By Chris Kiwawulo
The state minister for general duties in the health ministry, Sarah Kataike, on February 19, 2013, told Parliament that over 4,000 health workers had turned down government appointments at health centre IIIs and IVs.
The reasons for this, she went on, were; poor remuneration, lack of accommodation and poor working conditions. Whereas some medical workers whom New Vision talked to agree with some of the reasons the minister gave, others say there is a lot more than the minister’s arguments. This, perhaps, explains why some districts like Kitgum have spent years without a district health officer.
Appearing before the Parliamentary Committee on Health, Kataike said: “As of February 15, only 1,393 health workers had reported for duty out of the 10,231 vacancies advertised. A total of 5,713 health workers were offered jobs, so we still have 4,518 jobs to fill.”
Asked what challenges she faced during the recruitment process, she was quoted as saying: “Medical officers did not respond to the advert probably because they don’t want to live in villages.” She also expressed fear that the health workers, who report for duty may run away or not turn up due to lack of accommodation.
The minister says last August, the Government advertised 10,231 vacancies for health workers in 111 districts, but 24 anaesthetic assistants applied, out of the 263 needed and 30 ophthalmic clinical officers applied out of 159 required.
A total of 49 applied for the public health vacancies out of 117 needed, 119 theatre assistants applied out of 228 jobs advertised and 119 medical officers applied out of 152 needed. A total of 76 anaesthetic officers applied out of 182 needed.
How many positions are vacant?
Dr. Asuman Lukwago, the health ministry permanent secretary told New Vision that they carried out an assessment and found that 10,000 health workers’ positions were vacant. He said their target in the ongoing recruitment is to fill 6,170 positions, although only 5,713 posts have so far been filled.
“We hope to meet our target because there are some districts in Karamoja region like Amudat which did not recruit health workers due to lack of district service commissions,” he explains.
Besides, Lukwago noted, prime districts like Kampala and Wakiso were over applied to, meaning that many health workers will not be absorbed there. “We shall re-advertise and carry out round two of recruitment to fill vacant positions upcountry and I know many medical workers would go upcountry instead of remaining jobless.”
Why health workers shun upcountry jobs
Difficulty in adjusting to upcountry conditions
Rose Okilangole, the Gulu deputy district health officer in charge of reproductive health, says medical workers who have grown up and studied in towns find it difficult to adjust to rural environments.
She, however, disagrees with Kataike on poor pay. “In my experience, I don’t think it is poor pay that is making medical workers shun upcountry jobs, but rather, the rural environments without social amenities like televisions.”
Okilangole observes that some medical workers would want their children to study in those schools that they, themselves, went through because they presume upcountry schools are substandard. “Some medical workers believe traditional schools like Budo and Namilyango are the best for their children.”
A medical worker, who recently quit public service to join the private sector, agrees with Okilangole. The medical worker, who preferred anonymity, says most medical workers who accept to take up jobs in upcountry areas operate at the centres during the day and sleep in the nearest town centres after work.
“In fact I know about medical workers, who work upcountry, but sleep in Kampala. In essence, they commute every day,” he reveals. He says, there are a few cases of doctors staying upcountry where they work, adding that, “in most cases, those are medical workers who are born in such areas.”
Poor pay vs greener pastures
The medical worker, who preferred anonymity, says he quit public service over little pay, adding that some of his colleagues have since moved out of the country for much better pay.
The medical worker, says he was offered a job in Botswana, recently, at $2,800 (about sh7.4m), after tax deductions, with a house and other benefits, but he declined to take it because of family obligations.
It was recently discovered that many Ugandan doctors go to Rwanda and the southern African region in countries including Lesotho, Zimbabwe, South Africa, Swaziland, Zambia and Botswana seeking better pay. Some also go to the US and Europe.
In 2010, the health ministry revealed that 13 senior surgeons left Uganda for Rwanda in 2009 due to poor pay. South Africa employs 250 Ugandan doctors, Swaziland 10 and an unknown number was reportedly scattered in other Southern Africa countries.
In Uganda, a doctor starting out, earns about sh700,000 after tax deductions. A consultant surgeon in Rwanda is paid between sh5m and sh9m, while in Uganda such a consultant is paid sh2m.
According to findings by the Global Health at the University of Ottawa, Uganda spends $21,000 (sh56m) to train one doctor. The findings were published in the British Medical Journal in November 2011.
Poor living conditions
Sarah Kembaga, the in-charge of maternal health at Baitambogwe HCIII in Mayuge district, echoes Karungi’s concerns. “Poor living conditions, especially accommodation as well as lack of electricity and water make life difficult for doctors upcountry.”
Sub-standard schools, housing
Besides, Kembaga says, some medical workers refuse to take on jobs upcountry because many schools upcountry are sub-standard for their children, and besides, if the medical workers wanted to pursue further studies, they would find it difficult to work in such areas because they cannot ably commute to attend classes.
Like Kembaga, Adonia Samanya, a clinical officer in-charge of Mityana hospital’s Out-patient Department, notes that working upcountry makes it difficult for health workers to upgrade.
Samanya adds that lack of accommodation at health facilities makes it difficult for medical workers to take on jobs in rural centres. He also confirms that some medical workers travel long distances to and from their work stations every day.
“One time I was working at Kyantungo Health Centre IV, which is 27km from Mityana town, but I would travel on a motorcycle because I was residing in the town.”
However, Samanya observes that some medical workers shun work in upcountry health centres due to language barrier and attitude. “Some people simply do not want to work far from their homes.”
In a bid to motivate medical workers to take on jobs upcountry, especially in hard-to-reach areas, the health ministry introduced a policy, where allowances would be given to workers in these areas.
But medical workers say the allowances are not paid in time and in some cases, the districts that qualify to get the money are, for unknown reasons, excluded, which makes them lose interest in the jobs.
Maari Karungi, the Kanungu district health educator, says some health workers outside Kanungu town council were getting the hard-to-reach areas’ allowance, but those within the town council were not.
“What criteria do they use to allocate the allowances? The whole of Kanungu is a hard-to-reach area. This is one of the issues that demotivate health workers,” he says.
Karungi agrees with the minister’s reasons for medical workers shunning upcountry postings, but adds that: “Many upcountry areas like Kanungu have no means of transport.
None of the health centre IIIs in Kanungu, for instance, has transport, not even a motorcycle. Besides, many areas do not have electricity and water, which turns away the medical workers.”
Karungi’s says, it is little wonder that some medical workers are posted to upcountry health centres, but abandon the jobs after a few months.
Ministry of Health speaks out
On concerns that some medical workers in hard-to-reach areas were not receiving allowances and that this discourages others, Lukwago says the policy on hard-to-reach areas excludes medical workers who operate in urban centres.
“Ideally districts like Karamoja are hard-to reach, but the policy was designed in such a way that urban areas in those hard-to reach districts be excluded because they were presumed to have services like electricity, water and transport. Also, the policy was to avoid branding Uganda a hard-to-reach country,” he expounds.
“The ministry is also in the process of effecting the increase in medical workers’ pay as promised by President Yoweri Museveni.”
Commenting on the welfare facilities that do not attract medical workers to upcountry areas, Lukwago says the ministry is working hard with other stakeholders to improve the situation so that incentives like electricity and piped water are in place as well as transport.
Lukwago reveals that the ministry embarked on orientation of the young medical workers so that they get to understand that Kampala is not the only place where they can comfortably work. “There are many other beautiful things upcountry, which many of our young people do not know about.”
According to the World Health Organisation, the recommended doctor-patient ratio in a developing country like Uganda is 1 doctor per 10,000 patients. However, currently, Uganda’s ratio stands at 1 doctor for 24,725 patients.
According to the 2011/12 national budget, sh985.58b was earmarked for the health sector, of which sh193.52b was to cater for wages. This is about 0.19% of the total health budget.