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Measuring Health Workforce Distribution Inequalities in Uganda. Anna Awor, Elaine Byrne and Ruairi Brugha. The Challenge. Many challenges: Staff shortages uneven distribution gaps in skills and competencies low retention & poor motivation limited funding for recruitment

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measuring health workforce distribution inequalities in uganda

Measuring Health Workforce Distribution Inequalities in Uganda

Anna Awor, Elaine Byrne and RuairiBrugha

the challenge
The Challenge

Many challenges:

  • Staff shortages
  • uneven distribution
  • gaps in skills and competencies
  • low retention & poor motivation
  • limited funding for recruitment
  • constricted career structure
  • Lack of champions for health
  • lack of recognition & shortage of role models,
  • ineffective training materials and methods:

Without overcoming these challenges, attainment of Millennium Development Goals will not be possible in most developing countries.

objective
Objective
  • Assess regional distribution and skill mix of health workers at the Regional Referral Hospitals (RRH) in Uganda, in order to illustrate the imbalances in geographical distribution and skills mix
  • The analysis was based on the critical HRH levels in the Regional Referral Hospitals
the ugandan health system
The Ugandan Health System

Household/community/village

HC II

HC III

Referral Hospital or HC IV

District Health Service

Regional Referral Hospital

National Referral Hospital

MOH Headquarters

functions of the regional referral hospitals
Functions of the Regional Referral Hospitals
  • Preventive, promotive, curative, maternity, in-patient health, and blood transfusion services
  • Specialist clinical services such as psychiatry, ENT, ophthalmology, higher level surgical and medical, and clinical support
  • In-service training, consultation and operational research in support of the community-based health care programmes
  • Teaching and research

* each RRH provide services to 2 million people

methods
Methods

Using data from the ministry of health HRH audit report 2010, we:

  • Analysed the distribution of health workers in the 12 regional referral hospitals in Uganda.
  • Comparedproportions of vacant positions with the set norm for various cadres at the 12 RRH.
  • Analysed cadre-specific (skill mix) distributions of health workers focusing on the specialised services in the 12 RRH.
overall vacancy rates
Overall Vacancy Rates

The health sector strategic plan (HSSP II, 2006-2010) set a staffing level of 65%, of which 4 RRH are lower than this level:

  • Soroti at 60%,
  • Fort Portal at 56%,
  • Kabale at 49%,
  • Moroto at 31%.
vacancy rates for specific cadres
Vacancy Rates for specific cadres
  • Doctors: vacancy range 0-93% (Jinja, Mbarara: Moroto)
  • Nurses: -6-60% (Arua, Moroto)
  • Clinical Officers: -50%-58% (Lira, Hoima)
  • Anaesthetic Officers: 0-60% (Jinja, Mbarara, Fort Portal : Hoima)
  • Orthopaedic officers: 17%-92% (Gulu, Moroto)
discussion
Discussion
  • From the rates seen above, it is obvious that medical personnel are carrying out duties for which they are not fully trained, particularly nursing staff and clinical officers.
  • Equipping these cadre of staff with the relevant skills may be a solution to some of the HR problems faced in the health sector.
  • BUT they are already overworked ……….
conclusions
Conclusions
  • Need innovative solutions.
  • Task shifting is taking place whether the Ministry of Health wants to acknowledge it or not.
  • A multi-sectoral approach is required if task shifting is to be effected. It requires:
    • changes in curriculum
    • changes in policies
    • changes in salary scales
  • The implications of effecting task shifting are not known - need to address this knowledge gap. Otherwise most countries are not eager to tackle the issue.
slide15
Ref
  • Uganda HSSP II, Ministry of health
  • Human for health audit report 2010; capacity program