By Dr. Daniel Tumwine
A year before I completed my three-year master’s course to become a medical specialist, an important contingent came to town. It was a WHO high level delegation. They were in town for about a week — if you do not count the obligatory dash to Bwindi and Jinja — to deliberate on how to prevent health worker migration from poor to developed countries.
At the end of the meeting, the usual photo opportunities were had, business cards were exchanged and a Conference Declaration read out to the impatient media.
The Kampala Declaration of 2008 became the seminal blue-print for the movement for the prevention of global health worker inequalities. It has defined, coalesced and rallied a global lobby to address health worker inadequacies and resource inequalities.
The declaration that bares the name of our capital city has called to attention the worldwide shortage and mal-distribution of health workers. It has led to countries putting in place appropriate mechanisms to shape the health workforce market in favour of retention. Attend any international conference on human resources for health, and the Kampala Declaration will be invoked. The Kampala Declaration was a diplomatic coup and a human health triumph.
But, this was seven years ago. Today, Kampala is planning to send 261 health care workers, nay, 261 health care medical specialists to Trinidad and Tobago to ‘help strengthen diplomatic ties.’
Now, in the spirit of ‘strengthening diplomatic ties’, I will stick to diplomatic language. I think it is not only irresponsible and imprudent, but it is plain silly, impetuous and extremely reckless.
Uganda ranks high among countries in the world with a “critical shortage” of health service. Right up there between Angola and Bukina Faso.
Kenya and the Democratic Republic of Congo have more than twice the number of doctors than Uganda. There is a severe shortage of health care workers country wide.
According to the Budget Monitoring and Accountability Unit (BMAU) in the ministry of finance, only 48% of health positions are filled countrywide. For example Nakasongola district only has one doctor, who also doubles as the district health officer.
In Mityana district, four health centres are manned by one member of staff each. Fort Portal Regional Referral Hospital needs at least 50 more specialised and non-specialised staff to provide optimal care. I could go on ad nauseam, but I think you get the picture.
Now, Trinidad and Tobago is a beautiful country. It loves its cricket. It loves its beaches. It is the third richest country per capita in the Americas, after the United States and Canada.
Even if we assume that there are no doctors in Trinidad and Tobago, by exporting 261 of our finest medical specialist to the tiny Caribbean twin island nation — whose population, at 1.341 million, is less than that of Kampala — we will ensure that there is at least one (Ugandan) specialist per 4,600 people.
The current doctor to patient ratio of Uganda is 1 doctor for every 15,000 Ugandans. There is one medical specialist for every 25,000 Ugandans.
Uganda spends between sh52m to sh70m, depending on the source, just to train one doctor. Some economic genius calculated that for every doctor that migrates, the economy loses around $560,000 (about sh1.5b), which is a lot of money. But more importantly, a lot of deaths.
The migration of a single health worker has a profound effect on the community, not just in terms of its overall health, but on economic and social development, trade, employment, human rights and, of course, public health.
Admittedly, I was born of doctor parents who migrated at their prime. So I am a poor candidate to throw stones at glass houses. I grew up as part of an émigré community, half of it yearning to return to the motherland, and another half doing their best to assimilate to its adopted country and rid itself of the ‘Originaires’ tag.
Of the doctors born in Uganda, about 43% live and work outside the country. Over two thirds of my undergraduate class are out of the country. And we are not alone. A recently published study showing medical students preferences regarding postgraduate migration and future practice showed that only 8.5% of 150 medical students at Makerere University indicated that they never intended to emigrate. About 63% declared their intention to leave the country within five to 15 years of graduation.
Migration is an emotive and deeply personal issue. It is born of a complex meshwork of pull and push factors. For example, the average specialist in Trinidad and Tobago earns about sh12.8m after tax. In Uganda, a doctor starting out earns about sh700,000 after taxes. A consultant surgeon in Rwanda is paid between sh5m and sh9m, while in Uganda, such a consultant is paid sh1.5m. Botswana, a country that actively recruits Ugandan doctors offers them $3,000 (about sh8.4m) after taxes with a house and other benefits as a starting salary.
I honestly think that if Uganda and Trinidad and Tobago are to ‘strengthen diplomatic ties’, then Brian Lara should visit Uganda again and teach our youth cricket. We should not tear the Kampala Declaration into pieces.
The writer is a paediatrician at The Children’s Clinic in Kansanga and executive director of the Uganda Paediatrics Association
Migration of doctors a big loss to economy