State House health monitoring unit must disband, medics demand, as Museveni promises more pay
Striking doctors have said they can return to work as negotiations on their demands continue if three key conditions are met, and surprisingly the trio doesn’t include the pay raise.
On the pay raise, the doctors say they are willing to hold off their agitation as urged by government officials until the salary review commission harmonises the pay structure for all civil servants.
The doctors’ first condition is that a State House anti-corruption operation directed against their fraternity must stop, the perennial problems facing interns must be sorted out, and various duty allowances paid.
But in a late night press conference yesterday, minister of Health Jane Ruth Acing ordered all medical doctors to report back to work immediately or get fired.
She said President Museveni has instructed Resident District Commissioners (RDCs) allover the country to record incidences of absenteeism of the medical workers for disciplinary action.
Under the first ground, President Museveni has been asked to disband his State House Health Monitoring Unit (HMU) , whose anti-corruption operations have made life miserable for health workers around the country.
Dr Ekwaru Obuku, president of Uganda Medical Association (UMA), told The Observer in an interview on Wednesday that health workers have been humiliated by HMU; the unit’s work methods are draconian and yet it is not helping to improve the troubled sector.
“We told that to the president and he said ‘I formed it’,” Obuku said of the State House meeting of October 31.
Until last year, HMU was led by Dr Diana Atwine, now permanent secretary, ministry of Health. The unit, which was formed to combat theft of drugs and other items in public health facilities, reports directly to the Office of the President.
In February, an outraged Uganda Medical Association condemned the arrest by HMU of four medical workers after a woman in Mityana died in labour. Similar arrests have happened in Luweero and Soroti, among others.
“It is unpopular and feared to the extent that health workers run away and enter their houses to hide under the bed [when HMU visits]. It does not help, however disciplinarian it is,” Obuku said.
“[The unit] has been abused and used to witch-hunt health workers…We have not seen big corruption suspects being lumped up like that. If they want to fight corruption in the health sector, let them go for bigger health sector corruption in procurement; false pricing of anti-cancer medicines and what happens in delivery units,” he added.
The president can review HMU’s operations, he said. After all there is police, the auditor general, resident district commissioners, Directorate of Public Prosecutions, Uganda Medical Dental and Practitioners Council (UMDPU), and National Drug Authority, which can monitor public health service delivery.
Dr Obuku described the disbanding of the HMU as one of the irreducible demands if they are to go back to work. The doctors are on a countrywide strike since Monday in protest at the long-standing, but unmet, salary review promises. They plan to meet after 10 days to choose the next course of action if the government stays put.
Another condition is for the chaotic internship for medical students to be addressed: interns must be given appointment letters and their pay spelt out.
Obuku said interns should also be included in the public service structure. Medical students on internship have perennially been striking because their allowances take forever to come yet they do a lot of the work in referral hospitals.
The third demand is duty facilitation allowance, which includes; on-call allowance, overtime allowance, housing allowance, non-practice allowance, transport allowance, lunch allowance, medical risk allowance, and retention allowance. In total, the doctors are demanding Shs 88.9bn annually – to cater for 1,000 doctors.
Dr Obuku said as health workers, they would not pretend that all is well in the health sector. He said: “We’re talking about a total collapse of the health sector.”
Kiruddu hospital in Kawempe, a facility which handles referrals to Mulago, has become a death trap of sorts, he said.
“Now health workers are practising defensive medicine,” he said. “They come look at a pregnant woman and sign in the book, ‘I saw her at this time and there was no blood’,” Dr Obuku said.
“There is no money for drugs but they have money for fuel [for politicians]. Kiruddu has become a business hub for coffins. It has become a cemetery of sorts. People dying from avoidable ailments...,” Obuku lamented.
Last year, he revealed, drug supplies ran out in the middle of the financial year and this year, nothing has come. This strike has been building up and reached fever pitch when we could not find drugs to work with, he added.
It would appear that the meeting with President Museveni at State House Entebbe on October 31, which was expected to persuade the doctors to abandon the strike, didn’t achieve much.
They told the president they were “seeking a new consensus – a sort of doctors for Ugandans and Ugandans for doctors,” said Obuku.
The president then asked them to be loyal to the country but they retorted: how more loyal could they be?
“A doctor goes to Gulu to treat Ebola and dies,” they reportedly told the president, referring to the late Dr Matthew Lukwiya who contracted Ebola while treating patients in Gulu’s devastating outbreak of October 2000.
“We are using torches, [ordinary] razor blades [in theatres]. The president agreed to some things and told us to stay the strike. We called an extraordinary assembly to give opportunity to the members to decide and they said we go on strike as we continue with negotiations,” Obuku said.
“He [the president] said he would arrest us, which I am sure he can do. He has all the powers to do so. He already went to the bush but it’s expensive; he could use that money to sort out our issues.”
Currently, a doctor takes home an average of Shs 1.1 million per month. At Kampala Capital City Authority, a lower-level director earns Shs 17 million yet a senior consultant at National Referral Hospital Mulago earns just Shs 3.5 million.
The doctor-to-patient ratio in Uganda is among the worst in the world with 32,000 for every available doctor.
“The Ugandan doctor is not valued by [his/her] government; that’s why many are running to other African countries for greener pastures,” Obuku told us. “Leading countries taking Ugandan doctors are Kenya, Rwanda, Tanzania and South Africa. South Sudan is also taking more doctors from Uganda.”
About 65 per cent of the country’s medical workers are working for NGOs, mostly in HIV-related projects, leaving public health care severely understaffed.
“We are spending much more money in private health insurance schemes for State House, cabinet, statutory authorities,” Obuku said.
RIGHT OF ASSOCIATION
By uniting under their UMA umbrella, Obuku said, health workers are exercising their constitutional right to associate in line with Article 29 of the Constitution.
He said the constitution also allows aggrieved government employees to withdraw their labour.
“Government has to get a mechanism of engaging its employees. One of the ways is not to arrest them,” he said.
Instead of responding to the issues raised when she addressed journalists on Wednesday, minister of Health Jane Ruth Aceng instead dwelt on a claim that not all doctors were on strike.
But Obuku revealed that UMA brings together 712 medical doctors, 152 senior consultants, and 171 senior house officers. He said there are about 1,300 medical doctors in the country today, many of them working at the ministry of Health and others in local government service. These two categories rarely work on patients.
“Everybody is on strike. We left skeleton staff and consultants to attend to emergencies – fulfilling the international recommended guidelines that emergencies must be attended to,” he said.
STATE HOUSE RESPONSE
A letter dated November 6, 2017 from Molly Kamukama, the principal private secretary to the president, addressed to UMA, said Museveni had directed that UMA meets the salary review commission to give its input, and that there will be a phased approach in prioritising the doctors’ emoluments.
“Salary enhancement should start with the lower cadres, so that nurses can take home a minimum package in the range of Shs 600,000 – subject to the discussions and recommendations of the salary review commission,” the president directed.
He also said the entry level salary for a medical officer, subject to discussions of salary review commission, could be Shs 5 million.
“The more severe and specialised doctors should be paid the market equivalent; that is, what they would earn in the open market,” the letter said.
The president didn’t talk about the State House Health Monitoring Unit despite the fact that health workers had told him during their meeting on October 31 that they want it closed.
On intern doctors, the president said the modalities of internship need to be clearly addressed such as their remuneration and accommodation,
Atwine told parliament’s committee on health yesterday: “the government appreciates that the problem right now of public [health] workers’ pay is a big issue and is willing to remedy it.”
She, however, didn’t commit on the issue of interns and disbanding of HMU. Obuku had criticised the government’s priorities.
“We expect them to get money from the consolidated fund where they got money to pay additional 130 MPs that joined the House this term,” he said.