Surgeons warn of health sector crisis

Police block intern doctors who were planning to march to Parliament and the President’s office in Kampala in protest of government’s delay to deploy them,  on Monday. PHOTO |  ABUBAKER LUBOWA 

What you need to know:

  • The surgeons warn that the government’s delay in deploying medical interns after a nearly nine-month stretch would break the chain of recruitment of doctors.

The Association of Surgeons of Uganda has asked the Health ministry to immediately deploy 1,091 medical interns as medical officers on probation and pay them salary instead of allowances.

The surgeons, in their five-page document seen by this reporter, warned that the government’s deployment delay after a nearly nine-month stretch would break the chain of recruitment of doctors.

The absence of interns, who carry around 60 to 70 percent of workload in public health facilities—partly because of few doctors employed by the government—is having serious effects on access to health services in hospitals, doctors said.

“Give intern doctors appointments as medical officers on probation, indicating their salary scale,” the April 24 document, undersigned by Prof Frank Asiimwe, reads in part.

Prof Asiimwe is the head of the association.

“Deploy them with immediate effect, otherwise you (the Health ministry) are creating a gap in the chain of doctor recruitment, you are brooding an army of disenfranchised young [doctors] who at the slightest opportunity will turn their frustration on the unsuspecting public and the system,” the surgeons warned.

The association also appealed to the policymakers to cease to refer to intern doctors as students, saying they have already qualified as doctors from their institutions of learning. The junior doctors undertake an internship to get a practicing licence from their respective professional body, as a requirement.

The pre-interns, Uganda Medical Association (UMA), told MPs on Wednesday, have been waiting for the deployment for nine months. The protests by the pre-interns over the matter have attracted arrests by police in Kampala in the recent weeks. 

UMA said on April 5, Dr Jane Ruth Aceng—the Health minister—announced that there would be a delayed deployment of the “junior house officers/medical interns for the year 2023-2024.”

“Later, an announcement was made that subsequently there would be no payment for their work and that those who could not pay their way through internship would, therefore, not get their licenses,” the UMA presentation to MPs reads.

Ms Anifa Kawooya, the junior Health minister in-charge of General Duties, told the Monitor yesterday that they have a commitment from the Finance ministry that only 12 percent of the money required for interns is available.

“We do recognise and appreciate the services of interns. The little money that was proposed for them is Shs10 billion out of the 80 billion,” she revealed.

Ms Kawooya added: “I have not looked at the proposal from surgeons regarding having a wage bill for interns, but we shall take it to Cabinet and we take collective responsibility in decision making.”

At the current doctor-to-patient ratio of 1:20,000, the bumper harvest of the more than 1,000 doctors qualifying per year would reduce the heavy load on few doctors and improve access to care.

Reduce medical students

The junior Health minister said during the interaction with MPs this week alongside the Finance ministry, they discovered that the number of medical students graduating from training institutions is beyond the government’s internship absorption capacity.

She said discussions are going on with the Education ministry on whether to reduce the intake of students. Ms Kawooya quickly added that they are also planning on avenues such as telling medical interns to undertake the attachment without expecting payment from the government.

“We still have payment for senior house officers, which has not been made for the month of March. We will discuss how to handle this in the Cabinet to come up with a realistic way,” she said.

UMA said last week that “senior house officers (SHO) have not been paid for four to six months yet the Ministry of Finance wants to scrap SHO and medical interns allowances with effect from the next financial year.”

On the issue of the number of medical interns, the surgeons claim the Health ministry has dropped the ball.

“The Ministry of Health is either not aware of or seems to be caught unaware regarding the number of students joining medical school, and finally graduating as doctors five years later,” the surgeons wrote.

The Association of Interns instead accused the Health ministry of failing or wrongly advising the government to put on hold absorption of graduates of Bachelor of Medicine and Bachelor of Surgery into internship.

“The Health ministry has refused or failed to appropriately advise the relevant government ministries [Ministry of Public Service, and that of Local Government] and agencies [Uganda Medical and Dental Practitioners Council] to issue intern doctors with appointment letters that reflect them as civil servants under probation.”

Look elsewhere

Ms Kawooya, however, said the economy is in a rough place partly because of the disruptions caused by Covid-19.

The surgeons, on the other hand, say the Health ministry should consider enlarging the scope of public-private-partnership, engage the private-not-for-profit and the private-for-profit (PFP) health centres and hospitals, to address issues around payment for interns.

“Give them the standard operating procedures (SOPs) for running internship training, discuss a quid pro quo, and these private hospitals readied to meet these SOPs and take on interns that fit in their human resource and infrastructural limitations,” the surgeons recommended, adding, “A great percentage of the salaries for interns training in non-government hospitals can be contributed by those hospitals.”

The country has in the recent weeks experienced virtual protests from Ugandans on Twitter (UoT) about the bad roads in Kampala City, a move which resulted in the President ordering Finance ministry to release Shs6 billion for repairing and maintaining roads. The issue of bad roads was, however, reported across the country.

Currently, UoT, led by Mr Jim Spire Ssentongo, a Uganda Martyrs University lecturer, has turned its gun on the health sector, with people sharing pictures of dilapidated health facilities and challenges in accessing health services.

The Health ministry spokesperson, Mr Emmanuel Ainebyoona, however, said some of the pictures shared during the ‘Uganda Health Exhibition’ are either old or were taken from other countries.

Mr Ainebyoona told the Monitor that their budget is too low to address all the health needs of Ugandans.

The Abuja declaration—that Uganda is a signatory to—requires at least 15 percent of the national budget to cover health costs. However, the health budget was cut from the already paltry amount of 7.5 to 6.1 percent, according to information from UMA.


Issues Association of Surgeons want MoH to resolve

●  Interest yourselves in the number of students joining medical schools at year one, transiting to junior clerkship, then senior clerk, and those poised to sit the final/ fifth year exams.

●  For quality control, work with the relevant government ministry and agencies like Uganda Medical Dental Practitioners Council (UMDPC); medical schools to set a national final year exam.

●  Cease to even suggest, subjecting already qualified and awarded holders of MBChB to an exam, the suggested pre-internship exam.

●  Give intern doctors appointments as medical officers on probation, indicating their salary scale.

●  Deploy them with immediate effect

●  Stop paying intern doctors allowances, pay them salaries, put the salaries of interns on the MoH wage bill.

●  Work with other relevant ministries and government agencies to increase internship training centres.

●  Ensure district hospitals have consultants and are appropriately refurbished so they can take on the role of training interns.

●  Consider enlarging the scope of public-private-partnership to address issues of salary for interns

●  Advise government to shift the role of promotions and designation of officers from the Health Service Commission that does it for government to employ officers into the public service to the UMDPC that licenses and supervises all doctors in the country regardless of who is employing them.