Uganda’s health care system should be centralized

Uganda’s health system now turned ‘tribal’ under decentralization has a few health workers in rural areas, creating a wider variation in staffing levels across the country. 

Health workers prefer to stay in urban settings. As a result, the relatively few health workers in the country serve only 12 percent of the population, and the rural areas are widely neglected.

This means that rural populations almost have no access to health care services and are forced to travel long distances to find health care.

Now health officials are opting for the health system that existed in the colonial days and a project, IntraHealth International promises to improve average staff levels in some districts.

Under colonial rule, the one health system ensured that all health workers were interviewed at one central point and then they were transferred to health centres across the country.

Now districts advertise vacancies at their districts and Local officials, sometimes with very limited knowledge of profession at hand, interview the applicants.

The minister of Health, Steven Malinga says the health system has now turned tribal with officials at the district practicing nepotism at the expense of quality health services delivery.

“We can decentralize all other systems but not health. There are now 100 different systems, we can not plan,” said Malinga.

Lack of interest

In some instances some districts advertise for health workers and totally fail to get any interested applicants.

“For instance, when we advertised for consultants at district health facilities in hard-to-reach areas, there were no applications. Often times we are just disappointed,” said Francis Ntalazi, the assistant commissioner in charge of Human Resource management at the Ministry of Health.

This has made the health workers numbers inequitably distributed besides having low motivation and with the already insufficient numbers.

Under IntraHealth, a USAID funded project, the staffing levels for some health facilities will be increased under a new pilot $11 million project.

IntraHealth has a motivation and retention strategy, that will increase staffing levels from the current 48 to 65 percent in a few districts over the next five years, said Vincent Oketcho, chief of party for Uganda Capacity program, IntraHealth.   

“Successful implementation of this strategy rests upon partnerships that will contribute to effective health work force attraction, retention, efficient utilization, motivation and productivity,” said Dr. Sam Zaramba, the director General of Health Services.

Uganda’s health workforce is beset with problems low job satisfaction and working conditions. And these are linked to inappropriate deployment, low salaries, inadequate supervision, excessive workloads and poor job security.
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