Medical Brain Drain in Uganda, a Growing Disease of the Debtor

By Robert Kyomuhendo

Ugandan medical professionals continue to leave the country because of failure of the government to address their concerns while certain groups remaining behind continue to lay down tools, demonstrating for health sector prioritisation in the country. This has left the country in a dire health crisis with high death rates.

Senior house officers (SHOs) deployed for specialist training at various hospitals across the country declared a nationwide strike over salary arrears; this started on 20th February, 2023 and has continued for over two months.  On the other hand, graduate doctors waiting for internship deployment continue to face delays which have gone over a month, due to financial incapacity of the government, resulting in them staging a similar strike.

Medical brain drain which Mr. Twinomugisha Ali, the President of the Federation of Uganda Medical Students Association (FUMSA) defines as a phenomenon where medical personnel export their skills and acumen to other countries for the purpose of seeking greener pastures, arises from multiple factors which include low salary, uncompetitive benefits, heavy workload with no allowances, poor medical supplies and absence of machinery to carry out ideal practice. Dr. Kisambira Jauhar Zubair, the General Secretary of the society of Uganda Private Medical Practitioners also emphasised that poor payment schemes for health workers is one of the push factors. ‘The growing Uganda's debt has negatively impacted the economy and that hinders the affordability for alternative private healthcare that complement public health services,’ he added. 

The independent 2022 reported that according to provisional figures at the Bank of Uganda up to the month of October 2021, Uganda’s public debt had risen to about 20.8 billion US dollars, with 62% attributed to the total external debt exposure, for which budget support inflows are from multilateral creditors such as the World Bank’s International Development Association. Noteworthy, according to the article, Dying for Economic growth by Okuonzi, S.A, Uganda’s economic growth succeeds upon an economic policy, which extols export-oriented private-sector investment, requiring that public expenditure particularly for social services gets highly restricted while abandoning any social-welfare targets. In Dr. Kisambira’s view, the checks and balances of social welfare are determined by the creditors with how the loan is spent.

According to Makokha, K.A. (2000), in 1981, Uganda experienced the first introduction of Structural adjustment programs (SAPs) whose active implementation took effect from 1992 to present time. These are policies orchestrated by the major international lenders – the International Monetary Fund and World Bank – in which conditions are attached to loans to indebted and impoverished countries. However, according to Simon, D. (2009), long-term economic recovery programs later got incorporated with an aim of restructuring and revitalising the economies through extensive liberalisation and privatisation, diversification of exports, and the like. 

According to Mr. Twinomugisha, SAPs are generated to boost the economy and eradicate poverty. ‘At one end these create free markets, selling exports at cheap prices dictated by the government so as to clear the debts. In addition taxes are slapped on the locals whereas foreign investors are given tax holidays predisposing the nation to inflation,’ he added. 

It is therefore explicit to note that there are gaps in meeting healthcare needs at the expense of economic progress. As reported by the independent socialist magazine by Waitzkin, H., & Jasso-Aguilar, R (2015, August 7), we realise connections among imperialism, public health and health services, whose key mediators have no interest in broadly advancing the healthcare systems of Africa, but promoting vertical programs targeting specific areas of the creditor.

Thus we see the broken down healthcare systems across Africa and specifically in Uganda which is leading to medical brain drain in the country which is further exacerbating the healthcare crisis.