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Why Uganda cannot afford Cuban doctors

In November last year, doctors across the country laid down their tools for three weeks demanding that government fulfils a number of demands, including improved salaries, provision of housing and transport, domestic workers, stops the ‘war on doctors’ and disbands the State House Health Monitoring Unit.

Other issues revolved around impossible working conditions (shortage of medicines and medical supplies, disproportionate workload, lack of meals, etc). The government reacted angrily, claiming that the Uganda Medical Association (UMA) was holding the country at ransom.

Also last year, at a meeting held at State House in Entebbe, the doctors were not ready to take more empty promises from President Museveni. Regardless of a last-minute pledge by the president, they went ahead with their strike. One of the responses which has since emerged is a much-criticized plan to import doctors from Cuba.

Dr Diana Atwine, the permanent secretary, ministry of health, on May 2 told the Public Accounts Committee (PAC) at Parliament that after Museveni accused the doctors of "holding the government to ransom," he proposed the hiring of medics from Cuba to replace them.

The most recent data one could find from 2013, shows Uganda's doctor-to-patient ratio stands at 1:24,725, way off the recommended 1:1,000 with a nurse-to-patient ratio at 1:11,000.

The question is, would importation of 200 doctors have an impact?

Uganda and Cuba enjoy warm relations. It is well known in diplomatic circles and in government that some Cuban doctors are already running many health projects in Uganda.

Cuban doctors were instrumental in setting up Mbarara University of Science and Technology (MUST) in 1990s, and by 2017, MUST had trained over 1,000 medical doctors in Uganda.

Dr Ekwaro Obuku, the UMA president, says medical practitioners are still waiting for confirmation from government on how this "Cuban solution" will work.

According to Obuku, the problem is not lack of doctors, but the salaries and general welfare. Uganda being one of the countries with doctors leaving the country, the Cuban doctors cannot be a solution.

Parents and government inject a lot of money in training a doctor and it's very dismaying to see our doctors paid peanuts, something that forces them to leave the country or shun the public health facilities, he said. However, he also welcomes the idea of importing doctors but doubts government can maintain them.


The UMA puts the cost of training a medical doctor from primary school to university at Shs 70 million ($21,000) in Uganda.

"Uganda also passes out up to 600 doctors; at one point we have 150 specialists (doctors who have completed Master's) and around 550 doing internship, but very few are absorbed," Dr Obuku said.

On the other hand, UMA explained that aside from air tickets, housing and other related allowances a foreign doctor costs the government at least $3,000 (Shs 11 million) under the Uganda-Cuba arrangement, which money is paid directly to the exporting government.

As the negotiations are still going on, the ministry of Health is proposing to pay Cuban doctors $1,500 (Shs 5.4m), excluding housing, transport and security allowances while Ugandan doctors are listed to earn Shs 4.4m.

Double standards

A few years back, the ministry of Foreign Affairs advertised opportunities for Ugandan health workers to go to Trinidad and Tobago. According to the advertisement, Uganda wanted to "step up the existing outstanding unilateral relations" with Trinidad and Tobago.

At least 400 health workers, including senior specialists from government hospitals, applied to leave. This should have been an eye-opener to the government, though not much was made public after the advert, Uganda medical doctors are slipping away looking for greener pastures.

Figures from Uganda Medical and Dental Practitioners register for 2017 show that between 2010 and 2015, at least 265 (nine per cent Uganda doctors (non-specialists) out of a total 2,915, migrated from Uganda.


The UMA says the comprehensive cost for importing Cuban doctors likely outweighs benefits.

"I have seen places where doctors and midwives deliver women using spotlights and phones hung in their mouths, we wonder if these doctors will bear with that," Dr Obuku said.

Further, health practitioners believe the language barrier would create a need for nurses or midwives as interpreters.

He added; "This 'Cuban solution' undermines the [government's] Buy Uganda Build Uganda policy and threatens our progress. Ugandan doctors deserve to be invited to enjoy the fruits of Uganda's happiness."


Dr Abed Bwanika, a two-time former presidential candidate, said Cuban doctors will be pricey for government. Bwanika contends that since Cuba exports doctors and earns directly for their services, Uganda will face a huge financial burden.

Speaking in a Monday interview, he said government will pay about US$ 5,000 per doctor each month. Of that, about US$ 3,500 is supposed to be paid directly to the Cuban government. This means that for 200 Cuban doctors, government will part with over US $1m (Shs 3.4bn).

"Whoever tricked the government into this move is wrong. We cannot simply pay over 18 million per foreign doctor," Bwanika said.

However, Health minister, Dr Jane Ruth Aceng, says Cuban doctors are not meant to replace the local ones, but to complement the few local consultants in training and supervising intern doctors.

"These doctors will also be sent to stations upcountry where many Ugandan doctors don't want to go, it's not that we are outright replacing the whole medical team," she said.


+1 #1 Lakwena 2018-05-15 18:38
In other words, the Cubanization of Uganda's medical and education service is Mr. M7's disdain and kamanyiro of the people of this country.
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0 #2 Odongkara 2018-05-16 09:46
My question is has this government run any project very successfully free from corruption and shoddiness?

This Cuban thing is just another of such failed projects. At the end of it Uganda will be left more sick than in the beginning, hakuna mcheO
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0 #3 rubangakene 2018-05-18 21:43
Cuban doctors bring some 'human touch' to the profession. They go into the profession driven by the 'might of Apollo' rather than financial gain.

Of course Uganda can afford Cuban doctors. For every trip a government official travels abroad, that money can sustain a Cuban doctor for a year in the rural area.

In Qatar, the average Cuban doctor is paid a mere $1,000 USD per month with free accommodation! Bring the Cuban doctors to train medical assistants in the to run village clinics and manage health education for the masses!
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