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HEAT Programme

Health Education and Training (HEAT)

NCDE Clinical Officer Upgrade, Tanzania



Programme Title: National Centre for Distance Education

Clinical Ass't to Clinical Officer Upgrade, MCH Ass't to Enrolled Nurse Upgrade



Programme Overview


Global Location (s)

Morogoro, Tanzania


Provider Nation



Partner Nation (s)



Provider Institution

National Centre for Distance Education


Partner Institutions (eg technical support, donors funders)

Irish Aid

Ministry of Health and Social Welfare – Tanzania

Aga Khan Foundation

Cardiff University, UK

University of London School of Distance Learning



Programme Details


Year of Commencement

2000 Clinical Assistant to Clinical Officer Programme

2007 Maternal and Child Health Assistant to Enrolled Nurse Programme


Target Audience

The Clinical Assistant upgrade programme, is designed to upgrade Clinical Assistants to Clinical Officers.


For the Maternal and Child Health Upgrade, the target population is Maternal and Child Health Assistants, a cadre that is being phased out by the MoHSW. The MoHSW recently approved acceptance into the programme of medical attendants and nursing assistants who have graduated from Form IV.



Clinical Assistant to Clinical Officer Programme: The course curriculum covers such topics as surgery, communicable diseases, obstetrics / gynaecology, epidemiology, clinical laboratory, paediatrics, and statistics. A module on STIs is being developed in partnership with Cardiff University, and other modules are continuously being developed in response to health system needs. This training, based on practical paper-based courses, is based on content from Aga Khan University and Cardiff University.


Maternal and Child Health Assistant to Enrolled Nurse: The course aims to upgrade the training of maternal and child health assistants to enrolled nurses, and was initiated by the CDE as a 2-year programme. The curriculum includes training in a broad range of MCH services, including antenatal and postnatal care; assistance during delivery; care for infants and newborns; growth monitoring for children under age 5; family planning services; and HIV and AIDS services, including prevention of mother to child transmission (PMTCT). This content has also been developed in collaboration with the Aga Khan and Cardiff Universities.


Duration of Study

3 yrs for CA - CO Upgrade

2 yrs for MCH – Nurse upgrade

Students continue working through self-study during this time.


Structure of Study

Clinical Ass't to Officer: 3 years (or 2 years to upgrade) part-time

The CA to CO course consists of 14 modules and three practicum rotations.


The first two practicum rotations last 6 weeks each and are typically conducted at the student’s workplace or a nearby district hospital. This facility-based practicum portion is overseen by a preceptor.


The third rotation lasts for 8 weeks and is held at the CATC or COTC study centre with which the student is affiliated. Students choose when and for how long they want to attend the CATC or COTC for face-to-face sessions. Based on experience with previous distance learning students, Maswa CATC recommends that students attend in person at the CATC for the last 6 months of the programme.


There is no schedule for the course, only a list of the 14 modules and units within those modules, along with the maximum time a student may take to complete each. Given the already low level of student–tutor interaction, a prescribed schedule would at least provide students with more guidance on progressing through the course.


MCH to Nurse: 2 years part-time

The MCH to Nurse course consists of 7 Comprehensive Modules covering: antenatal and postnatal care; assistance during delivery; care for infants and newborns; growth monitoring for children under age 5; family planning services; and HIV and AIDS services.


There is also a practical component consists of three clinical rotations of 6 weeks each. The first and second rotations take place at students’ workplace or a nearby hospital during the first year, and the third rotation takes place at a Health Training Institute that is a Nurse Training Centre. Face-to-face tutorials are provided twice a week for 6 weeks by a Public Health Nurse, and practical demonstrations are given at Morogoro Regional Hospital.


Course fees

Paid by the Ministry of Health


Unit cost per head

The CDE conducted a cost analysis of the clinical assistant to clinical officer distance learning upgrade programme compared with the corresponding residential training upgrade programme. It found that the cost to the MoHSW for maintaining one distance learning student for 1 year is TSH 172,000 (USD 143), compared with TSH 300,000 (USD 250) for one student for 1 year for the residential course (MoHSW, 2007b)

Overall programme funding/cost recovery mechanisms

Charitable Funding from Irish Aid and Aga Khan Foundation


Delivery Mechanisms


Provision of materials

Paper Based materials, with interactive online videoconferencing materials currently in development


Academic support

Academic support is provided through the network of Study Centres and Training Centres in the provincial capitals. These are not solely for distance learning courses, but serve part of the general educational and training purposes of the ministry of health.


Communication between learners and tutors outside of the training centres is limited. Staff noted that tutors, as a group, have met only twice since the programme’s inception in 2000. Because of the small number of tutors, students have little interaction with them. Most students correspond primarily with the CDE programme coordinator in Morogoro rather than with tutors. At Maswa CATC, there is only one tutor specifically dedicated to distance learning students.


Administrative support

Administrative support is also provided through the network of Study Centres and Training Centres.



Participants’ Profile


Geographical spread of enrolees

From a wide range of rural districts, with the majority from Maswa, Kilosa, and Masasi/Mtwara provinces.


Number of enrolments per year

Clinical Upgrade : 702 enrolees

MCH – Nurse Upgrade : 84 enrolees

These are the total enrolments up to 2009, this suggests an average of 78 CA-CO students and 42 MCH students per year.


Details of fee payment among enrolees

Course fees paid by the MoHSW, or by NGOs if students are not employed in the Public Sector.



Alumni Activities


Geographical spread of alumni

To date, 97 clinical assistants have graduated to become clinical officers in a number of rural provinces throughout Tanzania (32 from Maswa, 36 from Kilosa, 17 from Masasi/Mtwara, 3 from Machame, 1 from Mafinga, 2 from Kigoma, 5 from Musoma, 1 from Lindi)




(All DL alumni)


The Alumni are trained for a specific role, so the graduates of the clinical program have all become Clinical Officers, and the MCH assistants have all become enrolled nurses. 




Course URL:



Reference Documents

International Training and Education Center on HIV (I-TECH). Tanzania Distance Learning Assessment: Assessing the Use of Distance Learning to Train Health Care Workers in Tanzania. 2009. Available at:


MoHSW. 2006. Strategic Plan, 2008–2013. Health Statistical Abstract, April 2006.


MoHSW. 2007a. Mpango wa Maendeleo wa Afya ya Msingi (MMAM) or Primary Health Services Development Programme (PHSDP) 2007–2017. May. MoHSW. 2007b. Distance education training needs assessment and unit cost study: A mini-study, May – June 2007. [unpublished].