Can Parliament Stop the Export of Doctors to Trinidad and Tobago?

This publication was authored by: Haggai Matsiko

Abstract / Summary

A petition submitted to Parliament on April 8th is calling on legislators to halt the move by the government to export over 261 medical doctors to Trinidad and Tobago. 35 civil society organizations (CSOs) want legislators to institute a probe into what many have criticized as“state-sanctioned brain drain” that threatens to rob Uganda of key medical specialists. 20 of the country’s 28 registered radiologists, four of the six urologists and one of Mulago National Referral Hospital’s three neurosurgeons are some of the specialists that could go to Trinidad and Tobago. These, just part of the 261, were selected through a rigorous recruitment process conducted by Ugandan authorities. Uganda, with 35 million people, has a health worker to population ration of 1:1,298 against the WHO recommended average of 1:439. The doctor-to-patient ratio on the other hand stands at 1:24,725 while there is one nurse for every 11,000 according to the Ministry of Finance budget monitoring briefing paper for June 2013. Trinidad, which has only 1.3 million people, has a doctor to patient ratio 12 times better than Uganda. Trinidad’s health system is ranked 68 and Uganda’s at 149 according to WHO. Lead petitioner, Justinian Muhwezi, the Executive Director, Institute of Public Policy Research Uganda (IPPR-U), says that the move will irreparably damage the public health sector and lead to loss of thousands of vulnerable patients. Already, Uganda loses 100,000 children to malaria every year and 16 mothers die daily giving birth, he says. Apart from IPPR-U and other organisations, the U.S. which contributes USD 400 million towards Uganda’s health sector and the E.U have also castigated the move. The Belgian government has even suspended €11 million worth of aid in protest. Parliament is the latest to join this campaign. “How can we then help another country when the Health Service Commission is complaining over shortage of midwives? Government must explain what is happening,” Speaker Rebecca Kadaga seemed to speak for a number of legislators while receiving the petition. Given that every year, legislators must spend millions on medical bills of their constituents, who have to get treatment from private hospitals because they cannot find health attendants and medicines in local government hospitals; this is as much their fight. Activists hope that a resolution by parliament against the move would infuse energy in their campaign, which suffered a major blow recently when court ruled against their injunction. On April 10th, Justice Elizabeth Musoke ruled on the matter, holding  that since the decision to export health professionals to Trinidad and Tobago was a decision of the Executive arm of government, it remains a political decision which would ordinarily have nothing to do with the courts. “The court would normally get concerned if the decision had been implemented by legislation; otherwise the courts may not be able to intervene in how government deploys its resources,” Musoke ruled. IPPR-U has vowed to appeal. But before the appeal, IPPR-U’s Kateera says they hope that if Parliament halts the move, it will be hard for cabinet to approve it. Kateera says they are banking on a three-pronged approach in this fight. Now the court of public opinion has already decided against this move, if parliament also halts it, Kateera says they will have made a major step that we can go ahead and make even stronger by appealing against the court ruling. But the central question is whether Parliament even has the power to stop the executive from implementing it. Over the years, several groups have petitioned Parliament including several victims of land grabbing. Teachers have petitioned Parliament seeking for its intervention to avert the declining standards in public education across the country and so have health activists that seek t an amendment of the constitution for the inclusion of the right to health. War victims also petitioned Parliament urging for more action against the Lord’s Resistance Army (LRA). The highlight of these petitions and several others has been a photo op with the speaker or her representative while receiving the petition. And some petitions have gone as far as attracting widespread media coverage but nothing more. Even on the matters where legislators have a lot at stake like the Anti-homosexuality law, which many voters wanted passed into law, parliament has not had its way. When it was passed, it was easily one of the most popular pieces of legislation and a potential vote-winner. But ever since it was nullified by the constitutional court, threats by legislators to re-pass it without executive support have remained just that—threats. The petition against the Trinidad deal has come at a time when the 384-member House is seen as a shadow of what it was at its zenith when it could force President Yoweri Museveni to make some concessions including getting rid of then Gender Minister, Syda Bbumba and then minister in charge of General duties Khiddu Makubuya, who resigned after PAC implicated them in a UGX 162 billion dubious compensation to Haba group of companies. For now, Parliament finds itself in a situation where most of its resolutions remain on paper. Before Kadaga forced the current Finance Minister, Matia Kasaija, to table treasury memoranda-- a document showing government action on parliament resolutions and recommendations —early this year, the last time government had tabled treasury memoranda was 2012. Even then , Kadaga had to first threaten to frustrate the UGX 800 billion supplementary budget. With its overwhelming majority, the ruling party needs only to call a caucus and convince its members to push for (or not) an issue. In the case of the Trinidad and Tobago deal, government already has a court victory and officials have also been keen to show that the deal has its benefits. Apart from strengthening relations between the two countries, Trinidad has promised to train Ugandans in oil matters in exchange for doctors, government officials say.Authorities also argue that even without the Trinidad deal, Uganda had failed to fill 42 per cent of positions in the health system not because there are no doctorsbut because of limited resources. Health Ministry Permanent Secretary, Asuman Lukwago, says that Ugandan universities are now producing as many as 320 graduates in the different branches of medicine who cannot be employed despite an existing need for their skills. The deal with Trinidad, therefore, could be presented as an employment opportunity for Ugandan doctors. Already, Uganda has been losing doctors due to poor remuneration. The starting salary of a freshly recruited doctor in Uganda is about UGX 800,000 after taxes (US$260). Their Rwandan and Kenyan counterparts earn triple that and have better perks. The health facilities there are also better. But as Lukwago admits, government efforts to set up infrastructure in remote areas have not attracted medical staff to want to stay on the job. Part of the problem is that some health facilities are in a bad state and in other cases doctors lack nurses to help them during operations. Because of this, Lukwago admits, some medical workers resort to other businesses that are less tasking yet lucrative creating internal brain drain. Activists say health workers have a right to take up employment wherever they choose. However, they find it contradictory that the process of exporting these skills that are much needed at home should be led by the government. Government insists that exporting doctors is not a new thing. Russia and Cuba have been sending medical workers to Uganda and vice versa. But for Dr. Michael Bayigga Lulume, who sits on the Parliamentary Committee on Health,  instead of exporting them, the government should be finding ways of increasing remuneration and putting in place facilities that can enable medical workers deliver their best at home. He says that his committee plans to ask the government to explain the policy under which they are exporting the medical workers. Many find the exportation of  the doctors contrary to existing public health policies. In 2007, the same government had instituted regulations to prevent Ugandan doctors from obtaining employment outside Uganda before serving at least five years in Uganda. The then-minister of State for Primary Health Care, Emmanuel Otala, even announced a 30 percent salary increment for medical workers in rural areas as one of the new measures. Uganda in 2008 also hosted a global conference aimed at combating medical brain drain. As activists see it, the main problem is down to government’s failure to invest adequately in the health sector. Despite being a signatory to the Abuja Declaration, which requires African countries to spend 15 per cent of their annual budgets, in the 2014 Uganda spent just 6.2 per cent on the sector. Activists want this to change. Apart from halting the Trinidad deal, they also want government to recruit 2400 additional health workers in the next financial year and implement a package of non-financial incentives that government can provide to improve retention of health workers.