Govt calls off plan to export doctors
A nurse attends to a patient at Kisenyi Health Centre III recently. Government has dropped plans to export doctors to Trinidad and Tobago. PHOTO BY ABUBAKER LUBOWA
What you need to know:
Reason. Health minister says the U-turn is based on the fear that exporting the health workers would present serious challenges to the country’s healthcare system
Kampala.
The government has dropped the much-criticised plan to export public health workers to the Caribbean country, Trinidad and Tobago, Sunday Monitor has established.
This follows a decision by the Ministry of Health to oppose the scheme, which had earlier been roundly condemned by a Ugandan think-tank, the Institute of Public Policy Research (IPPR), donor countries, politicians and other groups.
In a turn-around communication in an April 17, 2015 letter, Health minister, Dr Elioda Tumwesigye, warned that going ahead with the export of the health workers “presents serious challenges” to Uganda’s healthcare system. He argued that it would escalate the already existing shortages of health workers in the country.
Uganda, whose doctor-to-patient ratio was put at 1:24,725 in 2013, compares very poorly with Trinidad and Tobago, which in 2007 had an estimated one physician per 1,000 people.
Dr Tumwesigye appends to his letter a table showing staffing levels of different categories of health workers in Uganda’s regional referral hospitals, highlighting glaring deficiencies.
In the specialists category, for instance, the list shows that 75 per cent of the vacancies in 14 regional referral hospitals are vacant.
Further to that, Dr Tumwesigye points out that even the few specialists in these hospitals face depletion should the planned export of health workers go ahead.
“73 per cent and 63 per cent of all short-listed nurses and midwives are employed by the government. Almost half (44 per cent) of the specialists short-listed are employed by the government,” Dr Tumwesigye continued: “Analysis of the shortlist for these cadres shows that if all those short-listed were finally selected, we would be sending to Trinidad and Tobago over 90 per cent of (our) physicians, 50 per cent of paediatricians and gynaecologists and 30 per cent of the surgeons we have in our regional referral hospitals.”
Dr Tumwesigye noted that should the planned manpower export proceed, Uganda was poised to lose more of its higher calibre health workers since out of the 263 posts advertised, 123 were for specialists, who are harder to replace, and not general doctors.
Dr Tumwesigye could not be reached for a comment because he was reported to have travelled abroad. However, Health ministry Permanent Secretary Dr Asuman Lukwago said Dr Tumwesigye’s letter had “triggered some consultations” within the government and that the planned export of medics had since been “halted to allow for some more consultations.”
“We analysed the matter internally (ministry of Health) and then the minister raised it in Cabinet; that is how Cabinet works,” Dr Lukwago said.
How it started
Dr Tumwesigye’s letter, addressed to the Minister of Foreign Affairs, was copied to Prime Minister Ruhakana Rugunda and to the two state ministers of Health and the one for Labour.
The proposal to export the health workers has been widely debated but it still remains unclear who originated it, with the Ministry of Labour, which would ordinarily be in charge, denying having initiated it.
The advert for the healthcare jobs in Trinidad and Tobago pointed out that the scheme would, among other things, “promote and protect Uganda’s interests abroad.”
On July 7, 2014, the Ministry of Foreign Affairs published on its website a shortlist of 283 health workers in 14 different categories with the view of enabling the government of Trinidad and Tobago select whoever it would deem suitable to bolster its public health sector.
The successful applicants would be offered attractive packages to enter three-year contracts with the government of the Caribbean country and work in the country. This, however, was criticised on the basis that Uganda’s health system was itself stretched and particularly understaffed in critical areas.
The criticism against the scheme was almost immediate and spontaneous. Consequently, IPPR filed what was said to be the first public interest petition against the Uganda government to prevent “the imminent medical brain-drain.”
The proposal also drew open condemnation from the US government, which is a big funder of Uganda’s healthcare system. The government of Belgium, on its part, went a step further and announced a withdrawal of its funding to Uganda’s health sector if the export of the health workers was not reversed.
It was not immediately clear how this influenced the government’s actions, but Dr Tumwesigye’s letter offers insights into the matter. He told his Foreign Affairs counterpart in the letter that the senior management of the Health ministry had carried out consultations and reached certain conclusions.
Among the conclusions, Dr Tumwesigye said, were that the recruitment of health workers for schemes like this should target those who are unemployed or retired and that in the meantime, the government should work “to enhance attraction, motivation and retention of critically needed workforce, particularly the specialists.”
Dr Tumwesigye added: “An attractive package similar to the one advertised was a reality in the past in Uganda and can be realised again to ensure that we retain the sought-after health workers we are known to produce as a country.”
He further said the process of labour movement from Uganda to other countries should be managed by the Ministry of Labour “through development of appropriate policies, guidelines and regulations for labour movement, without disrupting social service delivery in the country.”
Dr Tumwesigye cited a possible starting point for a relationship between Uganda and Trinidad and Tobago, saying the high income Caribbean country could “support Ugandans beginning with pre-service training and subsequent bonding of selected health workers” to support its labour requirements.
He appeared to be at pains to emphasise the importance of reassuring donors, particularly Belgium, in this whole affair.
Alluding to scholarships provided by the government of Belgium to train medical specialists and others, Dr Tumwesigye wrote: “The purpose of this letter is to communicate to you this position and request you to inform some of our key partners about it.
I particularly request your ministry to urgently inform the government of Belgium on this stand for them to release Euros 5m (Shs16b) meant for sector budget for Financial Year 2015/2016 and another Euros 6m (Shs19b) for subsequent years.”
Background
In March, government insisted on sending more than 240 of its health workers to the Caribbean despite a Belgian threat to cut 11 million euros in aid. It said the export of health workers was “a good policy for the medical fraternity in Uganda,” saying it would also “address the unemployment problems.” Officials said the scheme is part of Uganda’s bilateral cooperation with Trinidad and Tobago, from which Uganda has also benefitted -- with aid such as oil and gas industry training and financial support for its police.
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