Government scheme sparks brain drain controversy in Uganda

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The decision by Uganda to send nearly 300 medical professionals the Caribbean has sparked a controversy that extends beyond the East African nation. Belgium says it will make cuts to the €11 million in aid it sends to Uganda. The United States has criticized the plan, as has Human Rights Watch, and activists in Uganda.

All say it is a form of state-sanctioned “brain drain.”

An advertisement posted by the Ugandan government in 2014 offered jobs for 283 health workers in the Caribbean country of Trinidad and Tobago. It quickly sparked controversy as people noted that Uganda’s 1 doctor per 24,725 people is below the guidelines set by the World Health Organization, and much worse than the 12 doctors per 10,000 people in Trinidad.

Ugandan government officials defended the program by saying it supported bilateral relations with the country. It also provides earning opportunities that allow expat medical professionals to send money home through remittances that then is taxed and spent in Uganda. The Institute of Public Policy and Research (IPPR), a Ugandan think tank, was not convinced. It launched a lawsuit to stop the practice.

“While the government is bent on exporting health workers, thousands of Ugandans are dying daily. Sixteen women die daily giving birth, but the government can’t see that as problematic. This [Ugandan case] is going to set precedents on the continent. We want governments to know that it is their responsibility to retain key professionals,” said IPPR Executive Director Justinian Kateera, to the Guardian in Feburary.

The IPPR argues that the government’s recruitment of health workers is a violation of the constitution by limiting access to health care. It hopes a court injunction will stop the program in its tracks and allow for a legal case against the government to proceed. Kateera is not alone. Janet Obuni, president of the Uganda Nurses and Midwives Union, also expressed concerns about the effects of sending away trained health workers on health care in Uganda.

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“We find it very unfortunate that the government that would take a step or decision to export its health workers to, as we said, a very small country that is very rich and that has even more health workers for its population,” she said to Voice of America. “I know the government is trying to fix the issue of not paying health workers well, by sending them out so that the health workers can be settled, because out there they will earn more money. What about the population here?”

The issue of “brain drain” has come under some scrutiny in the past few years. Rights-based arguments say that people should have the ability to seek out the best opportunities possible. For skilled health workers in Uganda, it is likely that there are better paying opportunities in other countries.

For Michael Clemens of the Center for Global Development and David McKenzie of the World Bank, it is also an issue of evidence that “brain drain” is not actually bad. The two posited that the idea of allowing the immigration of health workers increases makes the line of work more attractive, leading to more health workers who cannot all leave the country. The Philippines, for example, is cited as a place where it sends more nurses abroad that anywhere else, yet it has more nurses per capita that Britain.

“The level of medical care provided by doctors in Africa depends on a vast array of factors that have little or nothing to do with international movement — such as scant wages in the public health service, poor or absent rural service incentives, few other performance incentives of any kind, a lack of adequate medical supplies and pharmaceuticals, a mismatch between medical training and the health problems of the poorest, weak transportation infrastructure, or abysmal sanitation systems,” wrote Clemens and McKenzie in Foreign Policy.

The crux of the problem is the active involvement of the Ugandan government in sending health workers to Trinidad. It is the focal point for IPPR’s complaint. And Human Rights Watch’s Maria Burnett agrees.

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“Clearly, health workers should be able to work where they choose. But the question remains, should the government be spending money to facilitate the recruitment of its skilled health workers abroad, a move that could undermine the possibility of achieving positive health outcomes for all Ugandans?” she asks in a recent blog post.

Looking at the professionals who have applied so far, 20 were radiologists. Uganda only has 28 registered in the country. Losing such a large portion of an already-small cohort of skilled doctors is a concerning possibility for Uganda. Upping its budgetary allocation for health care from 8 percent to the Abuja declaration target of 15 percent may help address the problem.

One nurse told the AFP that she is paid $245 per month. It is expected that if she goes to Trinidad that she cannot only get paid significantly more, but she will have other benefits that will allow her to send more money back home.

“We are underpaid, we have a lot of patients and few personnel,” Obin told AFP.

She wants to stay, but applied to go to Trinidad to make a better life.

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Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]humanosphere.org.