A review of human resource for health in Uganda

Expenditure on health workers forms a significant proportion of total health expenditure in many countries. Evidence suggests that health systems in developing countries are understaffed and that health workers are badly distributed within the system. Health workers are also thought to be de-motivated and to face inappropriate incentives which lower their productivity.

This paper describes the procedures for recruiting and training health care staff in Uganda; the costs and financing arrangements for training; projected staff requirements; staff salaries; and migration of health workers within and from Uganda. It uses data from the country’s Ministry of Health and from the African Medical and Research Foundation.

Its findings include that:

• increases in health infrastructure, which went ahead under decentralised management, were not matched by central government attempts to recruit and train more staff
• Uganda has a population of 24 million but only 2102 registered medical doctors; and about 25 per cent of these doctors are foreign and could leave the country
• the Ministry of Health has no direct control over health training institutions, and so the output of trained health professionals does not respond to the demand for them
• currently, there is no information regarding the extent of migration of health workers at district level, but it is believed that many doctors and nurses leave to seek more highly paid work in other countries, particularly the UK
• doctors are thought to be de-motivated due to low salaries compared to other highly trained professionals; lack of housing, transport and other social amenities in rural areas are also seen as reasons for doctors to migrate elsewhere
• planned targets for achieving minimum staffing norms are not being met; problems include minimum entry requirements for admission into courses and inadequate management and funding of nurse training institutions.

Considering potential remedies to Uganda’s health care staffing problems, the paper suggests that a non-wage package could be put in place to attract and retain health workers, and that all health units should be provided with adequate housing facilities for staff with solar lighting and adequate clean water.

The paper concludes by suggesting areas for further research on human resources for health in Uganda, including the importance of health workers in the implementation of the country’s minimum health care package; the impact of migration on health workers on the development of health systems; and incentive structures for health workers.