Geographical Maldistribution Of

Health Workers;THE MEDICAL CHALLENGE

IN UGANDA

By Ephraim KisangalaMBChB-IV

AIM

• Appreciate the challenge at hand• Way forward

• Health Workers are people engaged in actions whose primary intent is to enhance health1

• Health workers are a most powerful resource for producing good health services which can ultimately influence the success or failure of the health system2

• Analysis of the 2002 Census data;• 59,680 persons with either a health or non-

health occupation, occupation but working in the health sector in Uganda;

• 2,919 were medical doctors, 88 dentists, 150 pharmacists, 20,186 had a nursing or midwifery occupation, 3,785 Clinical allied professionals, 15,228 nursing aids/ assistants & 4,530 traditional practitioners/ faith healers

The Problem

• There is an inadequate distribution of medical labour between the rural and urban areas.

• With 80-85% of population in the rural areasThe URBAN AREAS HAVE;64% of qualified nurses71% of medical doctors76% of the dentists81% of the pharmacists

Mulago Hospital has 17% of Uganda’s doctors

Highly trained cadres serve only a small fraction of the population

Bringing the picture home

• During the recent census, there were no doctors recorded in Kalangala, Nakasongola and Moroto districts

• Majority of staff were located in Central Region (over 60% of MOs)

Doctors/MOs in 2002

–1,349 in Kampala–505 in Wakiso–99 in Jinja

–Total 2,919 (60% in central region where about 12% of the population lives

Case Study: Kaabong in NE Uganda• Kaabong district approved

Posts filled average of 39.4% in 2007/08

• 8 Midwifes (6 in the district hospital) for 257,174 in 9 sub-counties

• Watchmen stepping in to prescribe! (ACSD exercise 2008)

Case Study: Kotido 2007/2008

• Out of the 118 health jobs advertised • only 41 responded all of whom were interviewed and

offered the jobs. • Of these only 36 accepted and took up the posts. • Only 29 of these were new people • of which only 6 were professional health workers;

the rest were support and administrative staffs. • All these a midst a promise of 30% incentive of 6

months in a lump

Health workers concerns in the Media

Way Forward

• Recruit rural students for professional courses• Locate training schools in rural areas• Obligatory service of graduates in rural areas• Incentives for working in these areas• Requirement of such service to qualify for

advanced specialist training

The rural population can be served by qualified staff!!!

It starts with you, the concerned health worker

Thank you!!!!