The Independent Uganda: You get the Truth we Pay the Price
COMMENT | Rebecca Nalwoga Mukwaya | During one of his recent national addresses on the status of COVID-19, President Yoweri Museveni thanked health workers who have worked tirelessly to treat patients. He described their work as ‘world class’ as no death from the pandemic had occurred yet.
Admittedly, the health workers have done an excellent job curbing the current pandemic. Of the over 100 COVID 19 infections in Uganda, there have been 55 recoveries.
Uganda had one of the best healthcare systems in the East African region but the political turmoil of the 70s and early 80s distorted them. The mushrooming districts also caused a strain on the human resource in the health sector.
Efforts at reconstruction and construction of health facilities, mass immunization taking place before the first birthday and access to Maternal health services have improved Uganda’s health profile in the past two decades. ,
The proportion of the population leaving within 5 km of health facility is currently at 72%, the country’s mortality rate is at 43 deaths per 1,000 live births, the Maternal Mortality Ratio at 368 deaths per 100,000 live births. All these show improvement but a lot needs to be done..
Despite the many positive steps, especially on the immunization front, the sector still faces a major challenge of inadequate staffing levels.
The inadequate number of staff and their poor distribution has had an effect on the health service provision across the country.
The Local Government Councils Scorecard Initiative in the assessment of FY 2018/19 did carry out Citizen Engagement Meetings as part of the assessment and citizens developed 447 action plans in 35 districts and of these, 132 strategies were in the health sector.
Bainomugisha et al (2020) note that inadequate number of staff in health facilities as one of the most outstanding challenges in the health sector in these districts and some lacking the required number of staff.
In one meeting held in Buyengo Sub county Jinja district, citizens did report about shortage of staff . One participant said, ‘ The staff at Kakaire HC III are not enough.It takes a very long time to get attended to and usually the people are many because this is the only facility in the area and you find that there are only 3 or 4 people attending to all the patients.
Such scenarios are a common sight in the health centres, take for instance an Out Patient Department at HCIV currently has one senior nursing officer, one nursing officer and three enrolled nurses about five people to handle all cases.
A health sub district can have a catchment population of approximately 50,000 people while a district hospital can have between 100,000 to 150,000 people. These staffing norms were instituted while the populations were lower however; the population has since grown four-fold.
The low numbers of health workers affect the health system in various ways. There is inadequate care to patient, as they spend a lot of time in the queues, while health workers work long hours and are overwhelmed and fatigued.
In such a case, it is easy to miss out a case which is a prime suspect for example of this COVID19 pandemic as one tends to rush to reduce on numbers before them.
These limited numbers of health workers stall the goal of Universal Health Coverage in low and middle income countries such as Uganda.
Amidst this human resource gap of over 25,000 health workers, Uganda also continues to lose those already in the system through brain drain in search for greener pastures.
The World Health Organisation recommends a doctor patient ratio of 1:1000 but the Ugandan case is 1:11,000.
The wage bill doesn’t allow to recruit more health workers and the Ministry Of Finance, Planning and Economic Development ( MoFPED) failed to release funds although the Ministry of Public Service is ready to recruit more.
Betwixt the COVID 19 pandemic, improving staffing norms would help in patient management better and thus better service provision. However, there is need for government to show willingness to improve these short falls in the health sector by committing funds for recruitment.
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Rebecca Nalwoga Mukwaya is a Research Assistant with the Advocates Coalition for Development and Environment (ACODE).
