Strengthening Uganda’s Healthcare System: Addressing Workforce Gaps through Education

A WHO policy brief calls for Uganda to reform its health worker education, regulation, and migration management through competency-based training, improved oversight, and bilateral agreements to address brain drain and workforce planning. These changes aim to strengthen the healthcare system and improve patient outcomes.

A new policy brief, prepared by researchers from the World Health Organization’s African Region (WHO AFRO) team, including Sunny C. Okoroafor, James Avoka Asamani, Paul Marsden, Giorgio Cometto, and Yonas Tegegn Woldemariam, highlights the critical need for reforms in Uganda's health worker education, regulation, and migration management. These reforms are essential to strengthening Uganda's healthcare workforce and improving health outcomes. The brief emphasizes that the current approach to health worker education, which is often disconnected from the realities of the healthcare system's needs, must evolve into a competency-based model. Competency-based education ensures that health workers are trained in line with national health priorities, focusing on essential service packages, mortality and morbidity trends, and emergency risk assessments. By doing so, the country can build a workforce that is not only fit for purpose but also adaptable to emerging health challenges. Such a transformation is seen as critical to Uganda’s efforts to achieve the health-related Sustainable Development Goals (SDGs) and improve the overall quality of healthcare delivery.

Uganda's Workforce Management Challenges

Currently, Uganda’s health workforce faces multiple challenges, particularly in terms of regulatory oversight and workforce management. While the Ministry of Education and Sports manages health worker education, the Ministry of Health and professional regulatory councils are responsible for the regulation of practice. However, these bodies operate in silos, and there is insufficient coordination between them. This has led to gaps in the registration and tracking of health workers, particularly those in the private sector, which accounts for 78% of health training institutions in the country. Without effective systems for tracking health workers' career trajectories, especially in terms of their migration and attrition, it becomes challenging to plan for the country’s health workforce needs accurately. The brief calls for stronger legal frameworks to guide the registration, tracking, and licensure renewal of health workers. Ensuring that health workers meet continuous professional development requirements and adhere to quality standards is essential for providing safe and effective care.

Addressing the Health Worker Brain Drain

One of the most pressing concerns raised by the policy brief is the issue of health worker migration, commonly referred to as “brain drain.” Uganda has been significantly affected by the emigration of its health workforce to countries that offer better pay and working conditions. However, the current mechanisms for monitoring and managing this migration are weak. The WHO Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, provides guidelines for ethical recruitment, yet Uganda has struggled to implement these principles effectively. The lack of reliable data on health worker migration makes it difficult to measure the true extent of brain drain and hampers efforts to address the issue. To mitigate the impact of health worker migration, the brief recommends that Uganda enter into bilateral agreements with destination countries. These agreements would allow Uganda to negotiate better terms for health worker mobility, ensuring that international recruitment does not undermine its healthcare system. Additionally, such agreements could be structured to support national workforce development by requiring destination countries to contribute to the training and capacity-building of health workers in Uganda. These partnerships could also help ensure that health workers who choose to migrate do so under conditions that respect their rights and contribute to both their personal development and the strengthening of Uganda’s health system.

Aligning Training with Uganda’s Health Needs

The policy brief also points to the importance of aligning health worker training with Uganda's specific healthcare needs. Uganda's health system is heavily burdened by communicable diseases such as HIV/AIDS, malaria, and tuberculosis, as well as non-communicable diseases that are on the rise. Training programs must be designed to equip health workers with the skills needed to address these diseases, as well as emerging public health threats like Ebola and COVID-19. The current curricula in many of Uganda’s health training institutions are outdated and fail to reflect the changing epidemiological landscape. The brief argues that competency-based education, which integrates knowledge, skills, and attitudes, is the most effective approach to preparing health workers for practice in such a dynamic environment. This approach ensures that health workers are not only technically competent but also capable of delivering people-centered, integrated healthcare that meets the needs of Uganda’s diverse population.

Strengthening Regulation in Private Training Institutions

Moreover, the document emphasizes the need for greater regulation and oversight of both public and private health training institutions. With a majority of these institutions privately owned, there are significant disparities in the quality of education provided. The brief calls for more rigorous standards to ensure that all institutions, regardless of ownership, are held accountable for the quality of their graduates. This would involve regular assessments of curricula, faculty qualifications, and training facilities to ensure that they meet national and international standards. Strengthening oversight mechanisms would also help ensure that Uganda produces a workforce that is adequately prepared to address the country’s health challenges.

Enhancing Workforce Planning Through Coordination

Finally, the policy brief outlines several key recommendations for policymakers. It urges the government to improve coordination between the Ministry of Education and the Ministry of Health to ensure that health worker education, regulation, and migration management are aligned. It also calls for the development of a robust system for registering and tracking all health workers, regardless of their sector of employment, and for enforcing the renewal of practice licenses. By addressing these challenges, Uganda can strengthen its health workforce and make significant strides towards achieving the SDGs, improving healthcare delivery, and ensuring that its population has access to high-quality, equitable, and integrated health services.