overall general hospital administration; 1.2. As the hospital accounting officer; 1.3. Overall coordination of medical services in all government hospitals and private health facilities in the zone. 1.4. Management and development of various cadres of facility human resources; 1.5. Coordination of all outreach activities and services in the zones; 1.6. Designing and undertaking, at least, operational research, if not other types; 1.7. And analyzing and utilizing the research findings in planning activities to improve service delivery in the facility, and / or region at large. Standards of Performance 1. Performance Contract Scoring Sheets - These must be filled regularly, 2. Hospital Reforms Scoring Sheets - These must be filled regularly, 3. Annual Work Plans These must be adhered to as planned, 4. FIF Summary Sheets - These must be filled regularly, 5. Hospital Inventory: Maintain all health facility inventories of buildings, stores, plant and equipment; 6. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital. 7. Validation The above documents must be kept safely for validation during supportive supervision. 8. Frequency Reports must be submitted monthly, quarterly, of annually, whichever is applicable. 2. As District Medical Officer of Health
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2.1. Overall superintendent of all health centers, dispensaries and community health units in the district; 2.2. Overall public health and sanitation services manager; 2.3. Overall primary health care manager in the district; 2.4. As the district health accounting officer; 2.5. Management and development of various cadres of facility human resources; 2.6. Designing and undertaking, at least, operational research, if not other types; 2.7. And analyzing and utilizing the findings in planning activities to improve service delivery. Standards of Performance 1. Monthly, Quarterly and Annual Reports : Ensure all reports are secure and submitted in time for policy information, proper planning, implementation, monitoring and evaluation of service delivery and regulation. 2. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital. 3. Register for Outreach Services: Ensure briefs on all outreach activities and services are entered in the register and lessons learned are addressed accordingly; 4. Validation and Frequency: All facility reports, inventories and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required; too, all facility units must be functional all the time. KRA 2: As an Assistant at County Level or at Program Level or Divisional Level at the Ministry Headquarters: Roles and responsibilities of the officer at this level are dependent on the nature of deployment and the standards of performance are therefore set to measure the performance of the incharge based on his Performance Contract indicators and other duties as are delegated. Standards of Performance 1. Performance Contract Scoring Sheets - These must be filled regularly, 2. Annual Work Plans These must be adhered to as planned, 3. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital. 4. Validation The above documents must be kept safely for validation during supportive supervision. 5. Frequency Reports must be submitted monthly, quarterly, of annually, whichever is applicable.

(b) Requirements for Appointment For appointment to this grade, the officer must: (i) Experience: Have served as Assistant Director of Medical Services / Medical Specialist II for, at least, two (2) years, and is recognized and retained as a specialist by the Board; (ii) Capability: Have demonstrated ability, initiative and professional competence in work performance and results in his own field at this level;
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(iii) (iv)

Training: Have the requisite skill to design, carry out and evaluate training; Research: Have the requisite skill to design and carry out operational research, analyze and utilize research findings in planning activities to improve service delivery. (v) Advancement to the higher grade will depend on personal and professional conduct, must have served for, at least, two (2) years in the current grade and must have acquired further training relevant to the improvement of work performance for, at least, 3 months, either in a relevant subspecialty or in health administration. 10.6 Dpy Dir of Med Serv / Dpy Chief Med Specialist, Job Grp T (a) Job Summary Either Duties and responsibilities at this level will be similar to those of Senior Assistant Director of Medical Services / Medical Specialist I and will cover divisions / departments / sections at facility level, district, county or national level in the specialized area of clinical practice. The officer will also be expected to provide the necessary guidance, training and development of support services to professional and technical staff in clinical practice in his own speciality. He should also, in addition, offer subspecialized services to patients with the expected expertise and guidance and mentorship to his junior colleagues in his field. The officer is expected to encourage, initiate and participate in research, operational or otherwise, and utilize research findings to improve the quality of service delivery in the region as clinicians.

Or If further trained in health systems management, the officer can be appointed to the office of Program Director, or Head of Division / Department at Headquarters. Responsibilities may involve activities such as planning and management of national healthcare programs at the national level directed towards the improvement of health services in the country; or management of projects or programs that may be developed from time to time by the Ministry for purposes of strengthening and enhancing the healthcare delivery system; or developing intervention activities or programs for the training of other health cadres in the field of community health and health management at district level. At the Headquarters, he supports the directors of Medical Services heading the various directorates in policy formulation and strategic planning, procurement of public health commodities, human resource (for health) management & development, monitoring and evaluation of health functions at lower levels, and are introduced to resource mobilization and partnership development amongst other ministerial functions. Officers at this level may, at one time, be assigned to special duties as members of task forces or technical working groups and, other times, represent the directors or the Director-General in certain meetings as administrators. Either Key Result Areas for Clinicians

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1. Professional guidance, training and development of support services to professional and technical staff in clinical practice in his own speciality; 2. Provision of subspecialized services to patients with the expected expertise and guidance and mentorship to his junior colleagues in his field; 3. Participate in outreach activities and services in the counties and districts; 4. Advocacy, initiation and participation in research, operational or otherwise, and utilization of research findings to improve the quality of service delivery in the region. 5. Assisting the County Director of Health in coordination of specialized service delivery in the county. Standards of Performance 1. Ward Rounds, Theatres, and Clinics : Record all clinical notes on patients disease conditions in the files and cards; 2. Departmental Inventory: Maintain all inventories of departmental stores, and / or plant and equipment; 3. Minutes of Meetings: Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the hospital and province at large. 4. Register for Outreach Services: Ensure briefs on all outreach activities and services are entered in the register and lessons learned are addressed accordingly; 5. Register of Research Questions and Findings : Ensure all research questions and findings are, not only disseminated appropriately, but also kept for perusal and implementation of the recommendations is undertaken accordingly. 6. Validation and Frequency: All patients notes, hospital reports, inventories and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required; too, all hospital units must be functional all the time. Or Key Result Areas: Health Administration at County Level 1. As County Directors of Health, Assisting 1.1 Overall coordination and regulation of health (medical, public health and sanitation) and related services in all government and non-governmental health facilities in the county; 1.2 Management of all health workers in the county in collaboration with the relevant arms of the county and national governments; 1.3 Coordination of all governmental and nongovernmental partnerships in the health sector at county level; 1.4 Facilitation of implementation of all ministerial policies, programs and functions at county level; 1.5 Amalgamation and dissemination of all relevant health data and information to and from the county in line with the ministerial vision, mission, goals and strategic objectives. Standards of Performance
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1. Monthly, Quarterly and Annual Reports : Ensure all reports are secure and submitted in time for policy information, proper planning, implementation, monitoring and evaluation of service delivery and regulation. 2. Facility Inventories: Maintain all health facility inventories of vehicles, buildings, stores, plant and equipment; 3. Minutes of Meetings: Ensure minutes are taken during meetings and kept for perusal to enhance continuity of governance in the facilities. 4. Validation and Frequency: All facility reports, inventories and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required. (b) Requirements for Appointment For appointment to this grade, the officer must: (i) Experience: Have served as Senior Assistant Director of Medical Services / Medical Specialist I for, at least, two (2) years and is recognized and retained as a specialist in his own field by the Medical Practitioners and Dentists Board; (ii) Professional Qualification : Or have acquired further training relevant to the improvement of work performance for, at least, 3 months, either in a related subspeciality or in health systems management; (iii) Capability: Have demonstrated ability, initiative and professional competence in work performance and results at this level; (iv) Training: Skill to design, carry out and evaluate training; (v) Research: Skill to design and carry out operational research, analyze and utilize research findings in planning activities to improve service delivery. (vi) Advancement to the higher grade will depend on personal and professional conduct, must have served for at least two (2) years in the current grade and must have attended a managerial course lasting not less than four (4) weeks from a recognized institution. 10.7 Snr Dpy Dir of Med Serv / Snr Dpy Chief Med Specialist, Job Grp U (A) Job Summary Either For Clinicians Responsibility at this level involves providing specialized opinion in the relevant areas of (sub) specialization at the national and county level. The officer is expected to provide national guidelines for standards of health care in the relevant (sub) specialization for both clinical and community health practice at the Ministry. The officer is also expected to give training to the support (professional and technical) personnel, and participate in the development of national plans and programs in the Ministry. Or
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For Administrators The officer shall assist Directors of Medical Services / Chief Medical Specialists in the planning and management of health care delivery system in the country or dealing with specified broad areas of healthcare; or, assisting in the formulation of national policies and plans directed towards the overall development of health services in the country. He qualifies for appointment to, for example, to head a Directorate, e.g. of Mental Health and Substance Abuse, of Family Health, Clinical and Rehabilitative Services, and such specialized offices. Key Result Areas for Clinicians 1. Provision of specialized opinion in the relevant areas of (sub) specialization at the national and county level; 2. Provision of national clinical guidelines for standards of health care in the relevant (sub) specialization for both clinical and community health practice at the Ministry 3. Training to the support (professional and technical) personnel, and participation in the development of national plans and programs in the Ministry; 4. Advocacy, initiation and participation in research, operational or otherwise, and utilization of research findings to improve the quality of service delivery in the region. Standards of Performance 1. Ward Rounds, Theatres, and Clinics : Record all clinical notes on patients disease conditions in the files and cards in the national / provincial hospital; 2. Inventory: Facilitate the maintenance of all inventories of departmental stores, and / or plant and equipment; 3. Minutes of Non-clinical Meetings : Ensure minutes are taken during all meetings, delegated or otherwise, and kept for perusal to enhance continuity of governance in the national / provincial hospital; 4. Register of Clinical Meetings: Ensure coverage of all key and thematic topics in grand clinical meetings in the hospitals; 5. National Clinical Guidelines: Ensure all relevant clinical guidelines are formulated and reviewed regularly and implemented at all times of service delivery; 6. Register of Research Questions and Findings : Ensure all research questions and findings are, not only disseminated appropriately, but also kept for perusal and implementation of the recommendations is undertaken accordingly. 7. Validation and Frequency: All patients notes, hospital reports, inventories, registers and minutes of meetings must be safe and available for scrutiny by supervisors from higher levels as and whenever required; too, all departmental / divisional units must be functional all the time. Key Result Areas for Administrators 1. Assisting the Directors of Medical Services / Chief Medical Specialists in the formulation of national policies and plans directed towards the overall development of health services in the country 2. Assisting in the planning and management of health care delivery system in the country or dealing with specified broad areas of healthcare;
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Standards of Performance 1. Schedules of meetings: Ensure calendar of regular meetings is adhered to at all times and minutes are taken during meetings and kept for perusal to enhance consistency and continuity of policy formulation and strategic direction; 2. Documents: Ensure policy statements, strategic plans, cabinet papers, national guidelines, ministerial circulars, etc are well done and communicated appropriately for dissemination of correct messages; 3. Representation: Ensure satisfactory representation of the office of the Chief Medical Officer / Chief Medical Specialist as and whenever required. (b) Requirements for Appointment For appointment to this grade the officer must: (i) Experience: Have served at the level of Deputy Director of Medical Services / Deputy Chief Medical Specialist for, at least, two (2) years, and is recognized and retained as a specialist in his own field by the Medical Practitioners and Dentists Board; (ii) Professional Qualification : Have attended a managerial course lasting not less than four (4) weeks from a recognized institution and shown competence; (iii) Capability: Have demonstrated administrative ability, initiative and professional competence in work performance and results at this level; (iv) Projection: A thorough understanding of the global, regional, and national developmental goals, policies and programs and the ability to relate them to the health ministrys functions; (v) Management: Skill to plan, organize, co-ordinate, direct and control operations at ministerial, departmental, divisional and program level; (vi) Influence: Ability to convince and obtain cooperation from others; (vii) Decision-making: Skill to carry out situational analysis, way options and select the most appropriate and feasible; (viii) Integrity: Quality of being honest, non-corrupt and morally upright; (ix) Diligence: Quality of being thorough and able to work under pressure and long hours (after-hours and at odd hours).

10.8 Director of Medical Services / Chief Medical Specialist, Job Group V (A) Job Summary The Director of Medical Services / Chief Medical Specialist is responsible to the DirectorGeneral in the Ministry for the organization, control and coordination of all forms of health services at national level. Overall responsibility entails overall planning, direction and development of health services including promotive, preventive, curative and rehabilitative services. Work at this level also involves provision of specialized opinion in the relevant areas of specialization at the national level. The officer is expected to provide national guidelines for standards of healthcare in the relevant specialization for both clinical and community health practice. The officer is also expected to give training to the support professional and technical personnel, and participate in the development of national plans and programs in the Ministry.
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The officers will advice on all forms of alternative medicine and their integration with conventional medicine for the future development of medical practice in the country. Directors of Medical Services / Chief Medical Specialists can be appointed to head national health institutions including and not limited to the current Level VI (teaching & referral) hospitals, the Kenya Medical Supplies Agency, or even be registrar(s) of the Medical Practitioners and Dentists Board. They can also be appointed to head the various directorates. Key Result Areas 1. 2. 3. 4. 5. 6. Advice on overall planning, direction and development of health services including promotive, preventive, curative, rehabilitative and related services; Advice on all forms of alternative medicine and their integration with conventional medicine for the future development of medical practice in the country; Provision of specialized opinion in the relevant areas of specialization at the national level; Provision of national guidelines for standards of healthcare in the relevant specialization for both clinical and community health practice; Training to the support professional and technical personnel; Participation in the development of national plans and programs in the Ministry.

Standards of Performance 1. Advice: There must be regular briefing to the Health Secretary on the status of health functions and services at national level, especially on the emerging challenges; 2. Specialized Opinion: The officer must be readily available to give specialized opinion whenever required; 3. Direction: Clear guidelines must be given for all relevant areas during development of new and review of existing clinical guidelines; 4. Training: The officer must be readily available to train support professional and technical personnel to enhance their capacity; 5. Leadership and Management: The officer must participate ably in the development of national policies, strategic plans, programs and specialized tasks in the Ministry. (b) Requirements for Appointment For appointment to this grade, the officer must: (i) Experience: Have served at the level of Senior Deputy Director of Medical Services / Senior Deputy Chief Medical Specialist for, at least, two (2) years, and is recognized and retained as a specialist in his own field by the Board; (ii) Professional Qualification : Have attended a managerial course lasting not less than four (4) weeks from a recognized institution and shown competence; (iii) Capability: Have demonstrated administrative ability, initiative and professional competence in general organization and management of health services at this level; (iv) Projection: A thorough understanding of the global, regional, and national developmental goals, policies and programs and the ability to relate them to the health ministrys mandate; (v) Knowledge: Be familiar with government regulations relevant to health;
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(vi)

Management: Skill to plan, organize, co-ordinate, direct and control operations at ministerial, departmental, divisional and program level; (vii) Influence: Ability to convince and obtain cooperation from others; (viii) Decision-making: Skill to carry out situational analysis, way options and select the most appropriate and feasible; (ix) Integrity: Quality of being honest, non-corrupt and morally upright; (x) Diligence: Quality of being thorough and able to work under pressure and long hours (after-hours and at odd hours). (xi) Advancement to the next grade will depend on Executive Powers entrenched in the Constitution. 10.9 Director-General (D-G), Job Group W (A) Job Description This office must be entrenched in a revised Kenyan Health Law or otherwise legislated for. The Director-General is the overall custodian of the health of all citizens in the country. He is the overall head of the technical arm of the Health Ministry and, therefore, the chief Government Health Advisor on issues relating to all health statutes, their interpretation, implication and application. The officer is answerable to the Principal Secretary for executing the following roles: interlinkage and integration of the technical arm with the administrative and political arms of the Ministry, effective coordination of all the activities of the technical health services, spearheading and overseeing the formulation and implementation of health policies and programs, resource mobilization for ministerial development plans, and hence assists the Principal Secretary and the Cabinet Secretary to realize the countrys ministerial vision, mission and goals in the overall provision of health services in the country. Key Result Areas 1. Advice: Serve as the chief advisor on all health statutes, their interpretation, implication and application; 2. Inter-linkage and integration of the technical arm with the administrative and political arms of the Ministry; 3. Coordination of all the activities of the technical health services; 4. Spearheading and overseeing the formulation and implementation of all health policies, strategic plans and programs; 5. Resource mobilization for ministerial development plans with the assistance of the Principal Secretary. Standards of Performance 1. Compliance: Ensure that all health activities in the country must comply with the health statutes as entrenched in the Constitution; 2. Responsiveness: All sensitive health issues of public concern must be handled with integrity, due diligence and speed; 3. Planning, Organizing and Coordinating : All activities of the technical health services must be performed in conformity with set plans, schedules, targets, budgets, and to the highest standards possible in order to achieve desired ministerial goals and objectives;
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4. Governance: All deviations from plans, schedules, targets, budgets, and standards must be promptly detected and remedies undertaken forthwith. (b) Requirements for Appointment For appointment to this grade, the officer must: (i) Experience: Have served as Director of Medical Services / Chief Medical Specialist or in a comparable and relevant position in the Public Service for at least three (3) years or in an equivalent position in the wider public (health) sector, national or international or private health sector for at least five (5) years. (ii) Academic Qualification: Have obtained, at least, a Master of Medicine (M.MED.) degree in any specified field (e.g. Pediatrics, Obstetrics & Gynecology, Public Health, etc) or its equivalent from any university or institution recognized in Kenya; (iii) Professional Qualification: Have attended a managerial course lasting not less than four (4) weeks from a recognized institution and shown competence; (iv) Knowledge: Be familiar with emerging global, regional, and country health policy issues, success levels of various strategies suitable for the country, and all related health statutes; (v) Management: Be able to articulate the vision of the health sector, exercise leadership and cultivate working relationships and sustainable development with stakeholders; (vi) Influence: Ability to convince and obtain cooperation from others; (vii) Decision-making: Skill to carry out situational analysis, way options and select the most appropriate and feasible; (viii) Integrity: Quality of being honest, non-corrupt and morally upright; (ix) Diligence: Quality of being thorough and able to work under pressure and long hours (after-hours and at odd hours). (x) Appointment to this post should be competitive, and selected officers should be vetted by parliament in order to meet national expectations.

Footnote 10.10 Contractual Services to Retired / Foreign Medical Officers 1) Should be duly qualified and registered by the Medical Practitioners and Dentists Board
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2) Must have demonstrated ability, initiative and professional competence in work performance and results 3) Must have scarce skills 4) Should be medically fit 5) His deployment should address national / county interest 6) No age limit

Revised by: 1. 2. 3. 4. Dr. David Kiima Director of Mental Health and Substance Abuse Dr. John Wekesa Head of Surgical and Rehabilitative Services Department Dr. Simon Mueke Head of Obstetric and Gynecological Services Division Dr. Izaq Odongo Head of Internal Medicine Divison

Headquarters, Ministry of Medical Services Afya House, P.0 Box 30016, Nairobi 00100, KENYA

Dated: December 2011 Effective: From July 2012

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