According to recent data from Uganda’s parliament, the country has 1 doctor per 24,725 people and 1 nurse per 11,000 people, both well below guidelines from the World Health Organization. By contrast, Trinidad and Tobago has 12 doctors and 35 nurses per 10,000 people.
So why is the Ugandan government advertising and recruiting to send more than 250 “highly qualified” health workers to Trinidad? The Ugandan government is not sending short-term humanitarian aid workers, or even longer-term technical assistance. It’s the middleman, screening and recruiting technically skilled health workers for private sectors jobs in a middle income country.
Ugandan activists believe the recruitment violates the right to health and puts Ugandan lives in jeopardy by depleting the country of much-needed personnel. A novel legal case filed in December 2014 is set to challenge the government’s action of facilitating the “brain drain.” The Institute for Public Policy and Research, a Ugandan think tank, is seeking an injunction to stop the recruitment, arguing that it violates international human rights law and Uganda’s constitution, and is an “unauthorized reversal of the national health policy objective of health system strengthening.”
Ugandan health workers suffer from low wages, poor working conditions, poor infrastructure, inadequate equipment and supplies, and work overload. In the end, health services remain out of reach of many Ugandans, and health worker retention and motivation remains a major barrier to people receiving care, especially in rural areas. One 2010 Ministry of Health study said that a doctor in Kenya earns roughly four times what a doctor in Uganda earns.
Ugandan doctors look beyond Uganda for employment already. Media reports indicated that in 2010, 250 Ugandan doctors worked in South Africa with more doctors scattered across other southern African countries.
Clearly, health workers should be able to work where they choose. But the question remains, should the government be spending money to facilitate the recruitment of its skilled health workers abroad, a move that could undermine the possibility of achieving positive health outcomes for all Ugandans?
Uganda’s healthcare system is already weak. The country has high maternal mortality rates, with 17 women dying each day in childbirth. It also has rising HIV rates. Civil society groups say that the government’s recruitment is “‘out of touch’ with the struggle for access to life saving health services” and called on the government to stop “defying its own evidence” of how limited skilled health workers negatively impacts access to health care.
The government has defended the recruitment, stating that it will not lead to a depletion of key staff and that workers have a right to seek employment.
The case’s next hearing will be March 2. It is one to watch as it winds through the courts – and in the court of public opinion in the run-up to the elections early next year. In the meantime, Uganda’s government can do much to retain skilled health staff by improving working conditions, including salaries and access to appropriate equipment. These basic steps will improve access to health care for all Ugandans.