Urgently fill the key technical positions at the Ministry of Health,

There is saying that when the elephants fight, the grass suffers. I am writing to express concern about the prolonged delays in filling key technical leadership positions at the Ministry of Health (MoH). When there are leadership gaps, the health system and ultimately health consumers suffer. According to the World Health Organisation, “A health system is the sum total of all the organizations, institutions and resources whose primary purpose is to improve health.” A health system needs not only staff, funds, information, supplies, transport, communications but also overall guidance and direction from people with key technical expertise. The MoH in Uganda has not had a Permanent Secretary (PS) since 2009 and Director General of Health Services (DGHS) since early 2010. When Ms. Nanono was suspended from the position of Permanent Secretary in 2009, the DGHS was appointed to act as the PS. When the then DGHS retired in early 2010, the Director, Clinical and Community Services (C& C), Dr. Nathan Kenyamugisha was appointed to act as both the DGHS and the PS. This went on for about eight months. Then the position of Deputy PS was created in late 2010 and Dr. Lukwago Asuman was appointed to fill this position and to act as the PS. However, the position of DGHS was never been filled and the Director (C & C) has been acting in this position for over 12 months as well as filing his own position. Dr. Kenyamugisha (with all due respect) is expected to handle the job of the DGHS in an acting position efficiently for prolonged periods of time yet this amounts to work overload if he is still the Director (C & C). The Ministry of Health has suffered a technical leadership gap for far too long. Yet, the political leadership is filled with three ministers and a presidential adviser on health. Additionally, there is a parallel monitoring system in the names of Medicines and Health Services Delivery Monitoring Unit under the Office of the President which is performing the work which should partly be done by the health professional councils and support supervision by MoH officials.
No explanation has been provided why these key positions have not been filled and why the positions of PS and DGHS have to be filled by acting persons for over 12 months. Are there no competent people for these positions? To appoint someone in an acting position should be a temporary solution while steps are being taken to fill the position permanently. The professional councils and the support supervision system need to be strengthened instead of creating parallel structures and increasing costs of public expenditure. The concern authorities should take steps to appoint competent persons to these positions instead of increasing the number of political appointees. We need a strong ministry of health with competent leadership to provide overall guidance and direction in order to improve health outcomes.