By Kamara Daniel

The African continent has made significant progress in advancing health workforce development. The capacity to train health workers in the Region has increased by 70% from 150,000 graduates in 2018 to more than 255,000 in 2022, as countries have invested in training health workers from over 4000 institutions and programmes. 

As of 2022, the African Region had 27 doctors, nurses, midwives, dentists, and pharmacists per 10,000 people on average over a two-fold increase from 11 per 10,000 people in 2013 and a 14% improvement from 2018. This advancement has improved the availability of qualified and skilled health workers leading to decreases in under-five and maternal mortality rates and longer life expectancy in the Region. Furthermore, the Region’s Universal Health Coverage Service index improved from 36 in 2010 to 48 in 2021 due to increased health workforce densities over the years. 

In 2022, Uganda had a total of 210 health training institutions across 66 districts. The total stock of health workers in Uganda was estimated at 158,932 in 2022 with a density of 25.9 doctors, nurses, and midwives per 10,000 population. The public health sector wage bill in Uganda has increased by 15% between the 2018/2019 and 2022/2023 Financial years. 

The African Region still has the lowest health workforce density compared to other regions worldwide. Employment for health workers has not kept pace with training outputs, resulting in a paradox where almost 27% of trained health workers cannot find jobs, prompting migration.

What can be done to streamline the Healthcare workforce?

Set a framework of performance to address the challenge of the workforce, even when the salary increment, are the health workers available at the health facilities. 

Orientation of the health workforce in Uganda, we need to establish the orientation packages per cadre and this can also be done through supervision, holding one accountable. 

Setting up incentives not only salary to make the health workforce more motivated to increase the result health framework in Uganda.

 The multi-sectoral collaboration and its importance, formal and informal structures to ensure the engagement is result-based to foster Monitoring and evaluation.

Increment of salaries, and engagement of the health workers, both at National and internal levels to determine the need.

Beyond the talk, the need to do investment in the healthcare workforce, one budget and develop a human resource work plan. Inadequate remuneration and poor working conditions remain critical issues, leading to strikes, industrial unrest, and abandonment of posts in some countries.

How can the health workforce in Uganda manoeuvre better?

Adequate minimal wedge allocation to all health workers to address the Inadequate remuneration and poor working conditions remain critical issues, leading to strikes, industrial unrest, and abandonment of posts in some countries.

To develop a strategy for health workers, capacity building plan with a clear goal to facilitate the gaps with less qualifications.
To carry out research on the high staff turnover and why they are always moving out for greener pastures.
Focus on identifying the trend of health workers, outline the specific needs and initiatives both internal and external strategies.
Monitoring and evaluation, to fully assess if the health care system is doing the necessary work and there should be a survey carried out, relevancy effectiveness and sustainability of the health workforce.
Supportive supervision at least each quarter to ensure that even the village people know that supervision is there from the Ministry of Health.

Public health managers should look into normal working norms to ensure the induction work, the managers should resume their work, utilizing the Health management committees that were formerly there to fully manage the health workers in all settings.

 What to begin with as we strengthen the health policy workforce in Uganda.

Training, recruitment and retaining of health workers in Uganda is an emergency. The Mindset change of health workers is alarming, the training schools continue to train, the specialists are not working, and interns are struggling on their own. The attitude of the general health workforce needs to be changed through Continuous professional development, and refresher training immediately.

Multisectoral Collaboration, are we really talking to each other? Have all different stakeholders talk to each other, and enhance communication as a team to achieve the set target SDGs.

Truly understating the health workforce; recruiting on time not waiting for clearance and prioritising quality health workers all the time and all the day to fully maximize the high numbers being trained by the schools.

Conclusion

The dialogue provided an opportunity for policymakers, health planners and partners to discuss and adopt appropriate solutions for addressing the health workforce challenges in Uganda. 

Adequate number and skill mix of the equitably distributed health workforce, are critical to achieving national health goals, universal health coverage (UHC) and the health-related SDGs targets. Ensuring adequate number and equitable distribution of human resources for health requires ready access to quality data and their use to inform evidence-based health and health workforce policy and plans in countries.

 Findings from the Health Labour Marketing Analysis carried out by WHO Uganda, indicate that Uganda has an estimated need for health workers of 342,832 compared to an overall supply of 154,016. This translates to 44.9% of the need for health workers being available. 

Ranging from increased allocations to more investment in health infrastructure, and improved health worker remuneration, it is evident that the country is on the right track to achieve universal health coverage targets by 2030.

The participants acknowledged that investing in the health workforce requires a whole-of-society and whole-of-government approach. This approach relies on multi-sectoral collaborations among government ministries, departments and agencies, development partners and the private sector.

Kamara Daniel is a Board Member of the Allied Nutritionists Association of Uganda, a Nutritionist- Bwindi Community Hospital, Participant in the Health Policy Dialogue on the Health Workforce in Uganda, 2024.

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