Health providers: are we accountable?
In April, PATA celebrated World Health Worker Week, while drawing attention to the critical shortage of health providers in Africa.
Jacquelyne Alesi sat down and chatted to Dr Balungi from Uganda about the brain drain
In Africa there is a shortage of 2.4 million doctors and nurses. A lack of an adequate health force can have critical implications on the health of its people. In Uganda, the doctor-to-patient ratio is estimated at 1:24,725 while the nurse-to-patient ratio is 1:11,000. The World Health Organisation (WHO) has recommended one health provider to every 1,000 people.[1]
Dr Jacqueline Balungi Kanywa, a Medical Care Manager for Baylor College of Medicine-Children’s Foundation, Uganda, explains that in her country, the social and financial responsibilities faced by many far outweigh the remunerations received as a health professional – a challenge that many health providers across Africa will be familiar with.
With doctors in Uganda earning as little as $232 a month,[2] it makes sense that greener pastures may be sought out.
Dr Balungi says, “Health providers in Uganda can ably compete for jobs beyond the borders of the continent, where the pay is much higher. They would of course like to stay in their home country, but the grass here is dry and brown and so, naturally like animals in the wilderness, they move to a place where there is more water and greener pastures.”
She explains, however that the challenge is more than a matter of income. For example, there is often a shortage of equipment, which hinders the work of health providers, is frustrating and impacts heavily on job satisfaction. She says, “Imagine sending out 1000 gardeners without hoes or seeds?”
Often prescribed basic medicines are out of stock or patients who live below the poverty line and cannot afford the medicine are subject to user fees. HIV drug shortages, for example, are currently puting hundreds of thousands of lives at risk in Uganda. Dr Balungi explains, “You want to deliver a baby and find that there are no gloves. You want to treat a patient with tuberculosis, but you’ve only ever read about N95 respirators in the books. In some cases, working in certain health facilities can also become a health risk to the health providers themselves.”
Parents and family members are also often asked to buy supplies needed by health providers, especially in emergency situations. Saving lives, Dr Balungi says, doesn’t come cheaply and asking families with little money to purchase supplies can be heart-breaking. User fees continue to be a barrier and limit the ability of many to access universal health care.
For this reason, health providers may become disconnected from the health facilities where they work and over time become more and more desensitized. Hierarchies, administrative bureaucracies and ongoing delays in securing stock can create resentfulness and most likely contributes to poor productivity and compromised service delivery.
Dr Balungi points out, “The WHO clearly states that it is possible to have universal primary health coverage if the leaders have the will to provide for it.”
But when leaders aren’t seen to be trying to achieve universal primary health coverage, and where countries continue to invest in everything, but health, it can be easier to turn to a country where health service is a priority.
On the micro-level, then, the brain drain isn’t all negative. Dr Balungi explains that health providers who work overseas often send money back to their families, indirectly creating prosperity and offering alternate livelihood opportunities for family members. “Health providers need to survive,” she says, “Those leaving for greener pastures cannot and should not be blamed.”
So why hasn’t Dr Balungi skipped town? Well, she explains, she has spent over 15 years working for health facilities in Uganda that have international support. For her, her role as a health provider has been positive and fulfilling: “Collaborations and partnerships are very instrumental in the Ugandan health care system.”
In terms of adolescent- and child-friendly HIV services, treatment and care, Dr Balungi believes that health systems need input from all stakeholders. Ugandan leaders, too, can do more.
She identifies the WHO building blocks as fundamental to a sustainable and functional health system, especially in HIV services: Leadership and governance, health care financing, health work force, medical products and technologies, information and research and service delivery.
For health providers to receive the support that they need to do their jobs effectively on this front, Dr Balungi also feels that each and every health provider needs to be accountable. She says,
“Let us be good stewards of the responsibilities that we have been given, right from the lowest person in the hierarchy to the greatest leader at the top. If we can remain accountable, I believe we can make a better health care system.”
While keeping health providers home may require more input from policy-makers and leaders, it is up to each health provider to keep showing up on the frontline and forming that vital health system building block: the health work force.
Dr Balungi says, “Before pointing fingers at any one else, let us do the best work that we can.”
How else can we make sure that #HealthProvidersCount?
This interview was compiled by Jacquelyne Alesi, PATA’s communication correspondent in Uganda. Jacquelyne will be assisting in the compilation of stories from the voices of the PATA network. As a global youth advocate, she has represented young people on the National Forum of People Living with HIV Networks in Uganda, sits on the board of the Global Network of People Living with HIV (GNP+) and she is an Ambassador to The Coalition of Children affected by AIDS.
