Health: Why Uganda's Health Sector Needs Cure

Published on 11th May 2012

A scene in Mulago Hospital maternity wing  Photo courtesy
When was the last time Ugandan trained medical and health practitioners felt happy and dignified working at home? It was during the Milton Obote 1 government. Dr Patrick Ogwang, a retired senior Gynaecologist, who was a health practitioner during Obote 1 era observes: 

“We were well facilitated financially. Our salaries and allowances enabled us to comfortably live a decent life unlike today when health practitioners have to struggle to educate their children. All the 22 (twenty two) hospitals which the then government built across the country were adequately staffed and fully equipped with enough drugs and medical equipment, a factor that eased the work of health practitioners. It did not matter where one was posted to work. Facilities in all the twenty two hospitals were the same.”

Dr Albert Mugisha, a retired paediatrician recalls that during that period, scholarships for further studies were awarded purely on merit. He says, “Many of us came back home on completion of our further medical studies abroad and we were proud to work at home.”

During that period, patients were well treated and fully catered for. Muzeyi Venansio Bbossa from Kayunga district, remembers that period with fond memories. “Whenever I fell sick,” he says, “I would be taken to Kayunga hospital and be well attended to without paying any shilling. As a patient, I would also be given, tea with bread and butter in the morning, matooke, rice and meat/beef at lunch time and a meal of my choice for supper all at no cost.”

Obote 1’s regime contribution to the health sector in Uganda will forever be cherished. During this time, Uganda was in ranks of very few African countries with an excellent functional health system. The regimes that followed thereafter (especially the late Idi Amin’s regime) wrecked this excellent health system.  Since then, Uganda’s health system is in shambles. Many health centers in the country are not adequately staffed and equipped. Health practitioners are moving to other countries where working conditions are better.

When I visited Mulago National referral hospital labour ward, I saw many pregnant women who were seated on their mats on the floor waiting to be attended to. A senior midwife, who agreed to talk to me on condition of anonymity, told me: “Our ward is too understaffed and not equipped with enough beds to accommodate the large number of pregnant women who seek our services.” In other hospitals in the country, cases of the women painfully delivering under the light provided by mobile phones and candles are always reported in the media. Many of them have lost their lives during this process. It is therefore not surprising that maternal mortality rate is still exceptionally high in the country.

In this same hospital, a neurosurgeon  who requested his name not to be revealed said that neurosurgical unit, which handles people with head and spinal injuries resulting from motor accidents, strokes, brain tumours, hydrocephalus and other nerve problems, is also understaffed and poorly equipped to fully serve the overwhelming number of patients it receives every day. “Conditions of work here are very poor. This has made some of our former colleagues to seek jobs in South Africa,” he said.

Hundreds of Uganda’s health workers are migrating to other countries South Sudan, Rwanda, Tanzania, South Africa and Kenya among others, in perch of green pastures. Some have also migrated to Canada, United Kingdom, France, USA and Australia, among others where working conditions are far much better than in Uganda. A nurse in South Sudan, for instance earns a monthly salary that is twice the one of a Doctor in Uganda. A nurse in Canada earns a salary that is twice the one of a specialist in Uganda.

Specialists such as oncologists, gynaecologists, heart surgeons, radiologists, neurosurgeons and paediatricians are migrating to other countries in droves. This is making the country to lose a lot of money spend on its officials who have to seek medical services abroad at the taxpayer’s expense. As we speak today, there are very few Ugandan medical specialists left in the country. The Neurosurgical Unit at Mulago National referral hospital for instance, has only four neurosurgeons, while in many other hospitals in the country, there are no specialists to talk about.

In countries such as USA, United Kingdom and Canada, medical specialists are paid much better than the members of parliament. On average, a general health practitioner in UK bags $118,000 annually and a consultant gets $204,527, which the medical and health practitioners in Africa can only dream of. This in addition to excellent working conditions in western health facilities. In Uganda, the case is different. A Ugandan MP is paid more than $70,000 per year in addition to getting a free expensive vehicle.  Compare this to $3,845 and $ 9,800 which a Ugandan medical officer and senior surgeon gets per year respectively and you will agree with me that Ugandan Doctors are paid peanuts. One Ugandan MP is worth 18 medical officers or seven senior medical specialists.

 A junior Doctor in Kenya earns $8,000 per year while a consultant surgeon takes home $17,300 per year. Rwanda, Tanzania, South Africa and South Sudan are also paying much better salaries than Uganda. Compare this to what their Ugandan counterparts earn and you will see why some Ugandan medical Doctors are seeking greener pastures.

Africa is currently spending a lot of money on training medical and health workers who it is increasingly failing to retain. Currently, there are more Benin citizenry Doctors practicing in France than they are in Benin. This situation is not much different in other African countries.

In sum, Uganda and other African countries should wake up and accept the reality that, the kingpin of any health system is its trained medical and health practitioners. They should therefore start remunerating their health practitioners handsomely, if they are to retain them. Failure will mean they will continue training medical and health personnel but lose them to developed countries, a move which if not stopped, will continue jeopardizing health sector performance in Africa and make it remain in shambles.

By Moses Hategeka.

The author [email protected] is a Ugandan based independent governance researcher, public affairs analyst.

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