KAMPALA: The Ugandan healthcare was recently hit by a crisis- a sit down strike by medical interns who have been demanding better remuneration according to a promise made to them by President Yoweri Museveni. The interns who earn Shs 700,000 (about $220) a month, complain the money is not enough to keep them going. Following a strike last week which paralyzed the sector, Ministry of Health officials agreed to meet with them to resolve the thorny issues. MediaScapeNews caught up with Dr. Diana Atwine, the Ministry’s Permanent Secretary, to put context to the issue:
What exactly is the problem between the ministry and interns?
The issue about interns was that, first of all, the number that come out of the University each year is completely not in consonant with the money that is provided from Ministry of Finance Planning and Economic Development. The underlying problem was that we didn’t agree with Ministry of Education and Sports to have a fixed number of interns so that each year we know the number to expect and therefore we budget appropriately. That’s number one. So, you find that some of the Universities are admitting more than twice a year. The numbers are not controlled and they keep on graduating as many as they want yet at the receiving end we don’t have the resources to match that unplanned number. That is the biggest problem.
What is the Second one?
The second one is that the amount of money that is provided to us has always been fixed. So, in order to meet the demand of everyone or interns that come to be trained, we divide the available resources to the number of interns. So, overtime, this money reduced from one million (take home) to about 700, 000 (something) after deduction of the taxes. So, that is the big problem. We wanted to have an understanding and to come up with a policy for interns management but those young people run to court and block the exercise because we wanted to have a well streamlined policy that will manage the interns for good. However, they went and blocked the whole process of making the policy in court and so, even whatever we were planning for them could not be formalized because of that problem.
The country thinks you people are very insensitive to the plight of medical workers. What is the truth?
It is not true that we are insensitive to the plight of the medical doctors. First of all, when we begin right from the top, the President has been the Chief advocate for scientists including doctors. Therefore as a government, we are very sensitive and we are very committed to supporting our medical workers. The challenge is the demand on finances. We don’t control it neither do we determine how much money we will be able to secure. So, we work within the budget that is available. We work within the resources. The resources that we get are not elastic. Each year, you just make a wish and the money becomes elastic. So, to say that we are insensitive, I think that is not true. Everything we have been doing, we have been doing with our doctors and that’s why even this time, we were the advocates. We are the ones who sat with Public Service to come up with all these rates. So, when they say that we are insensitive, I don’t know what that means.
You say you are criticized and misunderstood unfairly. Can you help the nation understand where the problem is?
The issue of training doctors and recruitment of doctors is not solely the responsibility of the Ministry of Health. The Ministry of Public Service has a big role in determining how many doctors we recruit, what the payroll is, how much money we get per year as the wage. So, when they say we are refusing or we are stealing people’s money, that is very unfortunate. Secondly, the Ministry of Finance is the one that provides the resources. Our work as the Ministry of Health is to articulate the need. We have articulated these needs. One; on the number of doctors we need in our hospitals, two; To increase the wage and three; To increase the enhancement of pay. We have articulated this for so many years and we don’t work alone. We work with other stakeholders. Why is the Permanent Secretary the problem? Why should we be abused every single day? What crime have we committed? We provide resources as they come. Our work is to budget and say this our need. We are not the ones that provide the resources. It is Parliament that appropriates money. So, how come we are not hearing anyone asking about these other players? Why is the Ministry of Health being unfairly criticised and abused and lambasted? Why? I think that is not fair.
We have seen a letter written by you going to hospital directors and asking for details about the interns. Why is there no database?
The interns are not static. They move away from one hospital to another to do another discipline in the training. Some come at different times and they move. We have the database but that database is not static. It keeps on changing. When people finish, some interns finished in September, some finished in October and some got retakes, they failed and they are going to re-clerk. So, all that is not static. Therefore to us the number doesn’t mean that we don’t have the database but that database keeps on changing every now and again because students keep on moving from one hospital to another to different disciplines
How is the ministry planning to resolve this matter?
The Ministry of Health has always planned for human resources. The first one is restructuring so that we are able to have more doctors. Remember that Uganda is still having a low doctor-patient ratio as per WHO. We want to improve this by increasing more workforce in our facilities and therefore we have undertaken restructuring. We are working with the Public Service to make sure that we are able to take on more doctors. We still want to work with the Ministry of Education so that we can agree on a particular number of people that we can budget for. You can’t have the budget for 800 and you receive 2000 interns and then you expect that the money will remain the same. It will not and it will never.
What should the country expect from you now?
We think we need to cap the numbers and be like other countries. They graduate 3000, but take 500 and you apply and we take you we train you. Like in Israel, you can apply for two years consecutively and you can’t do internship and it is not automatic that you will be taken unless we and Education agree on a particular number of trainees that we can take up because it is not elastic. Even our hospitals are limited. We don’t want to crowd hospitals with these young people and then they finish one year when they have hardly done anything and they are half-baked. We must take on the number that can be trained effectively in a hospital so that when they come out of those hospitals, they are confident. They are able to carry on the functions of the doctors and they need to be supervised. So, we have been discussing this with the Ministry of Education and we hope that we will come to an understanding and we are going to come up with the interns’ policy. We are finalising with Education and we hope that whatever we are going to agree on will be understood, acceptable and it will be able to help to resolve these recurrent issues because recurrent issues are basically not having sufficient funds to pay the interns but also to make sure that we can control the numbers that we can train effectively so that we don’t just produce quantity but we produce the good quality. That is one thing. The other thing is to expand our infrastructure in our hospitals so that it can accommodate more numbers that we are able to train, that would be ideal but in the meantime, if we cannot increase more training centres, then we cut the number of doctors coming for training.