A Surge of New Recruits for Uganda's Health Workforce

Between October 2012 and April 2013, Uganda added 6,889 new workers to its national health workforce, thanks to a provision approved by the Ugandan parliament last September—and IntraHealth International’s Uganda Capacity Program’s efforts to make sure the parliament had the right data at the right time. Since then, the government has allocated 49.5 billion shillings (almost US$20 million) to add new workers to the country’s long understaffed health workforce.

But swelling the ranks of Uganda’s health workforce is not easy. Districts faced the onerous task of not only determining what kinds of health workers their populations most need—midwives? nurses? pharmaceutical techs?—but also of advertising for them, screening them, hiring them, and making sure they’re paid enough and on time.

The Uganda Capacity Program has been there to help with all of those steps, from providing data on the numbers and cadres of health workers Uganda needs, to helping the government fill positions throughout the country—all while saving the government millions of shillings by reducing inefficiencies.

Short-staffed in Mbale

For years, Uganda’s health workforce has been operating at about half capacity. Only 58% of its health worker jobs were filled, leaving just one doctor and 13 nurses to serve every 10,000 people.

In Mbale District last year, for example, only 337 of 708 health worker positions were staffed. Burnout rates were high. Services were suffering. Clinicians could give patients only about five minutes of their time. One midwife—popular with the community and much in demand—found herself snapping at mothers after a 24 hour shift with no rest.

The new provision approved by the Ugandan parliament, though, has recruited 245 health workers to Mbale District. Nationwide, it will boost the percentage of filled health worker positions from 58% to 70%.

And it’s all thanks to the data. The statistics gathered by the Uganda Capacity Program’s biannual health workforce audits—and the dismal understaffing they revealed—led Uganda’s parliament to devote unprecedented funds to beefing up staff numbers at health centers throughout the country.

Since then, the Uganda Capacity Program has used those same updated facts and figures to help the Ministry of Health determine just how many health workers are needed where, and what their qualifications must be.

They’ve also helped save the ministry millions of shillings through smart advertising. In the past, districts have separately posted tailored job ads in newspapers. By helping to create a joint advertisement that covered all 112 districts and 21 municipalities and running the same ad in a multiple newspapers, IntraHealth helped the government significantly reduce costs.

And a new computer-based shortlisting tool saved invaluable time by trimming down the recruitment and hiring process from six months to three.

A quicker way to hire

Since the positions were first advertised, over 35,000 applications have poured in nationwide. Each district was confronted with the tedious business of manually sorting through heaps of paper applications, jotting down information about each applicant on a separate summary sheet, and holding meetings to review those summaries—all to narrow down shortlists of candidates to interview.

Traditionally, this type of shortlisting is expensive, labor-intensive, and slow.

To speed up the process, the Uganda Capacity Program worked with the Ministry of Health to use a computer-based tool developed by IntraHealth that sorts and prioritizes the applications and helps fill health worker positions faster.

IntraHealth’s e-shortlisting technology cuts the costs of creating a shortlist by about 50%. The database-driven system stores information on each applicant, allowing hiring officials to quickly compare job-hunters and their qualifications.

E-shortlisting also introduces objectivity into a recruitment process susceptible to corruption and nepotism. The new technology eliminates unqualified applicants automatically, ensuring those who make it to the interview stage have the right abilities and credentials for the job.

IntraHealth worked with Uganda’s Ministry of Health to make sure hiring managers in all 112 districts have access to the e-shortlisting software and that they’re trained to use it.

Midwives in short supply

Even with the wave of new applicants, Ugandan districts are finding that some positions are still tough to fill. Too few applications have come in from qualified midwives, anesthetic assistants and officers, public health nurses, ophthalmic clinical officers, senior medical officers, and cold chain assistants. A shortage of midwives is particularly bad news for the country’s maternal and child health services.

But IntraHealth staff and the Ministry of Health have been able to pinpoint some policy issues that could help streamline training and pay for health workers, as well as boost the number of skilled workers available.

For example, plenty of applications came into the districts from comprehensive nurses looking for midwife positions. Before last year, comprehensive nurses could easily cross over into the midwifery field. But these appointments are now prohibited because of a new scheme of service for nurses in Uganda that was passed last November.

Now, IntraHealth staff members are working to make recommendations to address this and other new workforce challenges.

IntraHealth’s Uganda Capacity Program is funded by the US Agency for International Development. Allan Agaba, Sarah Murungi, Isaac Kagimu, and Dr. Waniaye John Baptist Nambohe contributed to this article.

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