Health Workers’ Pay Increase Fails to Curb Absenteeism in Uganda’s Hospitals

Mulago Hospital - Health Workers' Pay Increase Fails to Curb Absenteeism in Uganda's Hospitals
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Despite a significant pay increase for health workers in public facilities, the impact on their commitment to work and overall output remains limited, as reported on Tuesday, October 17, 2023.

A year after the implementation of the presidential directive to raise salaries, legislators and government officials have identified chronic absenteeism as an ongoing issue. Some consultants, despite receiving an increased monthly salary of Shs12 million, only show up for work eight days a month, compared to the previous Shs6 million monthly wage.

Ms. Margaret Ayebare Rwebyambu, a member of the Parliamentary Health Committee, emphasized the urgency of addressing absenteeism in public facilities to enhance patient access to care.

Legislators also raised concerns about consultants occasionally shifting their work to private hospitals. Dr. Jolly Nankunda, a consultant pediatrician and deputy director of the Mulago Specialized Women and Neonatal Hospital, explained they have deployed officers to monitor consultants and specialists to ensure consistent service to patients.

Dr. Henry Mwebesa, the Director General of health services at the Ministry of Health, reported a case where a consultant worked only on Wednesdays and Saturdays. Interns sought guidance via phone, adding to the delays in patient care.

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Research indicates that absenteeism, previously attributed to low pay, deprives patients of their right to accessible care, often forcing them to resort to drug shops and clinics providing substandard care.

The Health Ministry disclosed that absenteeism, including both authorized and unauthorized absences, averages at 50 percent in public health facilities. The inadequate engagement of the health workforce, characterized by a high rate of authorized absenteeism at 38 percent, undermines motivation and productivity. The ministry identified an ineffective performance management system, weak leadership, insufficient supervision and support, and a feeble onboarding system as contributing factors.

To combat absenteeism, the ministry proposed scaling up absenteeism tracking and reporting at all levels, linking attendance to individual outputs and results, and instituting measures linking pay to attendance and performance.

Combined with low staffing, the absenteeism of medical staff results in longer patient wait times. The health workforce density of 1.6 per 1,000 falls below the World Health Organization (WHO) threshold for Universal Health Coverage (UHC). If 38 percent of health workers are absent, on average, only about 46 percent of the health workers in employment are present at health facilities. This further impacts the availability of the health workforce.

Patients at Mulago Specialized Women and Neonatal Hospital expressed concerns about extended waiting times, though the cause was not independently verified. While the quality of services appeared good, patients reported delays in being served.

Dr. Rosemary Byanyima, acting executive director of Mulago Hospital, stated that they closely monitor consultants to ensure the delivery of services. The hospital, renowned for its specialists, continues to encourage clinical work and research outcomes from their staff.

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