Ms Janet Obuni is the president of the Uganda National Association of Nurses and Midwives. She explains how nurses are doing their best to serve patients despite low pay, poor working conditions and lack of medical supplies in an interview with Saturday Monitor's Evelyn Lirri.

What is the biggest concern for nurses and midwives?

The healthcare delivery system is mainly backed by the midwifery and nursing profession who form about 70 t0 80 per cent of health human resource. One of the main issues compromising the quality of care is the shortage of this resource. We have very few nurses, midwives and doctors and other health professionals to be able to deliver quality care.

When you talk of few, what are the numbers and what should be the ideal?

At the moment we only have 53 per cent of positions of human resource occupied. This includes doctors, nurses and midwives. But the situation for nurses is grave. The World Health Organisation standard is that one nurse takes care of five patients a day if quality care is to be delivered and that one midwife takes care of four patients. However, in this country one nurse takes care of 50 to 70 patients in a day. In lower health units, one nurse is supposed to work 24 hours which compromises healthcare delivery to the communities.

How many nurses should lower health facilities have?

For optimum care, we need a minimum of three midwives and three nurses for every duty shift.

But what's the situation like today?

In most cases we have one nurse per shift. Some health centre are manned by non professionals such as nursing assistants but not trained nurses or midwives.

Have you raised these issues with the Health Ministry which is responsible for your welfare?

We have raised it with the Ministry and also Public Service because they are responsible for creation of positions and structures in health facilities. In the 1990s there was a ban on recruitment of health workers and this has been gradually lifted but this is not yet at 100 per cent. This explains why we don't have enough human resources for health and yet at the same time, the number of patients is increasing because of rising disease burden in the country. Many infectious diseases have come up, non communicable diseases like diabetes and hypertension are also on the increase and to be able to take care of patients effectively, we need the necessary number of health professionals.

Is high disease burden linked to health worker shortages?

Diseases come as a result of changing lifestyles and infections that have emerged like HIV/Aids, Hepatitis. But to be able to take care of patients, we need to have enough human resource and functional facilities in our health institutions. We are still operating with facilities of 1960s and 1970s and yet the population has grown. Health facilities need to be redesigned and also develop effective community programmes through primary health care so that communities can take care of their health before coming to the health facilities.

Are human resources, facilities and medical supplies non-existent?

Facilities exist but they need to be upgraded. We have a lot of shortages in health facilities like beds, drugs and supplies that are needed for provision of effective care to communities. That is why you often hear people complaining that they cannot get drugs and that they are not attended to.

How much has brain drain affected the nursing profession?

A survey conducted in 2006/7, revealed that nurses and midwives are among health workers who would remain in the country to work. Instead of going out of the country, many nurses have left the profession for other jobs because they are unable to meet their daily needs.

What about remuneration?

Nurses are the least paid health workers in this country. For example, an enrolled nurse or midwife earns about Shs220,000, which we think is not enough to take care of their needs. They are also supposed to take care of their accommodation and transport with that meagre income.

What do you want addressed as a priority?

We have written to the Ministry of Health about issues that affect nurses. These include facilities where we work, remuneration, medical supplies and abuse of nurses by patients' relatives and sometimes our supervisors.