According to the Ministry of Health, Human Resources for Health Recruitment Plan
(2011-2020),the health sector is currently grossly understaffed with nearly half of the approved positions being vacant. A deeper analysis of the current staffing reveals yet another dimension of this problem in that majority of the staff in post are either support or administrative staff. Qualified health workers including doctors, midwives, nurses and allied health professionals are in shortage and more especially in hard to reach rural districts and the new districts. This situation seriously compromises the performance of the sector and particularly in its contribution to national development. According to the trend analysis of the performance of the health related indicators done in the National Development Plan, it is unlikely that the MDG targets of these indicators will be met if the same trend continues. Infant mortality needs to improve from 76 to 41 while under five mortality needs to improve from 137 to 60 and maternal mortality ratio from 435 to 131 by 2015/1016 which is just 4 years away. Further according to the 2009/10 health sector performance report 7 out of the 8 HSSPII PEAP indicators fell short of the set targets. The percentage of deliveries in health facilities were at 33% against the HSSPII target of 50%. The % of approved positions filled by qualified health workers was at 53% at the end of HSSPII falling short of the 65% HSSPII target. Inadequate number of skilled personnel to deliver the Uganda National Minimum Health care package especially of mother and child health, communicable, non communicable and nutrition services was one of the key challenges highlighted in the performance report. The need to urgently address the current HRH crisis that the sector faces is therefore a high priority agenda. The gross understaffing is partly attributed to insufficient recruitment in all local governments for close to four years due to limited wage bill ceilings. Even when wage ceilings provided for recruitment, the funding for the DSC was not adequate to cover the recruitment costs leading to under utilization of the wage bill. Difficulty in attracting certain cadres of staff especially medical officers, dispensers, lab technicians and anesthetic officers has also posed a major challenge to previous recruitment efforts. It is no wonder therefore that even in districts which have relatively higher proportions of their approved posts filled, the major positions filled are those of support staff with low proportions of qualified health workers.
The districts currently have on average only 52% of the staff they need to work (this reduced from 53% after the creation of new districts). In real terms the sector needs approximately 49,000 staff in the district health systems excluding the national and regional referral hospitals but has only 25,000 staff are in post currently. This means that for the sector to be fully functional and perform according to expectations there is need to recruit at least 24,000 more health workers.
Additionally the limited motivation and retention packages given to health workers has contributed to poor performance, absenteeism and even inability to retain critical cadres even where health workers have been recruited. Currently, health workers receive a meager consolidated Duty Facilitation Allowance
(DFA) of Uganda shilling 90,000/- for senior consultants and other senior staff and 45,000/- for the lower level staff. This amount has remained the same for the last five years.
The health sector wage bill has remained constant at 178.07 billion, yet the costing of the HSSIP indicates that in 2011/2012, 688.02 billion will be required to recruit a sufficient number of health workers as per the current staffing norms. The health sector BFP indicates there are plans to recruit an additional 1000 health workers in 2011/2012 but requires an additional 1.8 billion.
Proposal: CSOs cognizant of the constrained resources recommend the recruitment of at least 5000 staff in the next financial year (FY 2011/2012). The cadres to be recruited would comprise mainly qualified health workers i.e. doctors, midwives, nurses and allied health professionals. According to the Human Resources for Health Recruitment plan, this translates in a total wage need of 34 billion and 2 billion to cater for recruitment costs incurred by the DSCs. it would be cost effective to allocate 2 billion to recruit 5000 than 1.8 billion to recruit 1000 health workers. Currently the health sector wage bill is 178.07 bn and increase of this by 34bn would bring the total sector wage bill to 212.07 bn. In order to retain existing healthworkers, and to attract skilled applicants to the positions, we propose additional motivation and retention packages in the form of increasing the DFA based on performance for all cadres of health workers from a minimum of 45,000/- and 90,000/ to 200,000/= and 400,000/- respectively.
If this is done the staffing level would move to 65% and if the trend is continued in subsequent years the NDP target of 85% staffing level would be met by 2014/2015 and subsequently this would have a positive effect on the national development goals. Payment of increased DFA based on performance will have a positive effect on motivation, and increase the capacity of the health system to retain all cadres of qualified health workers.
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