Mr Muniini K. Mulera
Dear Tingasiga:
Last week’s video recordings of some Uganda Police officers verbally and physically abusing Ugandan doctors caused great distress to many of us. The victims were fresh graduates from the famous Makerere University Medical School. Their crime? Peaceful assembly at the medical school to demand employment as medical interns, a basic and universal mandatory step towards independent practice.
Uganda currently has 1,383 medical doctors who are eligible for employment as interns in their profession. It also has 743 doctors who are ready to embark on postgraduate education as senior house officers (SHOs). These doctors have been so devalued by the government that they are treated like an irritant. Why, there was a recent attempt to force them to work without pay!
According to Dr Jane Ruth Aceng, the minister for Health, there are an additional 1,323 non-medical professionals (nurses, pharmacists, dentists) who are eligible for employment as interns in their fields. Lumping all these professionals together makes it hard to determine the number of medical doctors who will not be employed in the 2024/2025 financial year. What is clear is that a large percentage of graduate doctors will remain unemployed, even as the medical schools prepare to graduate more at the end of this academic year.
Employing these fresh graduates as interns should be a given. Having allowed them to invest five years of very hard work in medical school, they have a right to expect to be employed to solidify the technical, mental, and behavioural skills that are essential for independent practice. More importantly, Ugandan citizens have a right to expect these doctors to complete this mandatory step and become available to serve the country’s rapidly increasing population.
Can Uganda afford to employ all these trainee doctors? Yes, it can, and very easily too. It just requires a mindset change among the rulers of the country. The prevailing attitude at the top is one that, on one hand, views political patronage as an expensive necessity for regime survival and, on the other hand, considers medical doctors to be cheap service providers for the voiceless citizens. (The ruling class seeks taxpayer funded medical care abroad.)
This prioritisation of politics over health care service delivery is a poor investment, with the expected poor returns. The dysfunctional mini districts, more than a hundred so-called presidential advisors, multiple presidential appointees to commissions and other duplicate offices, and a very bloated parliament of 557 MPs, serve one purpose only. They are part of a huge patronage machine whose singular purpose is to keep the current president in power.
In the circumstances, a shift of priorities from funding a bloated political class to fair remuneration for doctors and other healthcare professionals may be too optimistic an expectation. However, it is the most practical immediate solution to this urgent need. Hopefully President Museveni, who is the ultimate decision-maker, will give serious thought to this issue.
Consider that the Ministry of Health received only $9.66m (about Shs35.8 b) to pay small stipends to medical interns and senior house officers (postgraduate medical doctors) for the 2024/2025 financial year. Now consider what a rationalised Parliament, with a representation based on the number of active citizens, not the current phantom of so-called interest groups, would do to this chronic lack of sufficient money for our doctors.
A Ugandan MP is currently paid a minimum of $114,000 (about Shs 422,000) per year. This does not include their multiple allowances, and cushy perks. This salary of a single MP can pay 27 interns at their current miserable annual salary of $4,226 (about Shs15.7m) each. Now, if Uganda had a Parliament of not more than 150 MPs, the elimination of 407 MPs would save the country $46,398,000 (about Shs171.8b) annually. This amount alone, if properly used, would help transform the nature of healthcare in Uganda. The ministry would pay very good salaries in exchange for 24-hour availability of all levels of doctors in public hospitals. This is what happens in countries whose health services Uganda’s privileged citizens seek at the taxpayer’s expense.
A long-term consideration is the rapid increase of the number of medical graduates. Uganda, with a population of 46 million in 2024, is theoretically attempting to narrow its doctor-to-population ratio, which remains way below the WHO recommendation of a ratio of 1 doctor to 1,000 people. Whereas it is very difficult to determine the actual number of doctors in active medical practice in Uganda, the current doctor-to-population ratio appears to be somewhere around 1:25,000.
In theory, Uganda needs to up the number of medical graduates. However, the priority must be the quality of medical graduates that are allowed to engage in independent practice. The medical schools, the internship training centres, and continuing medical education for maintenance of competence for all doctors must be of uncompromisingly high standards. That is why I favour fewer but well-staffed and well-equipped medical schools, with very high entry requirements, that produce doctors that stand shoulder-to-shoulder with graduates from any first-class medical school in the world. That was the reputation of Makerere Medical School and, judging from my personal experience with recent Makerere graduates that have come to Toronto for postgraduate medical education, which school continues to offer excellent education.
I do not know about the quality of education offered by the other ten schools that offer undergraduate medical education. However, the very high cost of setting up and maintaining excellent laboratories and other facilities for the foundational sciences invites careful consideration before launching a faculty of medicine in any university. The same consideration applies to the clinical disciplines in teaching hospitals. The remuneration of the teaching staff has a significant impact on the quality of bedside and theoretical medical education imparted to learners. All this requires integrated planning that enables all high-quality medical graduates to be absorbed into the public and private health care services.
Our attitude towards the cost of enhancing the number and quality of doctors available to us in Uganda needs to change. We need to appreciate that medical interns and other postgraduate trainees are the backbone of excellent patient care in accredited teaching hospitals all over the world. Furthermore, they are the ones who will provide health care to us tomorrow. They deserve our respectful gratitude, and higher pay.
Mulera is a medical doctor
