Medical practitioners under the Uganda Medical Association (UMA) have listed grounds under which medics will lay down tools.
In 2017, UMA suspended an industrial action following an agreement between the Government of Uganda and U.M.A. Then, the association’s reason for causing its members to lay down tools were what it described continued neglect of the Health Sector, specifically the human capital development, health workforce and aimed at addressing a recurrent shortage of medical supplies, state harassment, employment of doctors, salary enhancement and better conditions of service for Intern Medical Doctors and Senior House Officers.
Over the past 21 months, UMA says they have written letters, met with and engaged the relevant Government Ministries, Departments and Agencies to discuss these critical health systems gaps including human capital development and other emerging issues and especially the challenges caused by the COVID 19 but with little success.
“In fact, U.M.A met His Excellency the President at State House Entebbe on 1st June 2021 who reiterated specific directives to urgently attend to these health systems gaps given the prevailing CovID-19 pandemic that has claimed lives of over 2,700 Ugandans including over 50 health workers who died in the line of duty providing care to the sick,” UMA’s 6 August 2021 letter to Public Service Minister, Wilson Muruli Mukasa reads in part.
But despite these, UMA says a number of issues facing members of the association remain unattended to and that these issues are:
Recurrent shortage of medical supplies, technologies and vaccines.
According to UMA, the medics’ body welcomes governments’ increased investment in physical infrastructure, equipment, ambulances, transport means, medicines and blood transfusion services even before the Covid-19 pandemic.
“Also, the UMA further appreciates that despite the shortage of Covid-19 vaccines globally; Uganda’s health workforce was prioritized for vaccination,” reads part of the letter, a copy delivered and received at the Ministry of Health headquarters in Nakasero, Kampala.
But specific to the notice, UMA says the sheer deficit of investment in COVID-19 case management and Infection Prevention and Control became obvious with the rising number of COVID-19 cases during the second wave. Yet, UMA says, “since 2017 we, the Doctors of Uganda have raised alarm over critical medical care gaps, and again reiterated the same during the first wave of Covid-19 in 2020 such as: i. Lack of oxygen at the facilities that saw Ugandans die in despair when oxygen cylinders were dry and installed plants operated at below demand capacity
ii. Lack of functional High Dependency Unit (HDU) and Intensive Care Unit (CU) beds (bed, oxygen, ventilator, monitor, critical care medics), that left Ugandans in desperation and catastrophic expenditures in the private hospitals. iii. Limited access to emergency transportation, that is, a robust Uganda National Ambulance Service, to support safe referrals and continuity of emergency care and critical care during community quarantine. iv. Lack of Personal Protective Equipment (PPE) for the majority of frontline medical professionals (nurses, clinical officers, doctors inter alia) especially in the non-specified COVID 19 treatment units such as outpatients departments has put our lives at risk. v. Lack of medicines and other supplies for continuation of care for non COVID 19 conditions.”
As a result of the neglect, UMA says over 2,000 deaths of Ugandans in this second wave alone, including frontline health workers, could have been avoided.
Poor working conditions. UMA says that there has been hardly any improvement along this line since 2017 despite an agreement with the government.
“Health workers are forced to risk their lives to attend to Ugandans under dangerous working conditions contrary to the Occupational Safety and Health Act 2006,” the letter reads further.
These poor conditions, UMA says, “manifested as failure to protect, provide care for and compensate health workers who have been infected by, maimed or died from COVID 19 while at work. Over 3,000 health workers have so far contracted COVID-19 and over 50 died (nurses, doctors, clinical officers inter alia). Some of those who survived have suffered long term disability affecting their work or unable to work. To date, none of these medical professionals who died from COVID-19 has been compensated. Their families and dependents are suffering from hunger and some have been threatened with eviction from government houses.”
According to UMA, the majority of those who got infected or died have been working in places such as the Outpatients clinics, which often lacked PPE and where patients whose COVID 19 infection status is unknown present for initial assessment.
UMA adds, “There is no life or medical insurance cover to care for those frontline medics who fall ill, particularly in the line of duty. The majority has been left to care for themselves and accumulated catastrophic health expenditures in ICUs.”
UMA notes that there is no professional indemnity for health workers across the board, yet they are prone to litigation especially due failures arising from the poorly functioning systems such as lack of supplies.
The doctors body says the mental health strain has taken a big toll on the morale of the frontline medical teams with very poor or little rehabilitative services.
Unemployment. UMA says that there is an unemployment of doctors despite the acute shortage and unfilled vacancies in government health units.
“Today, Uganda produces over 500 new medical doctors annually and another 150
Medical Specialists (Anesthesiologists, Pediatricians, General Surgeons, Gynecologists, Ophthalmologists, Internal Medicine Physicians, psychiatrists, Ear Nose and throat surgeons in the various medical schools. Despite these numbers, approximately, 60% of the approved posts for doctors in public service are vacant including 75% for senior cadres of Consultants and Senior Consultants. Yet, in our recent quick survey we found at least 1,113 doctors are unemployed. The actual estimated figure will be over 1,900 unemployed medical doctors when the Intern doctors complete internship and are released in October 2021. Yearly, funds meant to pay for salaries are returned to the Treasury due to the posts being vacant. The Health Service recruitment cycle equally takes longer than six months to a year to complete. Moreover, only 79 out of 135 posts for District Health Officers (DHOs) are filled. DHOs are Medical Doctors and technical lead of all health services at the district level, crucial to all health interventions in the district including the Covid-19 response. Why is our health system starving of medical doctors in the presence of plenty? Yet, the current medical professionals are experiencing “work burnout” after handling two heavy COvid-19 epidemics. The Ministry of Health has instead of conducting fulltime public service recruitment resorted to short term contracts of 6-12 months specific for Covid-19 treatment units,” the letter signed jointly by Dr. Richard Idro (UMA President) and Dr. Mukuzi Muhereza (UMA Secretary General) reads.
Delayed salary enhancement. UMA says that as per the Collective Bargaining Agreement (CBA), on 30 September 2019, in a letter Ref PO/12, President Yoweri Museveni Muruli Mukasa to conclude the issue of paying scientists, uníversity lecturers and health workers to the agreed levels. According to UMA, an entry level Medical Officer is to be paid a monthly salary of Shs million and Shs 17 million for a Senior Consultant, with the rest of the cadres increased accordingly.
“Although this directive was implemented in universities and some parasternal, over the past 18 months, HE the President repeated this directive multiple times in his public addresses but to no avail. The conditions of service of our intern doctors, nurses, midwives and pharmacists has further detoriated with a large number now are dwelling in unsafe accommodation including peri-urban and where a number have been attacked, robbed and suffered physical and sexual abuse and severe bodily injuries while returning from work especially at night. UMA and the Federation of Medical Interns met with H.E the President at State House Entebbe on 1st of June 2021. Among other resolutions, the meeting resolved that the government employ all unemployed doctors, expand posts for doctors down to Health Centre III and that revised salaries be paid effective July 2021. HE the President repeated this directive publicly to Rt Hon Prime Minister and the Hon Minister of Health while speaking after the reading of the 2021/2022 national budget at Kololo Independence grounds on Jun 10th 2021: Employ all doctors at the revised salaries starting July 1. To date, no action has been taken, nor any communication made in that regard. Instead, our health workers again received the same salaries for July 2021,” says UMA.
UMA now says its members have been left with no option but to lay down tools.
“Therefore, this letter serves to notify your office of the Industrial Action by Doctors of Uganda starting within Ninety (90) days from Friday 6h August 2021..” reads the letter.
The laying down of tools come with demands that:
1. Pass a supplementary budget for sufficient medical supplies, and medical technologies necessary for the optimal working conditions of all medical cadres, including but not limited to PPE, Oxygen, Oxygen cylinders, and fully functional ICU beds. Given that COVID-19 vaccines are not accessible in large volumes for mass vaccination, the next wave of this pandemic should not find Ugandans desperate and dying from lack of oxygen;
2. Compensate all the 50 plus health workers who have died in the line of duty (Doctors, Nurses, Midwives, Clinical Officers, Laboratory personnel, support staff) and those among the 3,000 plus who were infected and survived but with substantive injuries (long haul COVID-19) during this COVID-19 pandemic in accordance with the Workers Compensation Act 2000.
3. Pass a supplementary budget for the enhanced salary of Medical Doctors starting 1st July 2021 in accordance with the Collective Bargaining Agreement before the Public Service Negotiation Machinery, Ministry of Public Service.
4. Advertise all vacant posts for Medical Doctors in National, Regional Referral and General Hospitals, and Health Centres level IV; and District Health Officers to be filed within six months from 31at October 2021, so that Doctors can serve all Ugandans effectively.
5. Include the Junior House Officers (JHOs]intern Medical Doctors and Senior House Officers (SHOs) in the Public Service Salary Structure, complete with appointment letters and emoluments at levels U3 Med 1 (Senior Medical Officer) and U4 Med 1 (Medical Officer) respectively:
Pay CovID-19 risk allowances without taxation to all frontline healthcare professionals and not those in COVID-19 Treatment Units since Ugandans with the pandemic come for diagnosis and treatment in all other departments of government and private hospitals and health centres;
7. Prioritize welfare improvements for Doctors outside of salary enhancement areas as per discussions and agreements made in the meeting with H.E on 1st June 2021.
MUSEVENI DIRECTS ON INTERN SALARIES
Just days ago, President Museveni directed that medical interns be paid a monthly allowance of Shs 2.5 Million.
In a letter addressed to the Prime Minister and the Ministries of Health, Finance and Public service, President Museveni says the medical interns should be given paid the stated monies because they work long hours.
In May, the medical Interns went on strike accusing the government of not addressing their demands. The interns wanted the government to increase their monthly allowance from 750,000 shillings to 5 million shillings that junior medical officers get. The interns also wanted the government to provide housing for them.
Following several meetings held between representatives of the interns, members of the Uganda Medical Association, ministry of health officials and the President, the strike was called off in June with the promise that the interns would get a salary increment.
“It was noted that medical interns earn a net pay of 750,000 Shillings which is not enough to meet basic needs. It is against this background, that I direct that all medical interns be paid half of the recommended pay of the fully appointed officers in the respective professions starting July 2021. For intern doctors, this should be 2,500,000 Shillings i.e. half of the 5,000,000 Shillings a medical officer is to earn,” the statement reads in part.
The pay increase will also affect graduate nurses, midwives and pharmacists that have all been learning 750,000 shillings monthly.
Dr Lillian Mary Nabwire, the President of the Federation of Uganda Medical Interns says that the increment will go a long way in improving the lives of intern doctors.
“This was the amount that we agreed upon with the president. It is not the 5 million that we wanted but it is better than what we were getting. Of course, there can never be enough money but from the 750,000 that we have been getting, this money will enable people to at least buy meals and even afford to pay rent in decent places,” Nanyanzi said.