Medical Workers under industrial action in Uganda in 2021. Photo by the Independent.

KAMPALA: The Daily Monitor recently reported that government, owing to financial constraints, is currently unable to address acute shortage of health workers in Uganda.

The report quoting the Permanent Secretary to the Ministry of Health, Dr. Diana Atwine, was published  just days before Hon. Amos Lugoloobi, Uganda’s State Minister for Planning, tabled to Parliament the annual budget estimates for the Financial Year 2022/23. This came at the height of public debate on reported funeral costs of the Late Rt. Hon. Jacob Oulanyah, Speaker of the 11th Parliament.

Globally, shortage of health workers is measured by the doctor-patient or nurse-patient ratio. By 2020, the total number of health workers with active licenses in Uganda stood around 67,047, showing a density of 1.6 per 1000 population. Over the past decade, Uganda has experienced remarkable improvements in workforce for the health sector, although these efforts are far below the 2016 World Health Organization’s recommended 4 medical workers per 1,000 people.

The 2020-2030 Human Resource for Health Strategic Plan shows that the Ministry of Health intends to raise staffing from 26,952 to 71,224 to achieve 100% staffing level. In response to this shortfall, government plans to recruit 30,066 staff for national, regional, district and lower level facilities. To this end, the Ministry of Health plans to develop a salary increment policy for jobs that are in high skilled occupations that have limited career advancement opportunities as a means of attracting and retaining staff. 

This means that the amount of the recurrent funds spent on wages is expected to rise from 593 billion Uganda Shillings in 2018/2019 to over 705 billion in 2023/2024, a growth rate of 14% over a five-year period or 2.8% growth per annum. This rate of growth is far less than the annual rate of economic growth of 6% that is expected during this same period and as such indicates the challenges government faces in retaining health staff.

Compounding matters, is the suboptimal public spending on health which as a proportion of gross domestic product, stands at approximately 7% translating to only 8.7% of the National Budget allocation on health, below the Abuja Declaration that sets a target of 15% national expenditure on health.

It is against this background that government previously proposed hiring over 200 Cuban doctors in response to industrial action by medical workers over staff welfare. , to mitigate the shortage of health workers. From the coverage of this story by Wizarts Foundation under Our Parliament radio show, news reports have proven to be reliable sources of information to the public, specifically reports by Daily Monitor.

As the proposal was still before cabinet, the exact details of the proposal were hard to come by, which is why it was important to interview the undersecretary in the Ministry of Health who at the time was Mr. Ronald Segawa.

Mr. Segawa justified the proposed intervention then, saying: “We are talking of 200 or so doctors from Cuba. The health workers in the whole country are between 40,000 and 60,000 so whereas it is possible for government to pay this small number of doctors some money to address a short term problem, it is not possible to apply the same mechanism to the other group. You cannot increase the salary of health workers for the short term. So you must be prepared to manage this increment for the lifetime. Yes the President has stated that the scientists and health workers deserve a salary increment that’s not under question but where is the money?!”

Media reports showed that the proposal to hire the Cuban doctors was taking place while medical workers were in a pay dispute with the government. As such it was important to interview Dr Fauz Kavuma, Chair of Publicity & Mobilization, Uganda Medical Association, with membership of over 6000 medical professionals. Dr Kavuma reckoned the intervention was ill conceived.

“Doctors out there in the villages can’t do any work. We have no medicine. We have nothing to use, no gloves, no nothing so we hope the government looks into this. When the Cubans also come they will face the same challenges, the lack of medicines and everything and then we will have well trained specialists in the hospitals but the people will not receive the service.”

To provide added context to media reports, the 2014/15 Human Resources for Health Bi-Annual Report by the Ministry of Health, which identified an acute shortage of pharmacists and the 2017 Statistical Abstract by the Uganda Bureau of Statistics which revealed that 4 in 10 staff positions for pharmacist were filled in 2015/16, proved useful sources for the media.

Additionally, the hearings where the Health Ministry officials appeared before the Public Accounts Committee of Parliament provided context. The Public Accounts Committee is one of the oversight committees of Parliament deriving its mandate from the Parliamentary Rules of Procedure, specifically Rule 174 that states the function of the Committee shall be to examine the audited accounts showing the appropriation of the sums granted by Parliament to meet the expenditure of the Central Government and the Judiciary.

In practice, the Committee is chaired by an opposition Member of Parliament. In the 10th Parliament, Hon. Angeline Osege served as Committee Chair and she criticized the proposed intervention; “This importation of government doctors does not help the country because it is not sustainable. Where has the money come from suddenly which could have paid our doctors but now all of sudden there is money to pay Cuban doctors. I think its poor planning on our part.”

Her criticism was to the effect that the intervention was for the short term and did not necessarily resolve the underlying issue of the skills and staffing gaps. 

Promoting Parliament literacy is one of the aims of the Our Parliament show and as such it highlights voices from the House that are lesser known such as the Deputy Opposition Whip in the 10th Parliament, Hon. Roland Kaginda Muguma. He was interviewed and was critical of the intervention.

“Go to China, Canada, America, there are Ugandan doctors, I wish they could convince Ugandan doctors who were born from here, who are working abroad to come back.”

It was noticeable while covering this story, that the Ministry of Health had data on the human resource gaps, suggesting the issue was well understood by policy makers, however there was a lack of clarity regarding the extent to which this data informed the proposal to hire the Cuban doctors. In light of how the media reported this story and the more recent revelations of the staffing gaps, greater media attention should focus on how policy decisions are made, such transparency can only help the public hold duty bearers accountable.

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