Human Resources in the Health Sector in Uganda

I should have posted this a lot earlier. Last week Duke Global Health Institute invited Dr. Edward Mukooza from International christian Medical Institute (Uganda) to give a talk on human resources in Uganda’s health sector. This is a quick summary, together with my reflections on the topic.

Uganda has a population of 35 million, and 84% of it is rural. The population growth rate is 3.4%. Total area is 241,038 km 2. A considerable proportion of national budge is devoted to health: 8% in 2013/14, or 5.2 billion. The per capita expenditure on health is $42.4, $12 of which is provided by govt

Uganda has a decentralized hospital system with multiple tiers — from district hospitals to village healthcare centers. Until early 1970s, Uganda had one of the best health services in south-Saharan Africa. In 1917, training was provided for Ugandans to become African Medical Assistants. The first midwifery school was opened in 1921, followed by the first medical school three years later. The second medical school was opened much later, in 1989. Now there are 4 medical schools in the country. In the 1970s, global recession, economic declines, and the hostile policies by the dictator government towards professionals forced many professionals — including doctors — to flee the country.

The current situation is not very encouraging. There are only around 70,000 health workers, 1.8 per 1000 people. This is much lower than the 2.28/1000 requirement by WHO. Only 70% of the posts in the public health facilities are filled in by qualified professionals. The density of nurses is slightly better — 13/10,000. There are around 4200 registered by Uganda Medical and Dental Practitioners Council, but only about 1200 are practicing within Uganda. Over the past 10 years, about 2000 have left Uganda to countries including Southern Sudan, Europe, and Canada.

A combination of factors are pushing doctors away. Compensation in Uganda is much lower compared with neighboring countries: a doctor earns 5 times as much in South Sudan than in Uganda! Even the pay in Rwanda, an economically less developed country (though a lot of Ugandans admire their transparent government and organized city-planning), is better than in Uganda. On average Ugandan doctors’ monthly income is only $300, and this number rises to $1000 for a senior consultant. Apart from compensation, the poor quality of hospital management, primitive facilities, heavy workload, unfavorable community location, and limited scope of professional development all deters doctors from practicing in Uganda.

Human resources have become a serious problem in Uganda. The density of medical practitioners does not match the population distribution. 70% medical doctors and pharmacists are in urban areas while 84% of the total population are in rural areas. Health workers have poor attitudes. The government is trying to tackle this problem by making data on Human Resources in Hospitals available (don’t know about the quality though), especially in public health system. It also tries to attract health workers to rural areas by offering higher wages (2.4million Uganda Shillings, or $900, per month).

The Q&A part was quite interesting. A woman asked about the priorities of the Ugandan government, and got a reply of “the govt put more resources on defense, infrastructure (roads and dams)”. I immediately laughed at the thought of extremely sketchy roads I saw in Nkokonjeru. Another female health practitioner who has worked in Uganda for over 10 years raised the question of why the government does not train more health workers to solve the basic problems like malaria. The government is actually doing that. As I see it, the biggest problem is to create a mechanism, or put it more precisely, a favorable environment, for talents to stay. This can be quite challenging in a country where corruption is rampant and professionals are undervalued.

I was surprised, and a bit disappointed, to discover I was the only non-public-health student in the audience. It’s just like showing up in a concert hall discovering me being the only non-music-major student. Duke Global Health Institute organizes many health- and policy-related seminars and talks (calendar). Anyone interested in these interdisciplinary studies should go.

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