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Uganda is left with fewer than 5000 doctors and no strategic plan to retain them

BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e25 (Published 04 January 2012) Cite this as: BMJ 2012;344:e25
  1. Henry Wasswa
  1. 1Kampala

Uganda is experiencing a massive shortage of doctors and now has fewer than 5000 to treat a population of 35 million, because thousands have left the country in search of better pay.

The east African nation lost hundreds of doctors during the chaotic 1970s and 1980s; but although the political situation is now calmer, the exodus continues, though now for reasons of poor pay rather than fears about personal safety. Thousands of doctors are now working in North America, Europe, Australia, and South Africa, where they can earn salaries several times higher than at home.

Of the 5000 doctors left, 40% work in private facilities and 60% in state hospitals. The Uganda Medical Association is concerned that the government has no strategic national plan to try to retain current doctors or to woo back those who have gone overseas.

Margret Mungherela, president of the association, said, “There is a hazardous and uncontrolled migration of health workers to other places and no effort being done by government to control migration. The government has not increased salaries for the last 10 years. There is a human resource crisis in the health sector in Uganda. It is at its worst and growing very rapidly. We are exporting doctors without getting anything in return.”

Fifty senior specialists have already left the country in the past decade, and more plan to follow. Of the 200 doctors who graduate in Uganda every year, most don’t take up posts in the country and look for positions overseas. The Uganda Medical Association wants Uganda to follow Kenya’s example and dramatically improve working conditions for doctors to make working there more attractive. In Kenya a newly qualified doctor can expect to earn around $700 (£450; €540) a month, while in Uganda they would earn just $300.

But the director general of health services, Jane Acheng, said that some retention measures had already been put in place, including training and scholarships, financial incentives to work in hard to reach areas, access to decent housing, and low interest loans. “We are carrying out a recruitment move to increase the [numbers of] doctors, but the challenge is the cost of living,” she said, adding that the government had realised that doctors’ salaries needed to rise and had plans to increase them.

Dickson Cliff Wabwire, who runs the 90 bed, church owned Mukono Health Centre just outside Kampala, which cares for around 3500 patients each month, said that the hospital was meant to have four doctors but had only three.

“These doctors are working because they are Christians and born again. I retain them because of faith and attitude, and I keep talking to them to stay,” he said. However, he admitted that he was not certain that they or he himself would stay there in the long term.

“I am not yet sure whether these doctors I have will stay,” Dr Wabwire said. “Even me, though I work with a Christian heart and attitude, my pay of one million shillings [about £260] per month for a senior medical officer is too low.”

Notes

Cite this as: BMJ 2012;344:e25

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