Policy Stakeholders Raise Concerns Over the Phasing Out Of Lower Level Health Cadres


Policy stakeholders on human resources for health in Uganda have raised concerns over the decision by East African governments to phase out lower cadre health workers, particularly nursing assistants and enrolled nurses.

At a policy dialogue organised by the Supporting Policy Engagements for Evidence-based Decisions (SPEED) for Universal Health Coverage in Uganda, held at Metropole Hotel in Kampala several participants brought out the fact that where Uganda is in development of human resources for health, it cannot afford to phase out any. The dialogue was attended by a varied range of stakeholders in the health sector in Uganda, including academics, practitioners (nurses, medical doctors, policy implementers, etc).

The dialogue was organised to explore the implications of phasing out some nursing cadres on nursing training and practice; the health systems in general and the likely influence of this reform on the progress towards UHC in Uganda.

The District Health Officer (DHO) Mpigi, Dr. Ruth Nassanga-speaking from decades of sub-national management experience-noted that the focus should be on how to support the cadres being phased out, on how to perform their roles better. “We need them but how do we make them perform their jobs better? Do we give them more responsibilities? Do we provide opportunities for upgrading?” she prompted.


Dr. Edward Kanyesigye of Uganda Christian University noted that once the Ministry of Health relinquished its role of controlling entry and exit into service, attraction and retention of health workers became a challenge. One of the key options, Dr. Kanyesigye mentioned is the posting of specialists in Obs and Gynae, surgery at the district hospitals so that they can train the young ones.


On behalf of the Uganda Medical Association, Dr. Margaret Mungherera strongly opposed the idea of countries like Uganda attempting to reduce the number of health workers, especially at the lower level. “The debate in the region is about Universal Health Coverage and community health workers which is key for preventive health care. We need a paradigm shift and move from curative care to preventive healthcare”, she said.

Sister Agnes Nzimuli, a Nursing Officer at Pallisa Hospital pointed out that while nursing assistants are trained they do not carry out the same duties as the registered nurses but they do conduct deliveries at the lower levels and some of them are in-charges at these facilities.

On the issue of retention of health workers, majorly medical officers, Dr. Mungherera pointed out that retention of human resources is not a priority in the Ministry of Health and the government of Uganda broadly. She added that at sub national level, one of the key challenges is tribalism.

She also pointed out that the Health Services Management Unit, is a politically-motivated establishment but has caused serious challenges to service delivery in the public sector.

The policy dialogue was a consultation on the matter of phasing out nursing assistants and enrolled nurses, at the request of the Permanent Secretary Ministry of Health to the SPEED initiative. According to Prof. Freddie Ssengooba, the matter has been discussed within the Ministry of Health several times before the PS sought out the technical support of the initiative.

Outcomes of the dialogue will be submitted to the PS who will then convene stakeholders to consider it along with other evidence.

Human resources for Health (HRH) are critical for supporting health systems towards UHC. During the National Symposium on UHC funded by SPEED for Universal Health Coverage (SPEED)[1] Project in August 2015 in Kampala, several challenges facing HRH in Uganda were noted. These include shortage in supply, both in numbers and in skills mix, to effectively respond to the health needs in Uganda. For instance, according to the statistics from Uganda Nurses and Midwifery Council (UNMC) report (2015), there are only 55,137 nurses /midwives in Uganda which translates into about six hundred thirty-four (634) patients per nurse/midwife.