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Talk about staff motivation and nearly everybody – employees and managers alike – will think of increasing staff salaries. Well, salaries are good but not the only major factor influencing the morale of health workers in Uganda.

Amy Hagopian noted in a 2009 study that Ugandan health workers are dissatisfied with their jobs, especially their compensation and working conditions. About one in four would like to leave the country to improve their outlook, including more than half of all the physicians. The same study highlighted reasons for staff attrition as better opportunities, contract expired, dismissed, domestic problems and going for further studies.

Having a team of well paid health workers in poorly facilitated health units will in itself de-motivate them. A doctor in a Health Centre IV, which has no gloves, medicines, unequipped theatres, and poor diagnostic facilities, will have every reason to miss duty even if they are paid well. Studies have shown that in poor countries, especially in sub-Saharan Africa, doctors and nurses, along with their colleagues in labs and pharmacies, face shortages of supplies, poor compensation, inadequate management systems, and burdensome workloads. The solution to our health workforce challenges is to strengthen health systems and the professionals who work in them.

No one would love to continue pouring water in a leaking pot before sealing the hole. As we train more health workers, let us not lose the ones we have. “Now is no time to think of what you do not have. Think of what you can do with what there is.” These words of Ernest Hemingway, a 20th Century American author and journalist, should not escape the notice of health managers and policy makers in this country.

In addition to improved remuneration, policy reforms to strengthen human resources for health in Uganda should focus on improving working conditions, workload and facility infrastructure (including water and electricity). An incentive like providing access to a computer and the Internet can attract and retain young computer literate graduates.

Dr Jairus Mugadu,
Makerere School of Public Health


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