Saved by the Data

This year, when Uganda’s Ministry of Public Service announced a ban on recruitment for all sectors—including health—it was bad news for the country’s human resources for health (HRH) crisis.

Uganda’s health care industry has been struggling along at almost half capacity for some time. Only about 58% of the country’s health worker jobs are filled, which leaves just one doctor and 13 nurses to serve every 10,000 people. Staff shortages, lack of motivation, low pay, imbalanced geographic distribution, and other HRH issues plague Uganda’s health workforce. The recruitment ban threatened to make matters much worse.

Not only would it mean that no new health workers could be hired for an entire year, but any positions that were unfilled—some 42% of them—would be lost, along with any that were vacated by workers who were leaving or retiring. But Uganda’s need for health workers is dire. The country ranks number eight in the world for HIV infections, and child and maternal mortality rates are dangerously high.

So Uganda’s Ministry of Health began scrambling for a solution. And they called on IntraHealth’s USAID-funded Uganda Capacity Program for help.

Right data, right time

For three years, IntraHealth’s Uganda Capacity Program has worked with the Ministry of Health, conducting annual, country-wide, health worker staff audits. The program keeps tabs on how many health workers are employed throughout the country, where they are, how many positions are vacant, and other key data.

The audits give Ugandan officials invaluable information about the country’s health workers and help the ministry to pay salaries, recruit new workers, and fill open positions. It’s the kind of data that buttresses a strong health infrastructure—and it is data that many African governments lack.

The ministry uses the results of these audits for HRH planning, specifically to develop national health-sector recruitment plans. But this year, after the Ministry of Public Service made its startling announcement, the Ministry of Health and the Uganda Capacity Program called together key HRH stakeholders for a meeting.

“I am looking for a solution to the HRH crisis so that I can advance it to the politicians for support,” said the Director General of Health Services Dr. Jane Aceng. “And we need to develop it together.”

Those gathered set to crafting a strategy based on the health worker audits. The group wrote a memo that summed up the HRH crisis clearly and used data from the audits to create recommendations for feasible, evidence-based solutions that would strengthen the health workforce rather than destabilize it. Then the group submitted the memo to the Ugandan parliament on September 13, 2012.

It was a contentious issue. But eventually the parliament found a way to dedicate 49.5 billion Ugandan shillings (or $19.8 million US dollars) to HRH, after trimming the budgets of 23 other ministries and government bodies. The budget passed on September 15, 2012.

Afterward, the Ministry of Health and the Uganda Capacity Program worked together, using the results of the HRH audits, to finalize an equitable and data-driven allocation plan for these resources in the future.

For now, the new funds will help officials recruit 6,172 more workers for Ugandan health centers this financial year. The money will also go toward raising salaries for doctors, which will especially help to retain those in rural areas. Next year, the ministry hopes to do the same for many other health workers as well.

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