Critics of export of health workers to Trinidad are shooting at wrong target

A decision by the Government of Uganda to export healthworkers to Trinidad has sparked intense debate especially from some civil society groups. These groups have criticized the move arguing that Uganda does not have adequate health workers in its hospitals and health centres to afford to give its precious labour to another country.

While it is true that staffing gaps in government hospitals and health centres are widespread, the civil society groups are hitting at a wrong target. This is because any Ugandan is free to work anywhere they feel their labour is better appreciated. Two, the argument that Uganda has not got enough health workers especially the lower cadres like nurses is false. On the contrary there are thousands of health workers who are unemployed and underemployed.

Take as an example, in December 2014 the Ministry of Health through its Health Service Commission advertised for 219 jobs at Mulago Hospital, Uganda Heart Institute, Uganda Cancer Institute, Uganda Blood Transfusion Services and all 13 regional referral hospitals. Over 2000 applicants were shortlisted for job interviews. In one of the vacancies, Mulogo Hospital needed only 12 nursing officers but received 337 applicants. The same hospital needed 30 enrolled nurses but 529 nurses applied. Other advertised posts also attracted massive applications to the extent that the Health Service Commission was left with no choice but to subject the applicants to aptitude tests in Namboole Stadium on March 26^th because it could not accommodate such numbers in its board room. Clearly from just this example, there is a huge army of not-fully utilized health workers in Uganda.

Instead these critics should be pressuring government to get serious with recruiting more health workers and improving their conditions of work. I know of over 100 health workers who the Ministry of Health deployed in health facilities in hard-to-reach areas but would go for as many as four months without pay. And when government would attempt to pay them payments would be for arrears of two months. These health workers were depending on their meagre monthly salaries to survive. A good number of them were not salaried, they were receiving Shs320,000 as monthly allowance which would not also be paid in time. In most cases they had to pay house rent.  Yet, these medics were expected to report for day and night duties. Surely, how would such an unmotivated health worker get the motivation to treat a patient as expected? The health worker would be worried of where to get his or her day’s meal instead of attending to a patient. Let alone, what do you expect such a health worker do if they get an opportunity to work abroad?

What we should be doing is to ask government to set its priorities right. Over the years the ministry of health has complained of insufficient budget for recruitment of health workers. The thousands of health centre IIIs and IVs littered across the country don’t have the required staff. No wonder we have had cases where storekeepers and askaris at such facilities also administering medicines to sick peasants!  

The health worker to population ratio in Uganda is 1:1298 compared to the World Health Organization (WHO) guidelines of 1:439. Yes, in spite of these challenges, some achievements have made in the health sector. Life expectancy at birth improved from 52 years in 2008 to 54 years in 2011; the maternal mortality ratio reduced from 435 per 100,000 live births in 2006 to 325 per 100,000 live births in 2011; and infant mortality reduced from 76 per 1000 live births in 2006 to 63 per 1000 live births in 2011. But these key indicators can be improved further if the existing heath workers are properly motivated and supervised. Have you ever wondered why some private health facilities which, even in some cases, pay their workers less money than what government pays those in public sector continue to offer relatively better service? Supervision is the trick. 

The Ugandan health sector has experienced challenges related to recruitment and retention of qualified staff; this is mainly due to low remuneration as well as insufficient career opportunities . In 2010 there was a very low doctor to patient ratio of 1:24,725 and a nurse to patient ratio of 1:11,000. Both at an international and regional level, remuneration of health workers in Uganda is much  lower than most other countries. A doctor in Kenya for example earns approximately four times more than their counterpart in Uganda.

In 2013, Uganda recruited over 10,000 health workers to work in health centre III and IVs. But the staff numbers were still below what is required. Mind you, not all the 10,000 recruits remained at work -some who suffered at the hands of bureaucracy have left. The delays in salary pay caused the departure of especially the young people who had just finished school and expected to settle down on their pay. The bureaucracy in paying betrayed the health workers recruitment efforts. Some worked for up to three months without pay and resigned or abandoned work. Few persevered.

The civil society should be asking why the conditions of work for health workers especially those in hard-to-reach and rural areas are not being made better. For me that should the starting point other than trying to frustrate the medics who want to work elsewhere conditions may seem to be better.