By Dr. Ekwaro A. Obuku
Investing in human resources for health is economically productive.
On August 13th, 2016 during the 1st Grande Doctors’ Conference and Fellowship Dinner at Imperial Royale Hotel, the Chief Guest Mr. Museveni put it clear that deployed senior house officers offer a national service and should be paid; otherwise it is “modern day slavery”.
Senior house officers are the specialist doctors in apprenticeship including obstetricians who save lives of mothers and babies with pregnancy problems; orthopedic surgeons who fix broken bones after crash accidents such as those on Masaka road; paediatricians who handle complicated cases of childhood diabetes and asthma; as well as Internists who control complications of blood pressure such as kidney failure and treat cancers too.
Shortly before that, Dr. Solomon Kyazze their chairman at Mulago presented challenges of senior house officers before a keen Mr. Museveni key of which were lack of scholarships, poor accommodation and non–payment for the health care service they provide to Ugandans. In his response, Mr. Museveni directed the new health minister present at the dinner to “make your regime different”. Indeed “hakuna mchezo” defines a renewed spirit, literally translating as a “no nonsense” period of social services delivery. The goal is to transform Uganda into a middle–income country by 2020, and leaving health workers behind is no secret formula to achieving this quest.
Since the 1960s economists have perpetuated the narrative that investing in the health sector is consumptive or non–productive, without returns on investment compared to say, road construction or agriculture. Recent data from the united nations high level commission on health employment and economic growth is demolishing this myth, also known as the Baumol hypothesis advanced by the seasoned American economist William Baumol in his 1967 paper. The early results from this commission, whose co-chairs are President Francóise Hollande of France and Jacob Zuma of South Africa, concluded that investing in the health sector is crucial for a resilient economy.
National teaching and referral hospitals greatly benefit from Senior House Officers!
The over 300 senior house officers at Makerere University, provide a crucial health service to patients with complications referred to Mulago hospital. Therefore, closing Makerere University was tantamount to closing Mulago. In comparative terms over 500 senior house officers countrywide constitute 30% of the active doctors labour force in public service.
They are the ‘Special Forces Command’ fighting all sorts of disease complications with patients referred from Uganda, Rwanda, Burundi, Congo, South Sudan, northeastern Tanzania and western Kenya. While Mbarara, Gulu and Mbale are public health referral hospitals benefiting from this free labour of the senior house officers; Uganda Martyrs Medical School in Nsambya hospital and Kampala International University hospital privately provide incentives to facilitate their doctors in masters of medicine programmes. Clearly, paying senior house officers at least 3 to 5 million Uganda shillings monthly is a sound business model in this symbiosis to learn by doing.
While Mr. Museveni’s strategy to invest in physical infrastructure is commendable, making existing facilities work makes business sense and it is no wonder that health centre level 2 are being phased out. However, research evidence shows that in Uganda’s context the more robust infrastructure are the human resources for health. The doctors, pharmacists, nurses and midwives are the cogs without which the wheels of health service delivery cannot move!
In our recent engagement with the KCCA Lord Mayor Mr. Erias Lukwago, we emphasized health service providers as key in determining quality of care by customer satisfaction or improved health outcomes such as uptake of immunization programmes or reducing maternal mortality. Noteworthy, the ministry of health surpassed its target of 1 hospital per 500,000 population achieving 1 to about 250,000 in Uganda. In Kampala alone, which has over 10 major hospitals, this target is even better with 1 hospital per 150,00 population. In sum, health workers are the machinery that deliver primary health care, a pro–people policy ushered in by the NRM regime. Investing in the human resources infrastructure should be the priority of priorities in this kisanja Hakuna Muchezo.
The writer is the General Secretary, Uganda Medical Association
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