Worst brain drain happening internally

By Dr. Daniel Tumwine

I recently went on a working trip abroad, where I bumped into three of my former classmates, all working in the same town.

All three brilliant physicians, as they were, had chosen to leave Uganda and ply their trade in their new adopted country. They cited, not just poor pay (they could live with that), but the atrocious working conditions, a rigid health system and the lack of clear opportunities to develop as individuals as some of the reasons why they left.

This reminded me of the time, two weeks before we sat our final specialist exams, when three delegations visited our squab post-graduate room. One was from Kenya, the other from Rwanda and the third from the UPDF.

The Rwandan and Kenyan delegations promised us not just greener pastures, but the whole farm, if we relocated to their countries. The UPDF delegation was more concerned with filling its medical quotas. There was no delegation from the Ugandan Government.

It is well known that on average, about 250 health workers leave Uganda every year for countries that pay better. My undergraduate class of 80 had about a third leave for other countries within five years of graduating.

One would not feel they had finalised medical school unless they had sat the United Kingdom entry exams.

Background

This brain drain started in the 1970s during the Idi Amin regime when highly qualified professionals (mostly doctors) left the country.

Records show that the number of doctors in Uganda dropped from 978 to 574 between 1968 and 1974, while that of pharmacists fell from 116 to 15.

My parents, who were highly qualified medical workers, joined this emigre group in the 1980s, and I grew up in the diaspora surrounded by a large community of Ugandan medical workers.

This trend has continued, despite a global effort to stop the migration of medical workers. In the past five years, over 800 doctors have left Uganda, most of them for neighbouring countries.

At regional and international levels, the remuneration of health workers in Uganda is much lower than that of their counterparts abroad. A doctor in the United Kingdom earns 12 times more while those in Kenya earn four times more than doctors in Uganda.

Since the turn of the decade, more than 20 senior consultant doctors have left Uganda for Rwanda where the pay is six times higher.

Internal brain drain

As much as it is bad that skilled professionals are leaving Uganda to work abroad, the worst brain drain is the one happening internally.

With the proliferation of non-governmental organisations (NGOs) tackling health-related issues, most doctors find themselves preferring to work behind a desk — not in front of a patient — crunching numbers, looking at reports and making sense of asset use and programmatic deadlines.

Whereas in the past sitting a UK entry exam was almost a prerequisite after finalising medical school, these days a public health or management degree is almost mandatory.

And in Uganda, our problem has never been lack of numbers. For example, South Africa and the United States have about 200 practising doctors, compared to about 1,500 registered doctors in Uganda, only about half of whom are practising.

Of my 16-strong paediatrics graduating class, three went abroad, while 10 are either in a programme or project run by an NGO.

Way forward

The Government has tried a few interventions to curb the problem. There has been an, albeit slight, increase in the remuneration of health workers and increased opportunities for professional development as well as recruitment of more health professionals.

The Government has also embarked on a programme aimed at attracting Ugandan nationals back home.

However, unless the core reasons for migration — poor working conditions — are addressed to include much better remuneration, better living conditions and the need to upgrade skills, the emigration of health professionals will continue to affect the public health system through the loss of senior and specialised workers.

The system will also be affected by the increased work-load, unnecessary transfer of staff, general frustration, low staff morale, loss of investment in the development of skilled health professionals and patients resorting to other means of healthcare such as traditional practitioners.

All these will lead to poor quality of healthcare being provided at public health facilities. 

As for my three colleagues I met abroad, they all wish to return home someday. But until then, they will prefer to remain part of the lost émigré community.

The writer is a paediatrician at The Children’s Clinic in Kansanga and executive director of the Uganda Paediatrics Association

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