Time For Parliament To Act — The FY2015/16 Budget Must Correct the Health Worker Crisis in Uganda
Uganda is in the throes of a health workers crisis—there is an absolute shortage of professional health workers, medics are inequitably deployed across the country, and they are paid abysmally low wages, leading to high rates of attrition and poor motivation.
Astonishingly, government is exploring a plan that would only pour fuel on the fire—by exporting 283 qualified Ugandan health workers to Trinidad and Tobago.
But Parliament has the chance to help stop this ill-advised proposal and to ensure the Financial Year 2015/16 budget corrects the factors that are pushing health workers to leave Uganda in the first place. The 2015 budget will be the final budget before the 2016 elections—no better time for Parliament to show it is responsive to citizens’ priorities. A large national public opinion poll recently conducted by Columbia University in 2014 showed Ugandan voters reported healthcare as the most important issue for the 9th Parliament to address. 25% of Ugandans report it is the most important issue for Parliament—an increase from 17% of voters polled in 2011.
But for too long, the health worker emergency has triggered virtually no intervention by government. This changed in 2012 when civil society attempted to make the health worker crisis a political priority. A prolonged advocacy campaign, led by civil society alongside Parliamentarians, ensured that the national budget was not passed until the health worker crisis was prioritized. Eventually the Financial Year 2012/13 budget committed 49.5 billion shillings to recruit 6,321 additional health workers and deploy them to Local Government clinics, while more than doubling the wages of doctors working at HCIVs.
Parliament also committed itself to prioritize health worker motivation in the Financial Year 2013/14 budget—through wage enhancement, in particular for midwives, who are the backbone of the health system. But this promise was not kept—and up to today health workers continue to toil without adequate pay, with non functioning equipment, and with poor training and support. Parliament is passing budget after budget without addressing this grave injustice.
Meanwhile, Uganda could lose another 283 of its scarce health workers thanks to a government plan to export them to Trinidad and Tobago to work in an elite medical facility. This move would deplete Uganda of midwives, nurses, doctors, psychiatrists, and other highly sought-after cadres of health workers. This move is being challenged in High Court; many Parliamentarians have also spoken out, recently joining civil society to petition the Speaker of Parliament to halt the deal. The Rt. Hon. Speaker herself told civil society that exporting health workers ‘did not make sense’ when women are dying in childbirth in clinics in Uganda.
Rather than correcting the factors that push Ugandan health workers to migrate in search of better pay and better working conditions, government wants to help health workers leave the country—further undermining a health system that is already failing to deliver essential services. Trinidad and Tobago, unlike Uganda, has no health worker crisis. The tiny, oil rich nation has a maternal mortality ratio of 84 per 100,000 live births (compared with 438 for Uganda) and a skilled birth attendance rate of 97.8% (compared with Uganda’s rate of 41.9%). Ugandan women are four times more likely to die during childbirth than women in Trinidad, and three times as many Ugandan children die before the age of five. Exporting 100 midwives effectively denies maternal health services from 900,000 pregnant women and mothers. The transfer of highly qualified doctors deprives care to 1.2 million patients.
Compared to Uganda, Trinidad and Tobago has 10 times as many doctors, 3 times as many nurses, 22 times the per capita health spending, and 32 times the per capita gross domestic product.
If implemented, this plan will mean more suffering and preventable death in Ugandan communities, particularly among pregnant women, newborns, people with HIV, tuberculosis and malaria, and other leading causes of preventable death in Uganda.
Moreover, Uganda stands to suffer an estimated 80.2 billion shillings in lost return on investment from the proposed export deal.
The Budget Framework Paper for the Health Sector 2015/16 describes poor wages of health workers and insufficient numbers as causing a ‘persistent service delivery gap.’ The Ministry of Health estimates that 129 billion shillings is required for salary enhancement for all staff in the sector annually. This is just a fraction of the estimated 377 billion shillings being spent on health care abroad for Ugandan VIPs.
The evidence is clear—Uganda’s acute shortage of health workers can only be fixed through investing in better pay, better working conditions, and better management. All people should be free to travel to seek employment as they please, but government should be prioritizing efforts to increase health worker motivation and retention—instead of developing schemes that would make suffering worse.
Importantly, public outcry has so far helped stall the export of health workers—the medics were meant to have departed more than 3 months ago. Foreign aid to the health sector is also at risk—the Belgian government recently announced 6 million euros in health sector aid would be suspended as a result of the government plan. And while the Minister of Health, Hon. Dr. Elioda Tumwesigye, recently told media that government was ‘rethinking’ the export of health workers, there is no solid evidence that the plan has been stopped.
Meanwhile, the clock is ticking: everyday 16 pregnant women die while giving birth and everyday countless disgruntled medics loose hope that government will enhance their wages and give them the tools they need to save lives. Alongside a halt to this scandalous export plan, civil society calls on Parliament not to pass the 2015/16 budget until it delivers what voters deserve:
a) recruitment of an additional 3000 health with a focus on deployment in underserved Districts;
b) an increase in wage by at least 50% for midwives and other priority cadres of health workers at HCIVs and IIIs; and
c) an increase in primary health care (PHC) funding for facilities at Local Government level so clinics have the medical equipment health workers require to deliver life saving services to their patients.