The Health Worker Crisis in Uganda; Will it ever End?


By Elizabeth Ekirapa

I recently visited one of the new districts in   Eastern Uganda, I had gone to meet the District Health Team with whom we are implementing a project. I tried to meet the District Health Officer, and gave up trying at about 3.30 pm. He had an endless list of things to do on this particular Monday morning and being the beginning of the week perhaps the list was longer than usually. His morning started with a visit to the maternity ward where he started reviewing pregnant women   whom the nurses felt needed review from a doctor. When I passed by the waiting area which was also doubling as the examination room with a makeshift private section separated by cardboard I found several patients waiting for him.  After seeing the patients he needed to rush back to the District Health Office to carry out his administrative duties. A team from the Ministry of Health also came in to meet him later in the day, not to mention those of us who were already waiting. If one of the pregnant women in labour needed an emergency caesarian section, the same doctor would be called to do the operation.

I asked one of the district officials if the doctor who had been working at this health centre IV had been replaced. I discovered he had not been replaced; he was now pursuing his masters’ studies. Although the district was reported to have a doctor at the health Centre IV and although he still received his pay through the district payroll he was actually now serving at the national tertiary referral hospital where he is undergoing training. This kind of situation has gone on for as long as I can remember; when doctors go for postgraduate training they are still counted as serving the district. I have always wondered why Ministry of Health does not correct this anomaly by creating a payroll for doctors undergoing training at the national tertiary referral hospital, so that the districts have an opportunity to recruit another doctor. One could argue that such doctors will go back to the district after the training; the truth is often they are not able to go back because   they end up too qualified for their previous position.

Can bonding help solve the problem?

Secondly, their aspirations in terms of increasing their earnings become even higher and cannot be satisfied by the meager government pay. I wondered what could help remedy this situation and I remembered a solution that we have never tried in Uganda. In some institutions, when the institution pays for your education you are bonded and you have to serve the institution for an agreed number of years. Uganda trains hundreds of doctors who do not end up in such rural facilities after their training. With a change in regulations, such freshly qualified doctors could be required to serve the country for one to two years before they are allowed to seek greener pastures. This would ensure a ready supply of doctors. Someone might immediately say that it would be difficult to implement this kind of bonding system, but I am one of those people who believes that for every problem there is a solution, you may not succeed initially but if you persist you would certainly get a way of enforcing the bonding. We must think of creative ways of dealing with our health worker crisis.

Before I end, of course I must mention the most obvious one, Uganda needs to recruit more doctors, in addition to developing packages for their retention and motivation. If you are thinking we don’t have the money for it, I want to ask you to keep your ears to the ground you will hear about the cash that politicians are   promising members of the electorate. I think it is more an issue of prioritization rather than an issue of lack.

Do share your thoughts about this issue I would love to hear what you think.