The Uganda Med­ical In­tern ques­tion

By: Winnie Watera

The scene of strik­ing pub­lic ser­vants is not a rare oc­cur­rence es­pe­cially by those in the ed­u­ca­tion and health sec­tor. How­ever, with band aid promises, that con­tinue to plague the sec­tors calm re­turns only to re­sume amid the un­ful­filled promises.  31st Au­gust was no dif­fer­ent, af­ter pleas by prospec­tive in­terns fell on deaf ears, they took to the streets and ended up at the Par­lia­ment CHOGM grounds in an at­tempt to meet the Speaker, who was un­for­tu­nately away on busi­ness. Well, the in­terns had quite a num­ber of things to say.  High on the agenda was ‘No to the pro­posed pre-in­tern­ship exam, no to the bondage by gov­ern­ment af­ter com­ple­tion, in­crease in pay­ment to UGX 1.2 mil­lion up from 600,000…’ Con­trary to their de­mands, the in­terns vowed to carry out mass in­dus­trial ac­tion.

Every in­di­vid­ual has the hu­man right to health; the right to the high­est at­tain­able stan­dard of phys­i­cal and men­tal health, which in­cludes ac­cess to all med­ical ser­vices, san­i­ta­tion e.t.c.  Med­ical per­son­nel in their ca­pac­ity also have their labour rights or work­ers’ rights. So, this begs the ques­tion : where do we draw the del­i­cate bal­ance to en­sure all par­ties fully en­joy their rights?

To put this into per­spec­tive, here are some rel­e­vant facts about Ugan­da’s health sec­tor. The coun­try is ranked 186th out of 191 na­tions as hav­ing the worst health care, only 38% of health­care posts are filled in Uganda, 70% of Ugan­dan doc­tors and 40% of nurses and mid­wives are based in ur­ban ar­eas, serv­ing only 12% of the Ugan­dan pop­u­la­tion, and the med­ical per­son­nel in gov­ern­ment hos­pi­tals are one of the worst re­mu­ner­ated. With all this, one can’t help but won­der what doom looms over Ugan­dans who can­not ac­cess med­ical care, em­pha­sis on the 80% dwelling in rural ar­eas or the 19.5% that live be­low the poverty line.

Bond­ing in­fringes on the in­terns’ rights, the right to choose where and where not to work, the lat­ter in this case is ob­vi­ously gov­ern­ment run fa­cil­i­ties which are marred with the generic im­ped­i­ments, of no or late pay, long work hours, poor con­di­tions. Med­ical stu­dents on gov­ern­ment are ben­e­fi­cia­ries from a cross­cut­ting gov­ern­ment pol­icy one that re­wards stu­dents, who have ex­celled at Uni­ver­sity.  Why then is bond­ing tai­lored for only med­ical in­terns?

Con­tin­u­a­tion of such ten­den­cies has only ex­ac­er­bated by gov­ern­men­t’s re­luc­tance to di­a­logue as equal part­ners with the ag­grieved par­ties does not, in any­way ben­e­fit the com­mon man. From a moral­ist point of view I tend to em­pathize with the Ugan­dan that is the most down trod­den in this sce­nario cog­nizant of the fact that the gov­ern­ment of­fi­cials that make these poli­cies re­ceive their health care from pri­vate lo­cal fa­cil­i­ties or abroad with the very tax­pay­er’s money, a tax payer whose only op­tion is that run­down fa­cil­ity.  Then again, I strug­gle with logic that the doc­tors need to get paid, and re­ally well be­cause of the kind of work and en­vi­ron­ment within which they work.

The court in­terim or­der block­ing the new poli­cies comes at a time when both in­terns and the gen­eral pub­lic are des­per­ate for a so­lu­tion. How­ever, for ei­ther party to en­joy their rights gov­ern­ment ought to re­think its strate­gies on solv­ing health sec­tor is­sues like the doc­tor short­ages, ac­cess to hard to reach ar­eas, con­stant brain drain.