Monday, February 2, 2015


A suit brought against government challenging an official program to export health workers to the West Indies will raise interesting questions about government’s responsibility to its citizens.

The Institute of Public Policy & Research (IPPR) in their suit filed last year argued that it was wrong for government to facilitate the export of  critical labour abroad when Uganda’s health service remain woefully understaffed.

In the news report on the subject several Ugandans came forward to narrate harrowing stories of how they had lost loved ones for lack of personnel at the health centers they visited.

Attorney General Peter Nyombi in response was quoted as saying it’s the right of every Ugandan to seek gainful employment anywhere.

The legal issues aside there has to be something fundamentally wrong with a country which is short of resources, be it human or raw materials, exports these to another country whose need may not be as great as its own.

As an indicator Uganda’s doctor to patient ratio is about seven for every 100,000 Ugandans. To attain the World Health Organisation’s (WHO) recommended 17 doctors per 100,000 we would need to more than double the number of doctors we now have. Our current numbers meanwhile have been built since independence!

You can expect too that our other health worker statistics fall way below the minimum requirements set by the WHO.

So clearly the health workers we are sending abroad are not surplus to requirements.

It’s ok to send manual labourers, househelp, one can even just make the argument for teachers and engineers but if one were to draw the line somewhere it has to be with health workers.

So after they have paid their taxes, insurance, mortgages and the annual holiday to some tropical destination, they will send back a few pennies home. So through their diligence and hard work they will rise to the top of their professions and be a credit to their homeland. Given the statistics it’s unlikely but so they will make some money and transfer the technology on retirement in the way of new investment in the field.

We understand the right to free movement of people and we wouldn’t begrudge a specialist doctor going abroad for better pay but when government itself is facilitating the brain drain you have to wonder.

"In abetting the exporting of labour government is admitting it has failed to help create jobs locally but even worse is abdicating its responsibility, actually actively sabotaging its own efforts to provide good health care of the citizens of this country...

You can build all the hospitals and health centers you want but if you don’t have the people to man them they become white elephants in the midst of need. That is criminal.

Government may argue that it has no money to pay its health workers a wage commiserate with the huge contribution they make but that does not stop them from facilitating improved services in the private health care industry to ease the pressure on its own resources. As a stop gap measure of course.

But the quality of private health care will only be so much better than the services in the public institutions. If public health is crumbling like in our case, the private sector will not be that much better.

This laissez faire attitude is good for promoting the private sector but does not work in redistributing the increasing amounts of the wealth this country is creating year-on-year.

"And the lack of funds argument is a thread bare excuse that doesn’t stand up to scrutiny, especially in light of the estimated sh300b that goes missing annually from state coffers. Not to mention the additional hundreds of billions that go uncollected because connected persons are evading tax with impunity or the misuse and even grabbing of government property for individual use or the perennial inflation of our public administration with the creation of new districts and ineffective agencies...

Government needs to be clear that improvements in living standards for all Ugandans, not only the few privileged connected ones, is its raison d’etre. We cannot all be flown abroad for expert treatment but we can at least have the basic minimum requirements to support an effective and all inclusive health sector.

Once that is internalized we will not have hair brained schemes like the one where we are exporting health workers to Trinidad and Tobago.

And by the way Trinidad and Tobago have a 118 doctors for every 100,000 of its 1.2 million population, who needs the help more?

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