In sub-saharan africa,<unk> s are clinicians who are trained and licensed to provide primary healthcare services. In kenya they developed as a separate profession in the 1920s when kenya was still a british colony to provide healthcare services to the native population. Their training was thus focused on the diagnosis and management of  local health problems which were mostly infectious diseases such as malaria and diarrhea. They also learned to diagnose the more serious cases and to refer them appropriately. They were mostly trained on the job in hospitals and had titles such as hospital assistant, medical assistant etc.
After kenya gained independence in 1963 their training was formalised and standardised, following a compressed medical model. In 1989 the<unk> s (training registration and licensing) act was passed and hence the profession entrenched in the constitution. They were mandated to prepare legal documents eg medical certificates and fill P3 forms and to produce evidence in a court of law. The act abolished all previous titles and henceforth only the title<unk>  was legally recognised.
However the term registered<unk>  (RCO), who were the crème of the profession, was in common use and has persisted to date, even in official documents.
In other countries such as malawi, this cadre was introduced in the 80s as a temporary solution to the shortage of medical doctors. Contrary to the situation in kenya,<unk> s are often the sole care providers for a whole district and are trained to take on the full functions of a medical doctor including emergency surgical procedures such as caeserian section and laparatomies.
Clinical officer
Medical technologist
Medical laboratory assistant
Nurse
Clinical nurse leader
Registered nurse
Mental health professional
Nurse practitioner