In a classic example of robbing the proverbial left hand to pay the right, the government of Uganda is recruiting over 250 medical workers for employment in Trinidad and Tobago, triggering what could be the country’s and probably East Africa’s first public interest litigation case against the medical brain drain.
The High Court will on December 1 sit to hear an application by the Institute of Public Policy Research Uganda (IPPR-U), seeking to block the Ministry of Foreign Affairs from proceeding with the recruitment of some 263 health workers for employment in the Republic of Trinidad and Tobago.
Officials say the government, which has failed to fill 42 per cent of positions in the health system, can afford to give away medical workers because many remain unemployed years after graduating from college.
A team from Trinidad and Tobago is expected in Uganda early December to make a selection from some 450 applicants for employment for positions ranging from nursing and midwifery to medical specialists. In some cases, the country will be losing some of the handful of specialists that have been sustaining critical services in departments like oncology and psychiatry.
The institute, which is seeking restraining orders, filed its application in the courts on November 20. It says it wants to halt the recruitment exercise because it has serious implications for the delivery of health besides being a violation of the public’s right to health.
“We are seeking a judicial review of the decision because we find it irrational that a government that is presiding over a health system that is short of human resources should be at the centre of efforts to export these scarce resources,” IPPR-U executive director Justinian Kateera told The EastAfrican.
According to some of the government’s own documents that have been submitted to support the petition, Uganda has a health worker to population ration of 1:1,298 against the WHO recommended average of 1:439.
The doctor-to-patient ratio on the other hand stands at 1:24,725 while there is one nurse for every 11,000 according to the Ministry of Finance budget monitoring briefing paper for June 2013.
According to the same brief, although the Health Ministry was allocated an extra $20 million in the 2012/13 budget year for recruitment of extra staff and enhancement of allowances for some cadres, only 6,100 were recruited, leaving a huge gap.
While Mr Kateera concedes that health workers have a right to take up employment wherever they choose, he says it is unethical and contradictory that the process of exporting these skills that are much needed at home should be led by the government, more so at a time when its own project to strengthen health delivery is struggling.
The Ministry of Foreign Affairs, which invited applications from medical workers in early March, has defended its actions saying the recruitments were good for the country because besides strengthening diplomatic relations the émigrés will increase income from remittances and gain new skills.
“There are many unemployed Ugandans to fill the vacated positions,” Ministry of Foreign Affairs spokesman Fred Opolot said.
Mr Opolot’s position was echoed by Asuman Lukwago, the Permanent Secretary at the Ministry of Health, who said there were many unemployed medical workers who would fill the gap.
“The reason why we have many unfilled positions in health facilities is not because of a lack of qualified people as such but rather because of budgetary limitations that don’t allow us to recruit and retain workers in the sector. So it is a good thing if these people go out because it will create opportunities for others,” he said.
These sentiments were echoed by Orijabo Geoffrey, a bachelor of nursing graduate who has been shortlisted for the interviews. He says while he graduated in 2007, he has not been able to find employment in the public sector because the government has refused to put graduate nurses in its employment structure.
“I have just been getting part-time employment in private health facilities; it would be a terrible thing if the petitioners succeeded in stopping us from going to Trinidad and Tobago,” he told The EastAfrican.
Mr Lukwago said the expansion in medical training with several private universities joining Makerere to offer medical training had resulted in a high number of medical graduates joining the job market every year.
According to him, the education system is now producing as many as 320 graduates in the different branches of medicine who cannot be employed despite an existing need for their skills.
A review of the shortlist however reveals that most of the applicants have trained to post-graduate level. In some extreme cases, districts like Moroto will be losing the only ear, nose and throat specialist employed at the regional referral hospital. At Mulago National Referral Hospital, one of the only three neurosurgeons has been shortlisted.
In a country that is still struggling with high maternal death rates, 100 registered midwives are lined up for export to Trinidad and Tobago. According to the Budget Monitoring paper, a health workers audit carried out in 2011 found 42 per cent of health worker positions vacant across the system.
Staff shortages were worse at the lower levels where the staffing gap increased to 55 per cent compared with 28 per cent at regional referral hospitals.
Mr Kateera said government participation and endorsement of this process was an abdication of responsibility.
“Trinidad and Tobago has 12 times as many doctors and 13 times as many nurses. On the other hand Uganda loses 70 per cent of all medical graduates, 20 per cent work in projects and policy, leaving only 10 per cent to clinical practice. The government should address the causes rather than treating the symptoms,” Mr Kateera said.