3 May 2018

Uganda: Hiring Doctors From Cuba Doesn't Solve the Problem

Photo: PPU
President Yoweri Museveni at an exhibition stall during Labour Day celebrations in Sembabule.

So Uganda went from a proposal to export medical personnel to Trinidad and Tobago to importing doctors from Cuba in just three years. Government has been in a protracted dispute with the Uganda Medical Workers Union over increasing the pay of its members and terms of service.

The vast majority of medical officers (non-administrative) fall in bands 3, 4 and 5 of the pay scales of the civil service. Most doctors after internship start off as graduate medical officers, rising to senior medical officers before entering the ranks of consultant and retiring as senior consultants.

Each of these ranks carries special responsibilities, but the backbone of the medical system are the foot soldiers, the medical officers who have just finished school and consultants who are in charge of training doctors.

Training doctors is mostly accomplished through treating patients with fairly complicated conditions who are admitted at government and private hospitals.

In the pay proposals, government proposes paying the 300 expatriate doctors about Shs5.5 million, which is more than the Shs4 million it pays its senior consultants or more than three times it pays its medical officers.

Medicine is a field where human capacity is even more important than physical capacity. Government has constructed many facilities, but most are crumbling because of lack of human capacity.

One example are the KCC medical facilities upgraded to alleviate pressure on Mulago hospital in the five divisions of Kampala. Two years ago, the Minister of State for Health Sarah Opendi made a highly publicised visit where medical personnel were arrested in Naguru for soliciting bribes from the hijab clad minister.

Today, outside Kiruddu Hospital whose sewerage works remain incomplete, a cottage industry of shanties operating as clinics and pharmacies make Kiruddu one of the most medicated square miles in Uganda just behind Wandegeya-Mulago. Obviously the medical personnel prefer to share their time between their facilities and the government hospital at great cost to patients.

Mulago Hospital is now routinely being sued for gross negligence where patients die of neglect a situation replicated in many district hospitals. Mityana Hospital was recently in the news when medical personnel asked for a bribe to extract a foetus from a mother, who had collapsed in labour. And after receiving those funds refused to sew her up.

Most first class doctors exhausted of waiting for better working conditions have migrated to other sectors making Uganda unique. The luckier ones have emigrated to other countries in search of better pay.

After graduating 300 doctors annually who can barely meet demand, the proposal to hire one batch of 300 doctors makes little sense. Cuba, of course, is happy to provide the help. Years of US sanctions have debilitated its economy.

Ugandans who can afford treatment abroad or who fall in the ruling class that is entitled to such care often arrive in South Africa, Kenya to be treated by Ugandan doctors. Sought after specialties like neurologists, pathologists and surgeons travel for half of the month in other countries like Kenya, Tanzania offering their services.

The low morale in the sector will be the first challenge faced by the Cuban doctors unless they are being posted in primary and outpatient care. The doctors will have to learn the local languages and come face to face with institutional neglect in the areas where they will be posted. Then the realisation that the salary while enhanced may not be a match for Uganda's high cost of living and high taxes.

After years of employment and training in Uganda, these doctors too will be looking for better opportunities.

Mr Ssemogerere is an Attorney-at-Law and an Advocate. 

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