Poor working conditions hinder health service delivery
As the world celebrates Labour Day to commemorate the achievements of workers, we bring to light the plight of health workers in Uganda who include medical doctors, nurses, and pharmacists, among others who have decried the constant poor working conditions.
These, they say, mostly include; poor accommodation, poor and delayed pays heavy workload and long working hours.
Such unfavourable working conditions, according to health workers are responsible to the inefficient service deliveries in health facilities such as long waiting hours for patients, which are always blamed on them.
In dire straits
Aggrey Byangana, the acting in charge of a Busanza Health Centre IV, Kisoro District says he attends to patients in both the female and male wards.
Out of the 15 health workers at the facility, the clinical officer, only two midwives and the officer in-charge are accommodated there and the rest have to rent in Kisoro town many kilometres away from the centre which worsens absenteeism.
“I have to spend Shs15,000 every day on fuel to travel from (Kisoro) Town where I stay,” Byangana says.
Because the fenceless health centre is surrounded by hills with no electricity supply which imposes insecurity, it makes it hard for them to attend to emergencies and mothers with abrupt labour.
The numbers of mothers who die while giving birth in Uganda is still high at 368 deaths per 100, 000 live births, according to the 2016 Uganda Health Demographic survey.
“The only solar panel at the maternity ward is worn out which renders it ineffective,” he says adding that neither do they have a functional operational theatre to handle cesarean births, ideal in the country’s health centre IV.
He states that the challenge of accommodation is compounded by the heavy workload at the facility which handles 100 patients on a daily basis.
Such unfavourable working conditions, they say, have contributed to many would be preventable zones which are instead blamed on health workers and they end up being harassed by patients and communities.
Instead, the politicians have taken advantage of the gaps in the health sector to find political capital and please their voters by storming hospitals and harassing health workers whenever they receive complaints from patients, health workers say.
Mid last month, Tony Ssempebwa, the mayor of Kasangati Town Council in Kira Municipality in Wakiso District, attacked and engaged in a bitter exchange with Dr Gerald Muwanguzi, a medical officer and Sarah Nankungu a midwife, at Kasangati Health Centre IV.
The mayor accused the two and other health workers at the facility of neglecting patients which makes the latter to wait for longer hours before they are attended to.
Dr Muwanguzi, however, responded saying; “I am the only doctor here; I have to attend to patients in theatre, out patients’ clinic and HIV/AIDs clinic. Report to the district that I am the only doctor at the facility and they deploy a second doctor.”
Neglected
The normal structure requires a Health Centre IV intended to serve 15,000 people and provide simple diagnostic, maternal services, blood transfusion, comprehensive and emergence obstetric care is headed by a medical doctor who is assisted by a clinical officer.
The incident was preceded by a spate of arrests of health workers in different health centres and hospitals over patient neglect and selling of government drugs and other equipment to the patients.
The health workers have, however, responded that they ask patients for money to fuel ambulances and buy drugs due to the rampant stock outs.
In March, Police and the heath monitoring unit at State House arrested four Mityana Hospital staff following the death of a mother who was reportedly neglected after she failed to raise Shs5, 000 for her medical care.
The arrest followed protests by hundreds of angry residents who stormed Mityana Hospital protesting the death of a mother and her baby in the labour ward.
The crowd entered the hospital, attempting to lynch the health workers whom they blamed for the death of Sylvia Nalubowa, 39, and her baby.
Similar arrests have occurred in different parts of the country, with more than 30 health workers facing arrests since the year started over patient neglect and asking money from patients.
Investigate cases
However, Dr Ekwaro Obuku, the General Secretary of the Uganda Medical Association (UMA) condemns the arrest of the health workers by the police and the political leaders, as disgraceful, arguing that regulatory bodies like the Uganda Medical and Dentist Practitioners Association (UMDPA) should be used to investigate and punish those found victims.
“It is unfortunate that the police and Health Monitoring Unit work act out of emotions before they listen to them,” Dr Ebuku states, accusing government and political leaders of failing in their supervisory roles and address the gaps in the health sector whose effects are in turn blamed on the health workers.
“You cannot blame health workers who are poorly paid and not motivated with proper accommodation,” he adds.
Grim reality
Indeed, a semi-annual budget monitoring report for the financial year 2015/2016 by the Budget Monitoring and Accountability Unit (BMAU) showed that on average 70 per cent of staff at the local government hospitals monitored are not accommodated.
According to the 2015/2016 annual Health sector performance review, Uganda has a staffing gap of 73 percent (anaesthetic officers), 60 per cent (pharmacists), 51 per cent, and 25 per cent (midwives).
Records from the Uganda medical Dental and Practitioners Council (UMDC) indicate that there are 6,000 registered practising medical doctors and dentists, 30 per cent of whom are estimated to be abroad and 30 per cent are absorbed in non-government organisations as administrators.
This leaves the country with an estimated 2,500 practicing medical doctors to cater for 35 million people, which is far below the World Health Organisation recommendation.
Although the WHO recommends a 1:1000 and 1: 600 by 2020 doctor-to-patient ratio, the Ministry of Health estimates that in Uganda the ratio is at 1:24,000 which leaves the doctors in service with a heavy workload.
Ministry of Health take
When contacted about the arrests of health workers by police, Dr Diana Atwiine, the permanent secretary at Ministry of health said it is because the professional regulatory bodies have not yet reached that level of being responsive.
“And you find that some cases are regulatory and others criminal in nature which require police to come in,” Dr Atwine said.
On the working conditions of health workers, Dr Atwine notes that although they acknowledge their grievances, the money is not enough at the moment to increase their pay but the ministry is yet to start discussions on how to extend to them non-monetary incentives such as tax waivers.
“But as you know, we are not the sole decision makers. There are many other stakeholders involved such as the Health Service Commission and Ministry of Finance,” she adds.
