The Monitor (Kampala)

Uganda: The Plight of Health Workers

On February 18, Uganda held its second multi-party elections and President Yoweri Museveni won the vote to extend his years in power close to 30. Due to the state of health system, Healthcare was one of the tickling issues that candidates had to address and the populace wanted answers to.

The opposition concentrated on bringing out the issues of drug stock-out and the lack of enough health workers, trying to show that the current government has not delivered much. Throughout his campaign, President Museveni solely blamed the poor health service delivery on health workers.

Shortly before Christmas, the media reported the president telling a rally in Tororo county that the major problem to Uganda's health system was theft of drugs by medical staff and he warned they would "pay with their back." This was not the first time the President sought to divert attention on what is really wrong with the healthcare system.

In July last year, he told the African Union meeting on maternal and child health, held in Kampala, that Ugandans were not getting good health services because health workers are corrupt and they steal drugs and other government supplies.

This piling of blame for an ailing health system on health workers has had its own consequences on the work environment of medical workers. Health activists are concerned about the pressure that has been added to health workers.

Health Promotion and Social Development (HEPS)-Uganda, a consumer protection group, and VSO's Global research and advocacy initiative have conducted a joint study, Ugandan health workers speak: the rewards and the realities, which shows that Uganda's health workers are operating in some of the world's worst conditions.

The report is a compilation of first-hand accounts of health workers at the front line--nurses, midwives, nursing assistants, clinical officers and doctors--on the plight of the working environment in Uganda. This is from 17 health facilities in six geographical regions.

"Few (patients) can afford even $1, about Shs2,000, to buy drugs from private shops, so day after day they walk 15 or 20 kilometres and wait, despite the pain," said one health worker. "They don't believe us when we say there are no drugs left. They think we steal them."

Another health worker asked, "How can any patient value a doctor, value a nurse when they say such things about us?"

Ms Rosette Mutambi, the Executive Director of the Coalition for HEPS-Uganda, said that negative statements from politicians before and during the campaign period have led to hostile relations between medical workers and patients. "Communities are demanding for drugs that are not in the hospitals and the leaders are telling them that the health workers are stealing them so the environment has become increasingly hostile. In fact, I met two health workers during our research who were considering resignation because of harassment and pressure."

Mutambi is concerned that health consumers have been misled on what the real problems with the health sector are. "We have demonised health workers so much in Uganda that no one sees them as human beings, no one thinks they choose this profession because they want to do good for the communities and without this respect, coupled with other overwhelming problems they face, Ugandans cannot get good healthcare."

Patricia Thornton, the lead researcher, said that a Ugandan health worker is never given a voice. "You hardly see the human face of a health worker, they are reported to be rude and abusive, steal drugs and supplies, extort bribes, absent themselves from their workplaces and neglect patients and all this is taking away the discussion from real issues affecting the Uganda health system."

Mutambi said that unless the government moves away from the blame game and addresses the problems of health workers, Uganda will not achieve a universal healthcare coverage. The shortcomings of the healthcare system are well documented but the political responsibility to face up to the task is still lacking.

The list of problems facing the health care system is endless including gross under-staffing, inadequate pay, crumbling infrastructure, limited and poor-quality staff accommodation, shortages of medical supplies and equipment, and poor supervision.

"We have realised that unless the problems of health workers are fully addressed, Ugandans will not have a decent healthcare service. Most issues stopping Uganda from achieving universal health coverage are beyond the working of medical professionals," she said.

According to a study, Positive Practice Environments in Uganda: Enhancing health worker and health system performance, by Charles Matsiko for the Positive Practice Environments Campaign and the Global Health Workers Alliance, medical workers in Uganda have a heavy workload due to the health worker crisis.

As of December 2009, the proportion of posts filled at public health facilities ranged from 70 per cent at Regional Referral Hospital level, to 62 per cent among District Hospitals. There is 55 per cent at Health Centre IV level and 46 per cent at Health Centre III level.

Due to low pay, many health workers must devise other means to cater for their needs. The study by Matsiko indicates that health worker salaries are too low compared to the market value of goods and services in the country and this is one of the biggest bottlenecks in attraction and retention of health professionals in service in Uganda. The health workforce crisis and the poor remuneration for those who are available have kept many Ugandans from accessing health services at a time when the national disease burden is enormous. Uganda's under-5 mortality rate is 137 per 1,000 live births, infant mortality rate stands at 76 per 1,000 live births while maternal mortality rate is 435 per 100,000 live births, according to the Ministry of Health.

Pre-natal and maternal conditions account for 20.4 per cent of the disease burden, malaria 15.4%, acute lower respiratory tract infections 10.5%, HIV/AIDS 9.1 per cent and diarrhoea 8.4 per cent. All these account for over 60 per cent of the total national disease burden. Malaria is still responsible for more illness and deaths than any other single disease.

"When they come to us they are sick, in pain; they want their drugs, not lots of words from us. The only way is to go out to where they are, talk to them, talk to the community leaders and then they will understand," said one medical worker quoted in the study. For now, the rights of health workers in Uganda are still tramped upon and it will remain to be seen whether the next five years will bring about a change.

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