Dr Katumba Ssentongo Gubala is the Registrar, Uganda Medical and Dental Practitioners’ Council, a body that registers and licenses medical and dental practitioners in Uganda, fosters good medical practices, high standards of medical education and advises government on issues pertaining to the medical profession.
Michael Mubangizi talked to him about the agency’s work and challenges of medical practitioners in Uganda.
How would you describe the state of medical and dental practitioners countrywide with regard to aspects such as professionalism, job satisfaction, training and the work environment?
First of all, the council is mandated to perform four basic functions: to ensure that we register all medical doctors and dentists before they start working; to ensure that the standard of training is maintained; and to ensure standard of practice. We also bring to book errant practitioners whose practice is in doubt; so, the council is in charge of discipline.
This agency registers private clinics and hospitals; so, we inspect and supervise those centres to ensure that there is a good work environment where people get services. On registration, we currently have 3,894 doctors registered to work in this country. We update this register every two days.
We have 1,025 registered clinics (at the time of the interview). The number has reduced from 3,000 last year, because we have put in place stringent measures to ensure that those who don’t meet the required standards don’t register. Each doctor can now only be registered to run one clinic.
One can no longer register many clinics that they can’t run — which would give rise to running clinics. We also consider certain things like infection control, waste disposal and others, which have to be in place and adhered to. We’re working with local councils and other agencies to enforce these.
We’re also empowering the public [to help in enforcement], like in fighting quacks [fake doctors], by providing information. This council also deals with both government and private practitioners. Previously, we’ve been working with the private sector, applying standards there, and now we’re going to focus on the government sector to ensure that everything is okay in terms of equipment and personnel.
What kind of complaints about health practitioners do you usually receive?
We [receive complaints from people] who feel that they weren’t handled properly, or that they were not attended to in time. For instance, someone reports to a health facility but their patient isn’t handled on time and, perhaps, dies as a result.
Some think they were given improper treatment and developed complications as a result. There are also complaints about privacy, where [sensitive] information about a patient leaks. The penalties [that the Council gives] differ depending on the complaint, but they range from verbal reprimands to warnings and deregistration.
You said registered clinics reduced from 3,000 to 1,025. Doesn’t that mean that we have about 2,000 clinics or people working illegally and putting patients’ lives at risk?
It means that they are not supposed to work and we’re going to close them. The first thing we are doing is to deny them the licence, so that they qualify to be closed down. Actually, some have closed after failing to register. But, of course, there are some that are big-headed, but we will soon start our operation.
What is your assessment of the work environment and job satisfaction of health practitioners?
The work environment is not good for practitioners both in private and government health facilities. We’re all struggling to see that work conditions are good in terms of equipment and human resource. For instance, the government wants its facilities to have [at least] 65 per cent [of the required] personnel, but so far, there are about 50 per cent.
This translates to heavy workload, fatigue and ill-performance, and people abusing patients. Equipment is also inadequate, but the government is working on that. Some agencies are trying to help the private sector to buy equipment on long-term loans. [Furthermore], like it is with the government, the private sector doesn’t have enough money to pay workers well.
We need strong systems that make private [healthcare] a viable business to pay staff well and have the necessary facilities, because we want the private sector to drive the government in terms of competition and service delivery — but if they don’t have enough workers and equipment, then there will be no difference.
There have been cases of death due to negligence by health workers. Is this because of lack of training or inadequate facilities?
There are many [factors to blame], including inadequate staffing and lack of equipment. Some patients are referred to certain health facilities because of lack of equipment [where they are being referred from], but the patient dies on the way. But, of course, there are also some people that aren’t very professional.
That is why people write to us (Points to the numerous files of complaints and petitions against health workers) to investigate and [ascertain] whether it’s a systemic problem or a professional one — because there are systemic failures that health workers have no control over. [For example], a patient is brought to you at night when electricity is off and there is no generator, or it lacks fuel; you will have nothing to do.
But you journalists [merely report] that somebody died in this hospital; there were doctors on duty but they didn’t help. Unfortunately, in the medical profession, there has been limited interaction with the media.
Unlike some other professionals such as teachers, who have been outspoken in demanding better work conditions and pay rises, medical practitioners have been quiet, yet they come across as a de-motivated workforce.
I think our training has been [weak] in terms of advocacy. I think the doctors’ Hippocratic oath has been coined in such a way that doctors think that whatever you say outside [the practice] is advertising, which we are barred from doing. So, we need to reorganise ourselves to determine what is advocacy and what is advertisement.
But [indeed], it is a demotivated workforce because of the factors that I have told you about, like low salaries compared to nearby countries. In Rwanda [for example], a doctor who has just graduated earns the same as a senior consultant in Uganda — a starting doctor in Rwanda gets about Shs 2.2m. This has led to many of our doctors running away to other countries.
Are there other reasons driving our doctors to work abroad, besides poor pay?
Of course. Equipment [is one factor]. Some people who trained in specialised [areas] abroad return to Uganda and when they don’t find the equipment they need to apply their skills, they go back. Motivation [is another]. Although most doctors have left to work abroad, some have remained and are working for that money. Such people need to be motivated, because [what they are doing] is really patriotism.
What is your view on the doctor-to-patient ratio?
According to the registered doctors, the ratio is about 1:12,000, when we should have 1:1,000.
Unlike in the past, many health workers in government hospitals today run private clinics, which leads to absenteeism in hospitals.
Yes, that’s a problem arising from the need for survival. Our friends in Kenya have introduced a non-practising allowance that bars a doctor from going to private practice. Ideally, these senior doctors aren’t interested in hopping from one place to another; there is no need of a professor to move from Mulago hospital to Rubaga. I would proudly say that doctors are people who are easy to satisfy.
Why are fake doctors on the rise?
We’re going to deal with this. The problem was poor coordination between the council and the districts. Now we have created a chain of registration and supervision — there was a gap that we have bridged. We aren’t going to finish all of them at once, but we want the public to assist us. The best way to fight a quack is by not going to them.
How can the public tell that someone is a quack?
This can now be done on phone; you can tell a quack doctor from your phone. Go to your phone SMS, type the word ‘doctor’, leave a space and write the full name of the person you are querying, then send the message to 8198.
It’s the same procedure for clinics: clinic-space-name of clinic under query-send to 8198. You will receive a message telling you whether or not the doctor or clinic is registered. We have access to such [inquiries] and if we find that a particular doctor or clinic is being queried so much, we go there to try to find out why.
But we also have a limitation; there are traditional healers who call themselves doctors. This council is in charge of medical doctors; it’s not in charge of traditional healers, so, for now, the law doesn’t allow us to [go after] them. But we’re revising our act so that the law empowers us to catch them.
There is a persistent claim that doctors steal drugs from government hospitals for their private clinics.
(Laughs) In Uganda, the word doctor is used universally; everyone is a doctor — even a driver that has worked in a hospital for two weeks. There may be some bad [elements], but as far as I’m concerned, I have only heard of one person who has been convicted — that was an in-charge in Karamoja who bought drugs and didn’t transfer them to the facilities. The rest were actually not doctors.
But the truth is that the drug [stocks] in government hospitals are not yet adequate. There may be some health workers stealing a tin or so, but it is not to that magnitude that has caused shortage.