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Exportation of Uganda Health workers, a threat to National Security by James Z - Articles - Nurses Arena Forum

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Exportation of Uganda Health workers, a threat to National Security by James Z by katty : July 12, 2017, 10:30:08 PM
While health workers have always migrated from Uganda to work in other countries, there is a worrying trend developing of mass recruitment of Ugandan public health workers by foreign entities.

In 2015, civil society organisations in Uganda battled with the Ministry of Foreign Affairs to prevent the exportation of public health workers to Trinidad and Tobago after the government of Uganda had entered an agreement with the Caribbean nation to share some of its human resources for health. The pressure from civil society resulted in the government withdrawing from this process and the exportation of health workers to Trinidad and Tobago was halted.

First forward to May 2017 and the Benghazi Medical Center in the volatile Libyan City of Benghazi contracted a private employee migration firm, Middle East Consultants (MEC) Ltd to recruit about 1,200 health workers to be employed in its hospital.

Such demand should come as good news to a country like Uganda with a high number of unemployed citizens as this creates opportunities for the young Ugandans who have undertaken medical training at great expense but fail to find employment.

The 2016 National Census indicated that 58% of all Ugandans in the productive age (14 years and 64 years) were unemployed. Indeed, the call for applicants has been well received by Ugandan health workers as evidenced by media reports of long queues during the application process at the Middle East Consultants office in Muyenga.

With such demand, it would be expected that the health system in Uganda is supplying more health workers than are needed for health care delivery hence the need to seek employment opportunities where there is more demand. This is not the case.

The Ministry of Health in its Health Sector Development Plan in 2015 reported that, nationally, only 69% of all the vacancies within the health sector were filled leaving 31% percent of the positions existent in the health sector unfilled. Furthermore, there are variations in the regional distribution of workers such that while only 45% of positions at the more accessible Health Center IIs are filled, 70% and 71% of the positions at Health Center IIIs and IVs are filled in Uganda. Much more specialized and larger health facilities like National and Regional Referral Hospitals have more positions filled than the lower levels of health care like the Health Center IIIs and IIs which perhaps explains why the higher levels of health care are overburdened.

The World Health Organization (WHO) suggests that a ratio of 2.28 health workers for every 1000 persons indicates that a country has a critical shortage of health workers and Uganda falls within the category of countries with a critical shortage because it has a ratio of 1.55 health workers per 1,000 persons.

On two separate incidents in the space of two years a significant number of health workers have been approached for recruitment outside the country despite the dire need of health workers in Uganda. In the first incident, the government; well cognizant of its own shortages, conspired with another government to deprive the people of Uganda of health workers. In the second incident, a foreign hospital, Benghazi Medical Center in a politically volatile city contracted a private firm to recruit health workers from Uganda.

There are several difficult questions which arise in the circumstances. Why are Ugandan health workers being targeted for mass foreign recruitment? Why is the government not recruiting the apparently available health workers in Uganda to reduce its critical shortage? Why are health workers in Uganda’s health system opting to abandon their country to work in foreign countries? Is the government taking any action to prevent the health sector from hemorrhaging its health workers to foreign health sectors?

There is also interplay of human rights which the government is required to protect, respect and fulfill. Primarily the government has an obligation to provide medical care which it should fulfill by hiring the adequate levels of staff to provide health care to the public. In light of the critical shortage of health workers in Uganda, it is clear that there is a severe failure by the government to fulfill this obligation. Health workers within the public health system also have a right to practice their profession and earn a living from it under healthy and satisfactory working conditions.

When health workers are poorly paid, have to operate under unhealthy conditions without adequate equipment and commodities to enable them do their job, and are consistently overburdened such that they are unable to provide the quality of health care expected of them in the circumstances, their right to practice their profession is violated. Dealing with heavy workload results in criminal liability for health workers for lapses in professional judgment and the failure to provide an acceptable quality of health care due to lack of adequate equipment and commodities to provide it. Poor pay and unsatisfactory working conditions often result in failure to provide for their families’ essential needs and loss of concentration at work because health workers are compelled to take on other gigs for extra income.

The Ministry of Health has been conspicuously silent while foreign countries poach on our human resources. And yet there is no question that the health sector in Uganda needs to be protected from the massive loss of health workers who are actually in short supply. It has been suggested by some that a ban should be placed on migration of health workers given their critical need in Uganda. This in my view would be an unconstitutional violation of the right to practice one’s profession wherever they want to especially in light of the poor treatment of health workers in Uganda. Sharks in foreign countries have sensed blood in Uganda and are aware that health workers in Uganda are highly qualified, competent and are there for the taking. First it was Trinidad and Tobago and now it is Libya, we can only expect more to come. Health workers should be given the priority they deserve in Uganda first by significantly improving their remuneration and working conditions and filling all the 31% of the unfilled positions in the public health sector.


James Zeere is a human rights lawyer and health rights Advocate.

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