Fixing doctors’ welfare will not close healthcare gaps

The news in the past week has been dominated by the strike that medical doctors announced. As is often the case, the Ministry of Health has called for patience since their demands have been in the process anyway. 

For ordinary folks, strikes by doctors often seem unethical, since preservation of life is what they live for. People then praise those of Lira who continue working, betraying the cause of their colleagues.
 
If there is anything we have heard a lot since Covid-19 last year, it is that scientists are special. We have left no stone unturned to demonstrate that without the scientists we would all be watching things below from up yonder. 

We have heard countless times that we need doctors, scientists and the health system to be prioritised. 
For something we have been hearing for a very long time, it is a wonder this takes the proverbial ‘forever’ to materialise. 

I have lost count of the number of strikes medical doctors have announced in the past. And the issues never go away. Maybe this time they should never return to work or find other lucrative things to do. 

They could learn from teachers who have become bricklayers, chapati vendors and second-hand cloth dealers in search for livelihood.

The thing is, the problems in our health system will not be closed by merely fixing doctors’ welfare or increment in salaries of medical workers. 

The problem remains a health system that is incapable of meeting the basic health needs of its population. 

Three years ago, with colleagues from Lehigh University in the United States, we set out to conduct research on short-term medical missions, at the time estimated to involve 1.6 million volunteers and $2 and 3 billion annually. 

The practice of volunteers coming from the global north medical volunteerism is largely seen to be very valuable, but there had been a growing critique of practices. 

Serious concerns are raised around possible harms to host countries and patients, including medical errors, non-alignment with local systems and priorities, cultural insensitivity, and the high cost compared to benefits. 

Like most areas of scholarship about practices emanating from the global north, often missing from these assessments are voices of host communities and national researchers.

It was evident that research on host country efforts to control the quality of visiting programmes were in short supply. So we set out to investigate host perspectives on short term medical missions.

We decided that in order to have the full context, we would start by looking at the gaps in the health sector, from policy to practice. 

We conducted some very interesting interviews targeting policy actors in health, non-governmental organisations involved and those who have engaged with the practice in communities. 

At the beginning of the research, I was oblivious to the extent to which this was a common practice. 

Medical camps, financed by agencies in the global north and their allies in the country or financing camps by local experts in remote places, turned out to be something of significant value. 

I was surprised, by how much value people placed on these services, although some concerns were brought out. At the core of it, was the glaring gaps in health service provision. 

However, a similar study was done in Ghana. Unlike Ghana, findings from Uganda found a much greater appreciation for short term medical missions. We were forced to establish why. 

It was clearly the gaps in health provision, had made these otherwise intermittent services much appreciable. 

In the absence of comprehensive universal health insurance and an almost none-existent social protection for the poor and aged, most citizens depend on such ‘good samaritan’ interventions to have their serious health problems fixed.  

We found that the health needs of the country are very many. While short term medical missions contribute to closing some of the gaps, these are limited given the scope of needs, which range from limited infrastructure, low budget support for health, inadequate levels of staffing among others. 

Sadly, it is unlikely that our health care will improve by focusing on the welfare of doctors without a holistic strengthening of the health system through increased budget support that in turn addresses the problems from more broadly. 

Ms Maractho (PhD) is the head and senior lecturer, Department of Journalism and Media Studies at UCU.  [email protected]