Kakaire A. Kirunda
15 March 2008
Kampala — BETWEEN March 2 and 7, Uganda played host to the first global forum on human resources for health.
The conference came at a time when the world is facing a critical shortage of health workers.
The forum brought together over 1000 participants, including government leaders, eminent development, civil society, academic and health professional leaders from around the world.
This, therefore provided an extraordinary platform for sharing and exploring solutions, consensus and capacity building, and galvanized the emerging global movement to the increasingly pertinent health human resources issues.
In countries like Uganda, there is a chronic shortage of health workers to serve a population of 28 million people.
According to the World Health Organisation's Africa health workforce observatory, which was last updated in 2004, there are only 2209 physicians,19,325 nurses and midwives, 363 dentists and technicians and 688 pharmacists and technicians in the country.
For laboratory technicians, the number stands at 1702 and there are only 1072 environmental and public health workers.
And at the end of the week-long discussions in Munyonyo, delegates came up with a 12-point action plan calling for a range of reforms ranging from training, management and financing to regulation so as to overcome the human resource problem.
Coming hot on the heels of medical workers' strikes at Lira and Jinja referral hospitals over unpaid allowances, calling for increments in health workers' pay was among the inevitable pleas that delegates sounded out.
But this raises the question whether pay is the answer to the health workforce crisis and the buffer against them seeking greener pastures abroad.
The Executive Director of the Global Health Workforce Alliance, which organised the Munyonyo forum, Prof. Francis Omaswa says it is more than pay. "It is not only salaries; there is what is called non financial incentives. It includes good management," Prof. Omaswa said.
"When you graduate you get offered a job, when you get to the job, you find that they are waiting for you, there is a house for you. The clinic has got drugs, there is equipment and you can actually help people. These are extremely important.
"If you are a person who uses uniforms, you actually have the uniforms. So, those are extremely important, just as important as salaries because if you pay me good money and you take me just to sit where I am not useful to the community I will go away," he added.
Several other experts agree with Prof. Omaswa. Writing in the Priorities in Health publication of the Disease Control Priorities Project, a number of health experts noted that raising salaries is often costly, as payroll expenses account for 50 to 80 per cent of recurrent costs.
They however argued that when financial incentives are targeted toward specific aims, they can be effective.
"For example, Thailand improved service provision in rural areas by paying bonuses to doctors willing to work in more remote locations and providing nonfinancial incentives, including different contractual relationships, housing, peer review, and professional recognition," the experts wrote further saying that other efforts have included increasing salaries by linking pay to performance.
Although the Uganda government has over the years promised to solve some of these problems especially that of attracting physicians to remote areas, this has not been put into action.
The last time government promised to fix this was at the 44th regional health ministers' conference organised by the East Central and Southern Africa Health Community in Arusha in March 2007.
"We are looking at various ways of solving this problem. We are for instance making sure that we equip and staff Health Centres at the Sub-county and County levels. This means that we have put a hold to the construction of the lowest health units at parish level.
Plans are also underway to start providing incentives to medical officers to attract them into working in remote and hard to reach areas, the State Minister for General Duties Dr Richard Nduhura told Daily Monitor in an interview at the conference.
With a lot of talk but little action coming and going, some activists quickly dismissed the Global Human Resources for Health forum as just another talking session.
Just as the forum opened the Aids charity Act Up Paris issued a release blaming the current crisis on the Group of 8 most industrialised countries [the G8], WHO and African leaders for the current crisis.
The charity asked the G8 leaders and the WHO to take aggressive action now to end the crisis, such as keeping their outstanding commitments on health aid and technical support to developing countries.
"The international community has organised a lot of meetings and big conferences wasting a lot of money but nothing happens. It does not help to keep holding conferences that never produce results," Mr Khalil Elouardighi said in an interview.
But according to Prof Omaswa, it is meetings and conferences that bring to the fore issues such as the plight of health workers. And talking of meetings, the second global forum on human resources for health convenes in two years. Then it will be known whether the Munyonyo meeting created an impact.
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