Building Uganda's Health Workforce: Urgent Reforms in Education, Regulation, and Migration

Uganda urgently needs reforms in health worker education, regulation, and migration management, focusing on competency-based training and stronger oversight to address workforce shortages and improve healthcare delivery. Strengthening international partnerships and ethical recruitment practices will be key to building a resilient healthcare system.

A recent policy brief from the World Health Organization’s African Region (WHO-AFRO), prepared by Sunny C. Okoroafor, James Avoka Asamani, Paul Marsden, Giorgio Cometto, and Yonas Tegegn Woldemariam, highlights the urgent need for Uganda to improve the management and regulation of its health workforce, particularly in the areas of education, practice, and migration. Uganda’s healthcare system is critical for achieving the Sustainable Development Goals (SDGs), but the current state of health worker education and management is insufficient to meet the country's needs. The brief emphasizes the importance of competency-based education, which integrates knowledge, skills, and attitudes necessary for effective health service delivery, and advocates for comprehensive reforms to build a health workforce fit for purpose and practice. The country’s health workers need to be trained using curricula that reflect Uganda’s specific health system needs, informed by local epidemiology, mortality, morbidity, and emergency risk assessments. A more robust and strategically developed workforce is vital for improving individual and population health, managing the health sector more efficiently, and ensuring that Uganda can respond to health challenges, including public health emergencies like COVID-19 and Ebola.

Private Ownership Challenges in Health Training Institutions

Uganda’s health workforce faces several obstacles, including the dominance of private entities in the education sector, which controls about 78% of health training institutions. Out of 210 health training institutions, 133 are privately run, 47 are private non-profit, and only 30 are government-owned. This distribution highlights the challenges in ensuring consistent education standards across public and private sectors, necessitating stronger regulation and coordination between the Ministry of Education and Sports, which oversees health workforce education, and the Ministry of Health, responsible for the certification and licensing of healthcare workers. Effective regulation is crucial for ensuring that health workers are adequately trained, certified, and licensed, adhering to ethical guidelines and standards of care. However, Uganda’s regulatory bodies are currently struggling due to a lack of resources and weak enforcement mechanisms, resulting in gaps in health worker registration and licensure, particularly in the private sector. The absence of a mandatory system to track the movement and practice status of health workers hinders the country's ability to plan and manage its workforce effectively.

Brain Drain Undermining Health Coverage

One of the most pressing concerns is the emigration of health workers, commonly known as brain drain. Many healthcare professionals in Uganda seek better employment opportunities abroad due to the limited availability of jobs, poor remuneration, and inadequate working conditions within the country. This migration undermines Uganda's ability to achieve universal health coverage (UHC) and creates a gap between the supply of and demand for healthcare services. The policy brief points out that Uganda has been included in the WHO’s 2023 support and safeguards list, which seeks to protect countries from active international recruitment and promote ethical practices in the recruitment of health workers. The WHO’s Global Code of Practice on the International Recruitment of Health Personnel, adopted in 2010, serves as a framework for ethical recruitment and encourages countries to develop bilateral agreements to manage health worker migration more effectively. For Uganda, these agreements could help the country negotiate better terms with destination countries and ensure that the migration of health workers does not negatively impact its national health workforce development.

Tracking Health Worker Migration and Employment

The lack of a strong tracking system for health worker migration exacerbates the problem, as there is currently no clear data on the number of healthcare professionals leaving the country. This situation complicates workforce planning and limits the government’s ability to make informed decisions regarding health worker education and employment. The Uganda Health Labour Market Analysis reveals that the country’s supply of health workers already exceeds the number of available jobs, and this mismatch is likely to worsen unless steps are taken to expand the financial capacity of the health sector and create more employment opportunities.

Urgent Reforms for Competency-Based Education

To address these challenges, the policy brief calls for several key reforms, starting with the adoption of competency-based education. By aligning health worker training with the specific needs of the Ugandan health system, such as its disease burden, morbidity, and mortality patterns, and emergency preparedness requirements, Uganda can ensure that its health workforce is equipped with the necessary skills and knowledge. In addition, strengthening regulatory frameworks to enforce mandatory registration and licensure of all health workers is critical. This includes regular renewal of practicing licenses and systematic tracking of healthcare professionals’ migration to monitor the movement of talent within and outside the country. Improved regulation would also help to safeguard patient safety and ensure that health workers adhere to ethical standards of care.

The policy brief also emphasizes the importance of strengthening oversight across both public and private sectors to ensure that health worker education is consistently aligned with national health priorities. Increased collaboration between the Ministry of Health, Ministry of Education and Sports, and other stakeholders is essential for achieving these goals. Moreover, Uganda should consider entering into bilateral health worker mobility agreements with destination countries to negotiate better deals for workforce development and health system strengthening. These agreements could provide a framework for ensuring that migration does not lead to a loss of critical health workers while also creating opportunities for knowledge exchange and skills development.

Uganda’s healthcare system needs urgent reforms to address the challenges in health worker education, regulation, and migration. Competency-based education, stronger regulatory oversight, and strategic partnerships with international stakeholders will be essential to ensure that Uganda can build a resilient, fit-for-purpose health workforce capable of meeting the nation’s health needs and achieving its long-term health goals.