The Health Workforce Crisis at a Glance

In my first two days of work, I got an on-the-ground glance of the health and human rights struggle in Uganda. Yesterday, I joined a group of health workers to present the “Health Professional Pledge and Call for Action” to members of Parliament. The pledge was signed by over 600 health professionals concerned about the state of the health sector and demanding help from key policy makers to improve Ugandan health services. On Tuesday, I attended a meeting with Parliament members and health NGO leaders to review the progress of the UN’s SRRH (Special Rapporteur on the Right to Health) in addressing health and human rights issues over the past five years.

A bit of background: Uganda currently has approximately 0.8 health professionals per 1,000 people; almost three times lower than the WHO minimum recommended number of health workers per population. Approximately 2,500 physicians work in Uganda – the equivalent of just one physician per 11,000 people if physicians were evenly spread throughout the country. Geographical imbalances and migration to urban areas leads to a severe lack of health workers of all cadres in rural areas, as health workers are hesitant to commit to posts with limited equipment/supplies and poor living conditions. Reports from the ground indicate that many lower health centers are staffed by unqualified health workers, as a result of qualified health workers being unavailable to fill posts.

Working conditions are also poor across health facilities. In a national survey of over 600 health workers across nine different districts carried out by the Ministry of Health in 2006, access to equipment, supplies, medicines, water, and electricity were all found to be severely compromised. And, only 36% of health workers interviewed felt that their workload was manageable.

Ultimately, it all comes down to funding. While there was recently an additional 98 billion shillings pumped into this year’s health budget, none of these funds were allocated to increasing the numbers of health workers in Uganda, improving their working conditions, or increasing pay or incentives. The health workers with whom I met hope that Parliament will consider making crucial changes to the health sector budget for 2008/2009 before it is finalized. If nothing changes, they plan to strike. Who is going to deliver the additional 60 billion shillings worth of ARV drugs allocated in this year’s budget if there are no health workers?