Bonding doctors

By Rukiya Makuma

Government to retain certificates of medical workers to stem loss of human resource to better paying countries

The College of Public Health in Mulago Hospital is a busy place as medical students, in their over-size white lab coats scurry around with what seems like a sense of urgency. They are the future doctors for the country. Among them are some of the smartest brains in the land and, statistically speaking, they are all already part of an elite class. Medical practitioners are a rarity in Uganda.

Unfortunately, whenever the students can spare a minute to talk or dream, the subject is often beyond Uganda’s borders. The students, especially those in the fifth year of the six year course, often go about their classroom work and ward rounds while weighing the possibility of fleeing the country as soon as they graduate.

Some, like Nakiwolo Mwamini, have already made up their mind. She is a 22 year-old vibrant girl in her third year on government scholarship at the medical school, but she says she will not work for any Ugandan hospital after she graduates three years from now. Her career destination is Rwanda, South Africa, or Kenya.

“I do not spend six years in school for me to earn Shs 500,000 a month with all the dedication and hard work involved in the profession,” she says.   Shs 500,000 is approximately US$ 220, the lowest  pay for a doctor in the region. The starting salary of a doctor in a government-owned facility in Kenya is approximately US$660, in Rwanda US$700, Tanzania US$560, and South Africa US$2,400. Mwamini says if she was assured of a Shs 1,200,000 (Approx.US$550) salary a month, she would keep around.

She is not indifferent to the investment in her that the government makes.

She is grateful that the government has been paying her tuition from first year first semester. Her Bachelor of Medicine and Bachelor of Surgery course costs Shs 1,344,000 per semester minus functional fees. Government also gives her an accommodation allowance of Shs 460000 per semester and a faculty allowance of Shs500,000 every academic year. In total the government spends Shs 4,108,000 on her and for five years, the figure comes to shs 20,540,000 (Approx. US$9,000).

But after all this investment the government has committed to her, she will seek for employment somewhere else.

“Government can pay my tuition,” she says, “but how they plan to keep me around after the five years is an issue that cannot be skipped.”

She is not alone in thinking this way. The students we spoke to at Mulago echo her sentiments. Sam Wangusu is a student in his final year. He says he is willing to serve the country after school but not because he is patriotic. Unlike Mwamini, he is above 35 years and is already a practicing doctor. The government is paying his tuition for a master’s degree and it is only for that reason that he will stay.

Wangusu says the profession requires dedication and hard work with little pay at the end of the day.  Most of the young graduates cannot afford to work under those conditions when they have alternatives in other countries in the East African community. He recalls a day when, together with his consultant, they operated on 16 women in Mulago between 8 pm to 12 pm.

“As we carried out the operations, the other women were wailing outside, concentration was difficult but we had to do our best, the line outside was growing, they would wheel in a woman who had failed to deliver naturally and we were only two people on duty at the moment. As soon as we delivered the child, we hopped on to the next woman; the theatre has one bed so whoever was delivered was discharged there and then, no time for recovery, not in the theatre at least.” Wangusu recalls the incident vividly like it happened yesterday.

What he is describing happens often at Mulago Hospital.  A doctor or fifth year student can deliver up to 20 babies in a period of 8 hours in a day.

“You get tired and just leave even when you know that you should have helped save a life,” says Wangusu sadly.

The 2009 doctor to patient ratio in Uganda currently stands at a worrying 1:18,000, compared to the internationally acceptable ratio of 1:5-10. Only 10 percent of the national budget was allocated to the sector in the 2010/11 financial year. Due to poor pay, some medical  personnel leave because they are frustrated. Many simply seek greener pastures.

Health sector experts have known for some time that government-employed health workers that do not flee over low pay often either take on private jobs or demand bribes from patients to supplement their incomes. Many refuse to be posted to areas where the prospects for an extra buck are minimal.

The number of patients at Mulago Hospital and other government-owned medical facilities is overwhelming and there are few medical personnel to attend to them. But what do the medical workers earn after the long day’s work?

A medical doctor in Uganda earns a net salary of Shs 618, 145 monthly, while a registered nurse gets Shs 398,121, which is way below the world market rates. An enrolled nurse earns Shs 271,418 and a support staff earns a paltry Shs 234,142.

Francis Runumi, the Commissioner for Planning in the Ministry of Health says poor pay and too much work are the major reasons why the country is faced with a shortage of health workers. Most of them opt to go to other countries where the pay is more bearable. He says lack of accommodation has also been a major problem in the country. Sometimes the ministry recruits health workers but they do not report for duty either.

Runumi says the ministry has presented a salary proposal to the cabinet for review.  The ministry is advocating an increment to double the salary, so that they reach comparative levels with the other East African countries.

He says the Ministry has secured US$130 million from the World Bank to improve the health sector and out of that US$85 million will be allocated to infrastructure development which includes putting up modern houses for health workers and rehabilitating hospitals in dilapidated states. The rest of the money will go to reproductive health.

Runumi says the ministry has established a bonding technique that requires graduates to spend at least three years of their time in the country working for a government hospital as away of recovering taxpayers’ money. If it is passed into law the ministry will demand from the institutions where the graduates were to hand over the degree or certificate documents to the ministry and they can only be given back after the required period has expired.

He says the ministry is facing a challenge in the quality of health workers churned out. He says most of them do not have the skills that are required in the market and the Ministry has been struggling to get their own premises where they can train their own medical personnel but government is slow in responding to this.

A report launched by the African Center for Global Health and Social Transformation (ACHEST) on Nov 11 at Serena Hotel Kampala identified low salaries, massive workloads, absence of  infrastructures such as building space, laboratories , computers as some of the reasons that may  hinder the performance of medical students.

“In our campaigns for development, the lack of medical doctors limits our chances for success,” said Steven Malinga, the minister of Health, “Our progress toward the millennium development goals that target reductions in maternal mortality, infant mortality, and HIV/AIDS, malaria, and other diseases is slowed by the lack of doctors.”

Malinga said training and retaining medical workers will help. A report released by USAID in June 2010 shows that Uganda  is short of 50 percent of the required health workers in the public service; the country needs about 46,977 health workers but only 28,000 health workers are currently in service.