Measuring Health Workforce
Distribution Inequalities in Uganda
Anna Awor, Elaine Byrne and Ruairi Brugha
The Challenge
Many challenges:
– Staff shortages
– uneven distribution
– gaps in skills and competencies
– low retention & poor motivation
– limited funding for recruitment
– constricted career structure
– Lack of champions for health
– lack of recognition & shortage of role models,
– ineffective training materials and methods:
Without overcoming these challenges, attainment of
Millennium Development Goals will not be possible in most
developing countries.
Objective
• Assess regional distribution and skill mix of
health workers at the Regional Referral
Hospitals (RRH) in Uganda, in order to
illustrate the imbalances in geographical
distribution and skills mix
• The analysis was based on the critical HRH
levels in the Regional Referral Hospitals
The Ugandan Health System
Household/community/village
HC II
HC III
Referral Hospital or HC IV
District Health Service
Regional Referral Hospital
National Referral Hospital
MOH Headquarters
Functions of the Regional Referral Hospitals
• Preventive, promotive, curative, maternity, inpatient health, and blood transfusion services
• Specialist clinical services such as psychiatry,
ENT, ophthalmology, higher level surgical and
medical, and clinical support
• In-service training, consultation and operational
research in support of the community-based
health care programmes
• Teaching and research
* each RRH provide services to 2 million people
Methods
Using data from the ministry of health HRH audit report
2010, we:
• Analysed the distribution of health workers in the 12
regional referral hospitals in Uganda.
• Compared proportions of vacant positions with the
set norm for various cadres at the 12 RRH.
• Analysed cadre-specific (skill mix) distributions of
health workers focusing on the specialised services in
the 12 RRH.
Overall Vacancy Rates at the RRH
Overall Vacancy Rates
The health sector strategic plan (HSSP II, 20062010) set a staffing level of 65%, of which 4 RRH
are lower than this level:
• Soroti at 60%,
• Fort Portal at 56%,
• Kabale at 49%,
• Moroto at 31%.
Vacancy Rates for RRH by Cadre
Doctors
Clinical
Officers
Nurses
Anaesthetic
Officers
Orthopaedic
Officers
Jinja
0
0
18
0
21
Mbale
9
40
25
0
46
Mbarara
0
0
21
25
47
Fort Portal
9
0
32
60
45
Hoima
43
58
43
20
80
Kabale
86
38
47
40
55
Arua
93
50
-6
25
50
Gulu
33
9
7
29
17
Soroti
80
17
29
0
92
Lira
33
-50
0
20
23
Masaka
40
25
16
0
31
Moroto
93
42
60
40
92
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•
•
•
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Vacancy Rates for specific cadres
Doctors: vacancy range 0-93% (Jinja, Mbarara:
Moroto)
Nurses: -6-60% (Arua, Moroto)
Clinical Officers: -50%-58% (Lira, Hoima)
Anaesthetic Officers: 0-60% (Jinja, Mbarara,
Fort Portal : Hoima)
Orthopaedic officers: 17%-92% (Gulu, Moroto)
Average Annual Output by Cadre
Cadre
Length of training
(years)
Number of schools
Average annual
output
Doctors
5
5
261
Clinical Officers
3
4
304
Bsc Nurse
4
4
89
Registered
comprehensive nurse
4
3
98
Registered nurse
3
8
177
Enrolled
comprehensive nurse
2.5
12
301
Registered midwives
3
6
172
Enrolled nurses
2.5
12
201
Enrolled Midwives
2.5
11
221
ENT officers
1
1
13
Anaesthetic officers
1
2
8
Discussion
• From the rates seen above, it is obvious that medical
personnel are carrying out duties for which they are
not fully trained, particularly nursing staff and clinical
officers.
• Equipping these cadre of staff with the relevant skills
may be a solution to some of the HR problems faced
in the health sector.
• BUT they are already overworked ……….
Conclusions
• Need innovative solutions.
• Task shifting is taking place whether the Ministry of
Health wants to acknowledge it or not.
• A multi-sectoral approach is required if task shifting is
to be effected. It requires:
– changes in curriculum
– changes in policies
– changes in salary scales
• The implications of effecting task shifting are not
known - need to address this knowledge gap.
Otherwise most countries are not eager to tackle the
issue.
• Thank you
Ref
•
•
Uganda HSSP II, Ministry of health
Human for health audit report 2010; capacity program