Last month a variety of stakeholders gathered to discuss the state of medical education, health worker training, and career development in Uganda. Supported by Seed Global Health, the meeting brought together various partners from academic institutions, professional societies, government agencies and international organizations to discuss gaps in medical training in Uganda.
We spoke with the Secretary General of the Uganda Medical Association, Dr. Obuku Ekwaro, to talk about the challenges facing medical education in Uganda, solutions on the table at this important, multilateral meeting.
What is the need for health workers in Uganda?
There’s a serious shortage of health care workers in Uganda. The latest data shows that there are less than two health workers for every 1,000 people. And that number has not changed substantially even despite the increase in population in Uganda. The current framework and policy around health workers in our country is nearly two decades old. Yet in that time, our population increased from around 20 million to more than 35 million while the doctor-to-patient ratio has remained the same.
One development offers hope: the number of medical schools has increased greatly. In the last 20 years, the number of schools increased from just two to nine schools.
What are the challenges that institutions face in trying to improve the quality of education?
Schools struggle to maintain the quality of education. First, there are issues with infrastructure and equipment. There is no equipment especially for those doing post-grad training, what you call “residents” in the United States. They simply lack the equipment for practice.
Second, space remains a challenge. The institutions we do have are struggling to accommodate all of their students.
Third, and significantly, institutions also struggle with a shortage of human resources – a lack of skilled educators to teach the next generation of workers. There are critical disciplines and basic sciences that are lacking in instructors. You have situations where surgeons are stepping in to teach basic science courses like anatomy or physiology. So that has been a challenge, being able to find the essential staff to teach courses. We don’t have enough lecturers, not enough clinical staff on the wards.
Finally, the institutions struggle with financing. Much of the financial commitment from the state is focused on primary education. If you look at the population of Uganda, more than fifty percent is below fifteen years old – logically, national policy focuses on supporting primary and secondary education. Thus prioritizing financing from the state for health workers can be a challenge.
Why are multi-stakeholder meetings like this important?
This multi-stakeholder meeting is significant in its inclusivity. Previous meetings about the health workforce policies in Uganda have sometimes left important actors out. Government officials and those making the policies, their thinking process is different from say, academia, from say members of professional associations, from students, members from health worker unions, they will also be attending. Members from upcoming universities, students who haven’t graduated, they have different perspectives. And they need to be included.
Meetings like the recent one in Uganda included key actors such as those who were affected, medical students themselves, and their teachers and supervisors. This is how it should be every time. We need all actors, not only government authorities and the policy makers. We need to hear from those who will be implementing the policy and those who will be affected. It makes for a more effective conversation that can advance the health workforce in Uganda.
From here, we are hoping that together we can develop some evidence briefs and policy recommendations based on research evidence and expert opinion. We will be looking at issues affecting post-graduates, challenges around introducing the universal examination for medical schools, and issues facing interns. Then we will begin to think of ways to move forward. How to begin working with concerned Ministries and working with Parliament to approve financial support for institutions.
You can read live updates from the meeting by visiting GHDOnline here.