Health sector experts have lauded Government for the salary enhancement for medical workers in the national budget, noting that it is a sign that the country is moving in the right direction.

Speaking to the New Vision, Dr. Samuel Oledo, the president of the Uganda Medical Association (UMA), said by enhancing the salary of medical workers, the government has proved that it can honor its commitments.

“That has been long overdue, but we are grateful, that the government has been faithful to the collective bargaining agreement and has honored it. Now it is upon us doctors to be professional,” he said.

He added: “Let us be available. Why moonlight? Money can never be enough. Besides, we are mainly trained to save lives, not for money. The legacy is seeing someone alive.”

The health sector has been allocated sh3.722 trillion in the Financial Year 2022/20223. The salaries of medical workers, scientists, and science teachers have been enhanced by Sh495 billion.

At the end of the phased enhancement of salaries for medical workers, an entry medical officer, dental surgeon and pharmacist will earn sh5m, a consultant sh18.5m, a senior consultant sh20m, and a nurse sh3.5m.

This has pushed the health sector wage bill from sh685.7b in the current financial year to sh1028.1b in the next financial year 2022/2023, which starts next month.

The bulk of the wage bill for the health sector, sh748.3b, which represents 73%, will go to health workers in health facilities under local governments.

Oledo told New Vision that the salary enhancement will go a long way in ensuring that they have peace of mind when saving the lives of Ugandans.

Budget Brief Case

“This salary enhancement is to help us so that we can be in the same market as other people, but it is not commensurate with the kind of service we render,” he said.

Oledo said together with his team, they have embarked on a journey to ensure that there is professionalism and discipline among medics in the country.

Peter Waiswa, an associate professor of health policy planning and management at Makerere University School of Public Health, noted that the salary enhancement is recognition by the Government of the importance of the human resource.

“It is nice that the government is walking the talk of prioritizing scientists and health workers. The increment is appreciated, especially during this difficult time. But it is not enough because it is not equitable. There are groups still left behind like the nurses,” he said.

Waiswa said the salary must be fairly distributed since doctors cannot work without nurses.

He also said salary alone is not a good motivator, therefore, Government needs to also invest in health infrastructure and equipment and also increase the number of medical workers in its facilities to lessen the burden on the shoulders of those already in service.

Dr. Jacob Otile, an advocate for better health and health systems, said beyond the salary enhancement, there is much that needs to be done to revamp the sector.

These include the recruitment of more staff to fill the vacant positions in the sector.

“In 2020, the staffing levels were at 74%, there are about 26% vacant positions that need to be occupied. We are not only saying increase the salaries, but recruit, have a proper recruitment policy and on retaining staff as well,” he said.

Otile noted that the staffing situation is worse in the rural areas, which hold the bulk of the population. He said whereas the national levels are at 74%, the rural levels stand at about 55%.

He said the Government is also still performing poorly in regards to attainment of the 15% of the National Budget allocation to health as it committed under the Abuja Declaration but says the improvements are a good indication that the country is on the right track.

“We still have bigger burdens, such as maternal mortality and newborn mortality that require us to better services. COVID-19 showed us how poor our emergency response and referral systems were,” Otile stated.

He said more investment needs to be injected into supplies, such as medicines and equipment, such as CT scans for regional health facilities to bring services closer to the population.

In the next financial year, the budget for health facilities under local governments has increased by sh247b, from sh596.06b in the current financial year, to sh843.2b.

The budget for all the regional referral hospitals has increased from sh160.4b in the current financial year to sh207.7b.

The health ministry allocation has increased from sh1,512b in the current financial year to sh1,557b in the next financial year.

The budget for the Uganda Blood Transfusion Services has been increased from sh18b to sh23.6b. The budget for the Mulago National Referral Hospital has been increased from sh69.3b to sh74.6b.

However, the National Medical Stores, Uganda Cancer Institute, Uganda Heart Institute, and Uganda Virus Research Institute have had their budgets cut, while other entities in the health sector have had theirs increased.

Prof. Francis Omaswa, the executive director of the African Centre for Global Health, and Social Transformation (ACHEST) said the country’s per capita expenditure on health is still way below the recommended figure of $68 by WHO and over the last 10 years it has kept on reducing.

He said the government can improve the figures by putting in place a health insurance scheme — national or community-based — to generate additional income.

“We have taken too long to get on board on this. Let us get a small package for everybody, which is delivered from the tax base, and then beyond that, we ask people to insure. We can encourage communities to have community insurance schemes,” he said.

sub-sectors underfunded

Peter Eceru, the program coordinator for advocacy at the Centre for Health, Human Rights and Development, said whereas the health sector’s budget has increased, much of it has gone into the wage bill, leaving the other subsectors underfunded.

“We are supposed to have regional equipment workshops and that is where we want to see a lot of emphases. Regional hospitals are referring patients to Mulago not because they do not have enough medics, but because they have no equipment to use,” he said.

Eceru said there is also not enough equipment to collect and process blood, which has kept the country in shortage over the years. Out of the 420,000 units of blood required annually, there is a shortage of 120,000 units.

He said this could be one of the reasons the country still has a high mortality rate of 336 deaths per 100,000 mothers since 42% of the deaths are due to lack of blood.

“In numerical terms, we have made progress, but we are still below the 15% international commitment we made. If you do not sort out the current high cost of medical services, even other projects, such as the Parish Development Model, will not succeed because it is in the nature of human beings to preserve life first,” he said.

Dr. Samuel Oledo, the president of the Uganda Medical Association, concurs that there is still much more that needs to be done, especially in the areas of retaining staff and improving superspecialized services to stop medical tourism and attract Ugandan medics working overseas to invest in the country.

“We have doctors who have studied, but because of the working conditions here, they have had less interest in being in the country,” he said.