Cuban doctor controversy

Does medical union, NOTU, understand what they are fighting?

Kampala, Uganda | FLAVIA NASSAKA | June 23 might mark a turning point in Uganda medical service sector. The National Organisation of Trade Unions (NOTU) gave the government up to that day to ensure it has raised the minimum pay of health workers. According to NOTU, the lowest doctor should earn Shs5 million from the current Shs1.1 million and a nurse should earn Shs2.7 million.

But fireworks are expected in June as the government is unlikely to comply with NOTU’s demands. And President Yoweri Museveni and his team are preparing for the clashes, on two fronts.

First, by mounting a massive public relations campaign highlighting the government’s commitment to offer good wages to doctors – and all other public servants albeit incrementally.

While speaking at the May 01 Labour Day celebrations at Ssembabule Town Council playgrounds in Sembabule District, Museveni said the government is not opposed to the enhancement of salaries of civil servants. But he said since civil service employs only 1% of the population and 99% are employed by the private sector, it would be unfair to devote most revenue to cater for the salaries of a small fraction of the population at the expense of the rest of the population.

He said doctors inciting others to abandon patients to die are “selfish, unprofessional, and going against the code of conduct of medical practitioners”.

“A doctor who preaches to others to abandon patients because of salary is a doctor no more. We in the NRA, we were fighting for many years to liberate Uganda without pay but we never abandoned the cause. Even these UPDF soldiers have been fighting and securing the country either at no pay or low pay but they have not abandoned the country,” he said.

Museveni’s argument is central to the government’s strategy on wages of health workers under the National Health Policy II 2010-2020. The Policy recognizes that up to 50% of health services in Uganda are provided by the Private Not for Profit (PNFP) facilities affiliated to religious bodies. These PNFPs have been able to achieve better results in health with fewer resources according to many reports. They are also managed differently.
For example, while doctors in PNFPs earn less than those in public service, the nurses, midwives and others earn more in private. The question is why?

The answer: Government hospitals have far more doctors per patients served than private hospitals, their salaries have been rising over time, and they get allowances such as retention allowance, and top-up allowance on basic pay. The government has also been constructing three-bedroomed houses for them, sponsors them for training, and offers them a clearer career growth path than the private sector. Finally, one report says, “salaries and employment are guaranteed in government facilities even when health workers do not perform”.

It concludes: “If the government increases salaries of health workers, it may leave the PNFP sector understaffed” as the health workers rush to fill up positions.

Still, the government recently raised wages of categories of health workers. A senior medical officer/senior dental surgeon who has been earning Shs1.3 million per month will now earn Shs2.7 million and an enrolled nurse will move from earning Shs400,000 to Shs600,000.