Tuesday, 30 April 2013


May 1st is International Labour Day, a day which commemorates a time of civil unrest in the late 19th century when workers in industrialized countries demonstrated for improved working conditions, wage raises and the establishment of a maximum working day and week. Many of the demonstrations were suppressed with force.

The conditions for workers in Uganda are not something to talk about since the NRM caught power in 1986.  The problem has all along been president Museveni’s wrong vision for the country.  This ill advised vision has seen brains migrate to greener pastures as Museveni decided to invest in wars to remove leaders of neighbouring countries among other region conflicts.  People have been well trained, but unfortunately, the looters of the national treasury have taken the cake that would reward the hard work of the skilled worker and what we continue to see is migration of labour many of whom are beneficiary of state sponsorship.  The matter has not been made better by salary scales which are upside down!  While some executives earn about shs 25 million a month, many senior people are paid peanuts, which is very demoralizing. 

The decentralization has not helped matters.  Corrupt politicians are party to policies and decisions that demoralize the technical manpower.  Everything is a mess in Uganda!

What my save the Uganda worker as of now is the peaceful exist of President Museveni, short of that, sorry!   

Museveni’s way of doing things unfortunately is self defeating.  He is now the chief pay officer, who decided to make a double pay to Members of parliament when they have already been paid for the work, while other salaried Government officers have no salary and motivation at all.

President Museveni is a road block to any meaningful reforms in Government, hence the reason we see that one proposal for increased revenue is increased tax rates!  While, adjustments in Government and stopping the thieving can do a lot for the ruined economy.

As Uganda Workers Mourn may 1st, the only prayer remains for the NRm organ to see sense and devise means of seeing Museveni retire, short of that, no hope for the Ugandan worker!

William Kituuka Kiwanuka

Challenges of retaining health workers in the PNFP Sector:
The Case of Uganda

Catholic Health Network

Sam Orochi Orach - Asst. Executive Secretary, Uganda Catholic Medical Bureau

Shortage of human resource for health poses a major challenge to achieving the Millennium Development Goals (MDGs). Uganda is among the 57 countries with human resource shortage reaching critical level. But the situation is even worse at micro levels. The private-no-for-profit (PNFP) health sub-sector complements government efforts to achieve the MDG, the health sector strategic plan II (HSSP II) and the health related poverty eradication plan (PEAP) indicators.

Uganda Catholic Medical Bureau coordinates the Roman Catholic health facilities network, one of the three PNFP networks in Uganda. This paper looks at the HRH crisis as experienced by the UCMB network giving the trend, examining the reasons, the destinations of attrition cases and what the network is trying to do to improve human resource stability. The information is based on quarterly reports received by the bureau from its affiliated health facilities.

Uganda is among the 57 countries with critical shortage of health workforce (The World Health Report 2006). The high burden of disease, including HIV/AIDS, requires scale up of some of the most labor-demanding interventions. The lean health workforce experiences heavy pressure to implement increasing range of services within the national minimum health care package (UMHCP) and meet the targets for the Health Sector Strategic Plan II, the Poverty Eradication Plan (PEAP) and the Millennium Development Goals (MDGs). There is also pressure to see further downward trend in the HIV prevalence. It has been estimated that the scale up of antiretroviral therapy (ART) alone in Uganda between 2005 and 2012 would demand a doubling or tripling in staff time given to ART (Rudolf Chandler and Stephen Musau, 2004). To scale up anti-retroviral therapy alone to meet the PEPFAR target would require about 10% of Uganda’s doctor workforce as at 2004 level (Smith O. 2004).

But scale-up of ART in Uganda has even moved faster than originally planned while health workforce remained almost unchanged.  This disproportionate growth in service demand and the skewing of health workforce deployment in favour of few diseases conditions worsen the functional gap in respect to implementing the range of services in UMHCP. But this is worsened by a workforce that is increasingly becoming unstable.   
Retention of Health Workers Health worker instability is worsened by, among others, internal and external movements or losses. HIV is reported to be the leading cause of health worker attrition in developing countries (WHO 2007; EQUINET AND HST 2004). Death, for example, in 10 years accounted for 30% of the 1984 cohort of Ugandan medical school graduates, 50% of which was due to HIV (Yoswa M Dambisya, 2004). But at a cross-sectional level the main reason for internal and external movements of Ugandan health workers is “poor working condition” (Charles W. Matsiko and Julie Kiwanuka, 2003), which often simply means poor pay. There is also desire to move out of rural to urban areas. These affect both the public and the not-for-profit (PNFP) sectors.

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