A midwife feels the heartbeat of a foetus at Mulago Hospital

By Arthur Baguma

WHEN Nakaggwa was nine months pregnant, she thought her baby was dead. She could not feel the foetus move. She was weak, achy and had been bleeding on her way to hospital.
As the midwife examined Nakaggwa, her husband pleaded: “Try to save her life.”

“It’s my duty to save lives,” the midwife replied. Tales of harassment and abuse by parishioners of one of the oldest professionals-usually overshadow the sacrifice and challenges nurses endure while on duty.

“We work long hours for little pay,” says a midwife at a government hospital. “Our work is not appreciated yet the working conditions are bad,” says another nurse at a private hospital in Kampala.

Health experts say the situation is getting worse with more nurses quitting.
The global nurses’ attitudinal survey released last week, reveals that a nurse who graduates in Uganda, is likely to spend less than five years in the profession before fleeing for greener pastures.

Out of 200 nurses interviewed in Uganda, only 32% against a global average of 53% are likely to remain in the profession in five years’ time compared to 38% in Kenya.

The situation is better in the developed world with 68% of nurses in the US preferring to stay in the profession, similar to Canada where 71% of the nurses stay.

The survey released by The International Council of Nurses, the global federation of national nurses associations, rates Uganda the lowest of the 11 countries surveyed.

The survey of 2,203 nurses indicates that only 12% of nurses in Uganda are satisfied with their career. Heavy workload, little pay and long working hours are some of the reasons they leave the profession.

Uganda has a nurse:patient ratio of six per 100,000 against the World Health Organisation recommended ratio of 2.5 per 1,000.

The Uganda Nurses and Midwives Union says the severe workload faced by nurses in Uganda impacts on patient care and health.

“If not addressed, it will lead to additional exodus of nurses from the profession within the country and the continued erosion of Uganda’s health system.”

The International Council of Nurses points out the urgency of responding to the needs of nurses in Uganda.

How does Uganda compare with its neighbours?
Statistics show that Ugandan nurses are poorly remunerated in comparison to their counter parts in the region. The lowest paid enrolled nurse in Uganda earns a net salary of sh230,000.

A middle level nurse in administration and one in clinical practice, for instance a bedside nurse, earns about sh420,000. The highest paid nurse in administration at the level of an assistant commissioner earns sh530,000.

Compared to Kenya, the lowest paid nurse earns about sh380,000, while the highest paid earns sh2.12m. A Kenyan at the level of a Ugandan earning sh430,000, earns sh650,000.

In Rwanda the lowest paid nurse earns sh180,000 francs and the highest paid earns 1.3m francs.

However, in Uganda, nurses working in government facilities are better paid than those in the private sector.

For example a nurse in the private sector earns sh280,000, while a colleague in a government facility, at the same level, earns sh420,000. Uganda has 44,009 nurses serving a population of 33 million.

Mulago motivates nurses
The country’s largest hospital started the Midwife of the Month Award initiative five months ago.

Winning this award is based on being empathetic towards patients, good documentations of observations and interventions, using evidence-based nursing care and a team player.

The head of the of obstetric and gynaecology department, Dr. JK Byamugisha, says services in the maternity ward have vastly improved as a result of this initiative.

However, Mulago still has a lot to demand in terms of infrastructure and human resource. He cites the problem of few medical attendants and the need for the government to hire more medical personnel and expand infrastructure.

The ratio of nurses to patients staggers between 1:5 and 1:10. Because of the lack of midwives and nurses, this results in occasional poor service delivery.

The obstetric and gynaecology department is the busiest in the world with 30,000 deliveries a year.