Medics attend to a patient at Gulu Regional Referral Hospital’s maternity ward recently. PHOTO/SIMON WOKORACH
Health workers in Uganda face overwhelming workloads, low pay, and limited career growth, which leads many to leave the profession or seek opportunities abroad. Despite government efforts to improve conditions, challenges such as staff shortages and inadequate resources continue to take a heavy toll on those dedicated to saving lives.
While waiting to be admitted to nursing school, Maria Nakalema decided to volunteer at St Anthony, a healthcare facility in Mitala Maria in Mpigi District. Her choice was motivated not only by a desire for experience but also by her excitement to don the white nurses’ uniform. To Nakalema, what began as a wish to be seen in the white round nurses' uniform gradually evolved into a passion for helping people recover by selflessly providing bedside support to patients and emotional support to their caregivers.
She found satisfaction in witnessing patients improve despite the numerous challenges they faced. After undergoing rigorous training at one of the nursing schools in Kampala, Nakalema was one of the four students retained at the hospital out of the 28 who graduated that year. Upon retention in 2004, she was provided with accommodation and had access to four free meals a day. She also received a salary of Shs150,000 per month. However, these benefits lasted only three years. Thereafter, she was expected to pay her rent and fend for herself with the meagre salary she was earning. While this would not pose a challenge as she had no family yet, the work-related difficulties she encountered would eventually take a toll on her, leading to her resignation and departure for a similar role in the United Kingdom.
The frustrations
“I worked for the same hospital, but after six years, the highest salary I ever got was Shs330,000 gross. By the time I left, I had been managing one of the wards as a lead nurse for two years,” Nakalema says.
“My day would be busy from start to end. It got to a point where I would start a major ward round for the gyn and surgical ward. After the ward round, I would attend to patients, leaving no time for meals. At the end of the day, I would be so tired I could barely stand.”
“This led to frustration and broke me down. I decided to get unpaid leave for a month, and it was during this time that I resigned and got another job as a counsellor.” After a few years in her new job, Nakalema processed her travel to the United Kingdom, where she is currently working as a nurse.
When dedication is not enough
Proscovia Bagavoire, who was a nurse at Mulago National Referral Hospital for eight years, left health work for social work due to the workload. “Working as a nurse comes with a meagre earning and a huge workload, yet the high cost of living coupled with family needs compels one to be financially stable.” She adds, “Another challenge of being a health worker is the demanding schedule; working long hours, including public holidays. There is little time for leisure or personal matters, as you can be called upon at any moment.”
Struggling patients
Joy Nsamba, a retired nurse who formerly worked at Mukono Health Centre IV, reflects on her time in the nursing profession: “I still love the practice, but the conditions that patients go through take a toll on you as a health worker,” she says. Nsamba was stationed at the outpatient department, where one of the biggest challenges was ensuring patients had access to treatment. “While the facility often had some basic medication, supplies would occasionally run out, leaving patients without options. They either had to go without treatment or buy the drugs themselves,” she recalls. “There are countless times I gave mothers money to buy medicine for their children.
On days when I did not have any to give, I felt terrible. Being a health worker is more than just a job, over time, your patients become like family. You cannot just watch them suffer.” Patients, too, bear the brunt of the shortages. Grace Namuyimba, a mother from the local community, shares her frustration: “Sometimes you come to the hospital hoping to get medicine, only to be told there is none. It is frustrating, not only for us but also for the nurses who genuinely want to help.”
Thriving amid the challenges
Dr Henry Bukenya, who used to work as a doctor at Mulago Hospital, decided to supplement his income through private practice. “I opened a medical centre to top up my earnings as a doctor, but also because the work at the hospital often felt incomplete; many patients would leave without receiving proper treatment,” he explains. Despite the challenges, some health workers find fulfilment in their ability to help others, driven by the meaningful impact they have on patients’ lives.
Government efforts
The challenges raised by health workers are not new to lawmakers. Earlier this year, during a meeting with health officials from various hospitals, members of Parliament's Health Committee acknowledged that the health worker-to-patient ratio remains critically high, placing an overwhelming burden on medical personnel. Currently, the doctor-to-patient and nurse-to-patient ratios stand at 1:25,000 and 1:11,000, respectively, far below the World Health Organisation’s recommended ratio of 1:1,000.
To improve health service delivery, the government has implemented several measures aimed at motivating health workers. In 2022, salaries for medical professionals were significantly increased: senior medical consultants now earn Shs17.4m, up from Shs7.3m; medical consultants earn Shs12.7m; and principal medical officers receive Shs8m, up from Shs4.5m. Enrolled nurses now earn Shs1.3m, nearly double their previous pay of Shs613,000.
In addition to salary adjustments, the government offers both financial and non-financial incentives, such as bonuses, housing for rural health workers, and on-the-job training.
The ministry’s perspective
Dr Charles Tusiime, the registrar of the Uganda Medical and Dental Practitioners Council, acknowledges growing frustration among health workers, largely due to unmet intrinsic and extrinsic needs on the job. He points out that many of these needs remain unmet, particularly regarding employment. He notes that the number of doctors graduating each year has significantly increased.
“Previously, only about 300 doctors graduated annually. But in recent years, that number has risen to 1,500. This is a large number that the current healthcare system cannot fully absorb. As a result, many of those who remain unemployed either start private practices or leave the country in search of jobs or better-paying opportunities,” he says. He adds that while the government has made efforts to absorb more doctors by improving the doctor-patient ratio, limited resources have hindered full retention.
