East Africa

Uganda: Exporting medics will help expose them to best practice – PS Lukwago

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Wise decision? A court judgment to a green light or halt exportation of at least 263 health workers by the ministries of Health and Foreign Affairs to Trinidad & Tobago was expected on March 2 but was postponed and expected this coming week. The Belgium government last week withdrew Shs34 billion to Uganda’s health sector over the matter but Ministry of Health Permanent Secretary, Dr Asuman Lukwago, told Sunday Monitor’s Frederic Musisi that Uganda is in surplus of medical workers.


There is conclusive evidence of acute shortage of health workers in the country, but why would Uganda insist on exporting medical workers it doesn’t have and who is behind the process?
It was the Ministry of Foreign Affairs that received a request from Trinidad that was intended to accelerate bilateral relations between the two countries. Trinidad would train our people on oil matters in exchange for doctors. They therefore involved other stakeholders, like my ministry and the Health Service Commission, into this process to study the request and see how we could go forward.
When Foreign Affairs comes up with an arrangement it binds the entire government which means in the perspective of collective responsibility, it binds government departments.

What was/is the specific role of your ministry in this scheme?
Our role was to advice the Ministry of Foreign Affairs, for example, who should be targeted, where should these health workers comes from. But we also advised them not to deplete our departments. The arrangement was to recruit those medical workers who are not employed but are experienced. We advised them to put up an open advert and some conditions we spelt down.

But according to the shortlist majority of candidates are from local government hospitals and 93 are from Mulago National Referral Hospital…
The so-called 93 medical candidates from Mulago are people who have been working as interns or those who have been on training or those who have been on postgraduate courses, have completed training but are not yet absorbed because the system is incapacitated for now. So they might appear like they are from Mulago, but they are not recognised as Mulago staff.

Have you personally looked at or reviewed this shortlist?
We have technical people working on this and I’m convinced they have looked at information on everyone. To a certain extent some of the candidates may want to say we can default on our work places or come from Mulago where we have been employed but these are small numbers and cannot change the country’s statistics; that means we can replace them.

But with the year in, year out cries of acute shortage of medical staff in government health facilities, did you as technical people take a step backwards to reflect on this?
Uganda has some challenges of shortage of human resource on the frontline but it does not mean shortage in capacity. There are some frontiers like midwives, nurses, general medicine doctors, among others where we have excess and the biggest question becomes whether we should just let them be there without work or put them in line to wait for vacancies to pop up but for how long?
On frontlines where we don’t have excess these people are already absorbed by government. Everybody’s wish is for government to take up everybody but government cannot because the resources are finite. But our higher institutions of learning also produce more every year so where do we put them? The same is for teachers, economists, journalists and other groups.
If what is happening to doctors happens to teachers, economists and journalist, it would be good for the country. Uganda has a lot of teachers but countries like Central African Republic don’t have teachers. Somalia might need English teachers yet there are so many of those who are not employed.
We are talking more doctors because health touches our lives more. But if we’re to mobilise about 1,000 teachers to go to any of those countries, such a debate would still come up notwithstanding there are hundreds of unemployed graduate teachers.

The 2013 Budget Monitoring and Accountability Unit report indicates that even with the recruitment of 6,100 staff for the next five years, still there would be shortage. How do you justify enough?
The specific figures are in our reports. But for your information, doctors have been informally going out and have been crossing borders to work in countries like South Sudan, South Africa, America, and Europe. This time around, government just wanted to formalise the process of their going to Trinidad & Tobago. So I think we should be talking more about the safety of our children-Trinidad is largely a black country but we don’t know whether their cultures have changed so we don’t want our people to find any trouble there.
That it was why Foreign Affairs is taking the lead this time around—they will be provided with passports and the ministry will also follow them up in case the host country fails to comply on the terms and conditions, for consular services, and other issues.

It is common knowledge that Trinidad already has enough doctors with the prescribed World Health Organisation (WHO) doctor patient-ratio, and Uganda’s justification of “accelerating bilateral relations” symbolises the weakness of our institutions. Isn’t there a game plan to absorb them instead?
It is true we don’t meet the WHO doctor-patient ratios, but any game plan is constrained by the financial implication. For us we are happy now that such debate is coming up because everybody has been yearning for a private sector led economy which means competition. Having these people going is another way of keeping us awake, that while we continue to train people they have nowhere to go.

We hope the debate will go to the highest level and the Finance ministry can see the need of ring-fencing at least more than Shs50 billion for staff remuneration—from staffing, absorption and retention. We are crying of shortage amidst plenty; some time back we put aside about shs60 billion and recruited about 600 on contract but after five years that Budget was stretched and we couldn’t absorb anymore; now we are indebted to them by up to seven months. So we had to stop recruiting because the ministry couldn’t find any money to retain them.

Does this explain why health facilities run without medical attendants?
It is true, but in management when you are confronted by such issues you look at solutions. What would be the way forward; one of them is to train more and do human resource capacity development, send them where they are needed because besides earning they are going to learn more new things that they can implement when they get back home.

How many Ugandan doctors go abroad and come back home to work with you?
We have a lot of Ugandans in the diaspora but how did they go? When they go on their own they never come back but under such a government arranged programme they will obviously return and with better skills.

They don’t come back because no one helps them to go and to follow them up; if I suffered while crossing the Mediterranean, saw people dying and drowning on the ships/ferries or whatever means and say, I land in Spain, why should I come back? But under this agreement we can sign an agreement that say after two years a team can come back and we send another.

Doctor Albert Cook who started Mengo came here not because Britain had a lot of doctors but because there was need to explore. As African we must visit other parts of the world and see what is done there, learn their capacity, create some opportunities for partnership.

More worrying is that the shortlisted candidates are specialised doctors, whom the country is largely banking on. Shouldn’t government be struggling to retain them?
Yes I know, but if one of them walked over to me and said, ‘You are a PS, you get your salary. what about me/us,’ what can I tell them? I know about such people but the government is handling a restructuring process and they will be replaced. Here the government came in because Trinidad tabled a request and we said we must get a safer way of protecting our people, since they have been going anyway.

By the way if Trinidad had resorted to a secret recruitment they would still go. We have a number of medical staff who have never come back here, like the senior paediatrician Dr [Muniini] Mulera who is based in Canada–how he went, was he assisted by government?

Have you given up that you can’t do anything to reverse the process or lobby to increase these people’s pay?
No, my hands are tied. They are not tied because of naivety but I know how government operates and it is through standards. People call it bureaucracy but these standards are good. It is these standards that define our ceiling; to make sure that we are not amorphous because when we become amorphous then we cannot operate the government as a result of over stretched resources.
So my suggestion really is, it is good the public has picked interest in the debate but to guide the public they should concentrate more about the safety of these people and the way we would want them treated while away because we don’t want to hear of doctors being treated as maids, harassed or indoctrinated into cultures that are funny for us, and so on.
To go work in Trinidad and gain more experience to me is like apprenticeship, as you [media] have already said Trinidad is ranked 67th in the world in the rankings of health systems.

On the other hand Uganda is ranked in the 149th position…
That’s true, but you know Trinidad has a small population and it is an oil economy too.

Have you conducted a risk-benefit analysis of sorts on this arrangement to justify your actions and the likely effects?
We have a lead agency—our technical people who are working with Foreign Affairs on this exercise while the Ministry of Public Service is evaluating the entire equation. All concerns must have been catered for before, but also from the debate all fears are being looked into. As a government we cannot provide all solutions, society has a role to play.


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