Pay rise fails to hook health workers to their workplaces

The huge pay rise for health workers in public facilities has not had a significant impact on their attitude towards work and output, government officials and legislators have indicated.

This is coming a year after the implementation of the presidential directive started. Among the vices that legislators and officials said persisted is chronic absenteeism from work, with some consultants showing up for work only 8 days a month yet getting a full monthly salary of Shs12 million. The monthly salary of consultants was increased from the Shs6 million they were getting previously.

Ms Margaret Ayebare Rwebyambu, a member of the Parliamentary Health Committee, told our reporter after a tour at Mulago Specialised Women and Neonatal, that there is an urgent need to address absenteeism in all public facilities to improve access to care for patients.   

“As Members of Parliament, we really come against that [vice of absenteeism] where some of the consultants come in, and then move around and clock out, going to private hospitals,” the Mbarara district woman MP.

Talking about the action to address absenteeism, Dr Jolly Nankunda, a consultant paediatrician and deputy director of the Mulago Specialised Women and Neonatal, said they have assigned officers to specifically monitor the consultants and specialists to ensure they are offering services to patients.

Dr Henry Mwebesa, the Director General of health services at the Ministry of Health, said during a recent supervision tour of selected hospitals across the country, they discovered that one of the consultants was showing up for duty only eight days a month. 

“This is the consultant whose salary has been enhanced to Shs12m…I keep asking them, ‘Can you do that in a private facility? Why would you do that in a government hospital and get away with it?’ Our problem is still governance, those who supervise the health workers,” Dr Mwebesa said.

The Director General revealed that the consultant was only working Wednesday and Saturday. “And we have interns there. When interns have a problem, they write notes, take a picture and send it to him then he gives them guidance on the phone and then they [interns] wait for him on Saturday,” he added.

Research reports show that absenteeism, which was previously linked to a lack of motivation due to low pay, deprives patients of their right to access care, pushing them to drug shops and clinics –many providing substandard care. 

According to information from the Health Ministry, “total absenteeism including absenteeism with approval still averages 50 percent [in public health facilities].” The unauthorised public sector absenteeism rate is 11 percent and authorised absenteeism is 38 percent, bringing that average to 50 percent.

“There is an inadequate engagement of the health workforce characterised by a high rate of authorised absenteeism of 38 percent, weak health workforce performance, low motivation and productivity and limited impact. This is due to ineffective performance management system, weak leadership, inadequate supervision and support, and weak onboarding system,” the Ministry said in the Ministry Of Health Human Resources for Health Strategic Plan 2020-2030.

In the proposal to reduce absenteeism, the ministry said there is a need to “scale up and maintain absenteeism tracking and reporting at all levels; Institute mechanisms to link attendance to duty with individual outputs and results and to institute measures to link pay to attendance to duty and performance.”

The absenteeism of the medical staff, coupled with low staffing in public health facilities, means patients will spend more time waiting to be attended to as the few workers handle patients.

“The health workforce density of 1.6 per 1,000 falls far short of the 4.45 per 1,000 population WHO [World Health Organisation] threshold for progress towards UHC [Universal Health Coverage]. If 38 percent of the 74 percent of health workers are absent then in reality on average only about 46 percent of the health workers in employment are present at the health facility at any one time. Overall, the availability of the health workforce is low,” the Ministry further noted in the plan. 

During the tour at Mulago Specialised Women and Neonatal, patients, who are optimistic about quality services at the hospital which boasts of some of the top specialists, about 40 in number, said the waiting time is too long. However, this reporter couldn’t independently verify whether the long waiting time was due to absenteeism.

“The time spent here is too much. I came here at 7 am but up to now we haven’t been handled,” says Ms Irene kasule, a resident of Kakiri in Wakiso District. She spoke at midday. She had come for antenatal care. 

Mr Polly Nuwagaba, a health worker who had brought his wife to the antenatal clinic of the facility, said: “From outside the quality of services appears to be good. But up to now, we haven’t been served.”

Prof Charles Ibingira, a senior researcher from Makerere University College of Health Sciences, who is leading a project to improve maternal, sexual and reproductive health, said even the staff who are at work are not doing their best.

“Uganda has very many policies for addressing maternal, sexual and reproductive health issues. But most of the implementers, even doctors, don’t know what the goal is. They just wake up and do what they were taught at the medical school without minding about the policy and what the country wants to achieve,” he said.

Dr Rosemary Byanyima, the acting executive director of Mulago Hospital, on the other hand, said they are closely monitoring the consultants to ensure they are delivering services to patients.

“Mulago Hospital is very busy, so you find a consultant on Monday, he is giving lectures; on Tuesday he is doing a major ward round; on Wednesday he is in theatre; on Thursday is running an outpatient clinic, and on Friday he is doing some research,” the consultant said. 

“But we expect them to put in some more time in clinical work. And even the research they are doing, we want to see the outcome,” she added.