“…I hear some people saying that I am their servant; I am not
a servant of anybody. I am a freedom fighter; that is why I do what I do. I
don’t do it because I am your servant; I am not your servant. I am just a
freedom fighter; I am fighting for myself, for my beliefs; that’s how I come
in. If anybody thinks you gave me a job, he is deceiving himself…”
But he that is greatest among you shall
be your servant.(Matthew 23:11)
But he that is greatest among you shall
be your servant.(Matthew 23:11)
But he that is greatest among you shall be
your servant.(Matthew 23:11)
When health is not a human right in
Neo-liberal Uganda : Uganda Doctors go on strike leaving patients stranded :
When a senior Ugandan consultant doctor earns about Shs 3.4 million, consultant
Shs 2.6 million, and a medical officer Shs 1.1 million as a Member of
Parliament earns over 24 million
Written by ALON MWESIGWA, BAKER BATTE LULE & ZURAH NAKABUGO
says it has one option now: sack the striking health workers and hire
new ones. But that option is not that easy or cheap either.
An analysis by The Observer shows it
would be the expensive option that would cause irreparable damage to an
already seriously sick sector given what knowledgeable observers say.
President Museveni said last week that he was ready to hire new health
workers if those on strike don’t go back to work.
The president did not say from where
though, and even his promised army replacement doctors are yet to report
for duty at public hospitals. There are about 1,000 health workers on
strike under the auspices of the Uganda Medical Association. Ivan
Engoru, a labour law don at Makerere University, said withdrawing labour
has got both international and national dimensions.
“In the international dimension, we are
talking about the legal framework with the International Labour
Organisation (ILO) which sets standards for labour-related matters. Then
locally, we have the Constitution that has provisions that deal with
economic rights, the Employment Act and the Labour Union Act,” Engoru
“But engagement in labour is generally
treated as a private matter that two parties can agree; that one is
providing labour and the other hiring pays for the labour. That, in
effect, gives the person who is giving the labour the right to withdraw
it,” he added.
This is exactly what the doctors did.
Government must either meet their demands or decide that it no longer
needs them and, therefore, hires other professionals. Is it a feasible
idea? It comes at a huge cost – bigger than meeting the current demands.
First, according to a doctor familiar
with the sector, Uganda’s health sector is already short of the health
workers needed for it to function well.
Uganda’s doctor-to-patient ratio is
estimated at 1:25,725, with a nurse to patient ratio of 1:11,000. The
World Health Organisation (WHO) recommends one physician per 1,000
people. Uganda needs to hire more doctors instead of firing the few in
“A patient comes to a hospital and there
is just one health worker. He/she has to attend to the children, the
expectant mothers. That’s the reality. That’s how our public hospitals
run,” a health worker told us.
Another cost is in terms of experience
that would be lost if these health workers are let go. Uganda Medical
Association (UMA) accounts for most of the senior professionals Uganda
has. For instance, the association has 712 of the 1,300 doctors in
public service. At least 152 of them are senior consultants, with
another 171 being senior house officers.
“We analyzed the deficit of doctors and
found that about 50 per cent of the established posts aren’t filled in
our [public] hospitals. There is still room to recruit another 1,000
doctors to deploy in hospitals like Kabale Regional hospital which has
six doctors out of the recommended 20,” one doctor told The Observer.
The second cost would be lost trust in government on health workers’ job security.
“If you fired my predecessor for
demanding better working conditions, how sure am I that you will not
humiliate me with ease?” another doctor said.
There is also a cost to the taxpayers.
Uganda currently spends at least Shs 70 million to train a doctor.
Firing at least 1,000 and denying Ugandans an opportunity of getting
services from them means the country will lose at least Shs 70 billion
in the money that was spent to train them, according to one analyst.
When let go, more doctors will seek
greener pastures in the neighbouring countries where they are on high
demand. Another loss could stem from potential mass class action
lawsuits filed against the government for wrongful dismissal.
Another health worker said: “We have
consulted our lawyers and they advised us that industrial action is
justified if the safety of the worker is at risk. Doctors were exposed
to various occupational risks hence triggering the strike. Summary
dismissal from employment during a strike is contrary to the law hence
it is likely attract litigation.”
Engoru said ILO rules give workers
rights to association and the right to collective bargaining. In the
same instrument, is embedded obligations on the part of an ILO member
state not to victimize or discriminate against any employees on the
basis of their participation in an industrial action.
Then there is the extremely high human
cost. A lot of ordinary people are losing their lives from treatable
diseases because there are either no health workers or essential
supplies in hospitals. From Kiruddu to Jinja to Masaka, there have been
people claiming their loved ones died after they found no one to take
care of them at the hospitals.
When The Observer visited several
hospitals on Saturday, skeleton staff attending to emergency cases said
they were also withdrawing their labour to let the army do the work.
Museveni said last week that he would deploy the army, police, and
prisons doctors to work in public hospitals.
But these institutions can only deploy
less than 50 medical doctors, a hopelessly inadequate number. At Kawempe
General Referral Hospital and Naguru’s China-Uganda Friendship
hospital, by Saturday, there were no army doctors or nurses in sight.
Kawempe offers vital gynaecology and
obstetrics services and treatment of cervical cancer. On average, the
hospital receives 100 patients daily, mainly mothers who come to give
Hadijah Namugala, a patient who was
found outside the postnatal ward, had waited for a security guard for
over two hours to stamp her discharge letter. She said medical workers
discharged her and told her that they were stopping to work on Saturday
to allow the army take over.
“But I haven’t seen any army doctor or
nurse around the ward since I was admitted here on Sunday (Nov 12) to
give birth. I was referred from Kasangati Health Centre because my high
blood pressure was not stabilizing and I needed specialised doctors to
help me deliver,” she said.
“Of course when I reached, they kept me
waiting and didn’t work on me that day. The following day when I gave
the nurses Shs 100,000, they took me to the theatre and I was operated
very fast. I gave birth to a baby boy,” she said.
Namugala, like many Ugandans, said she
had been buying drugs from the pharmacies outside the hospital and also
paid nurses Shs 10,000 to administer the drugs until she was discharged
“Even removing the catheter, which is
the bag that collects urine after operation, you pay Shs 5,000 to
nurses. If you don’t, you remain with it. So, government should help us
address the doctor’s problems because people are going to die,” she
The doctors and nurses who didn’t want
to disclose their names at Kawempe General hospital said they are all
going to lay down their tools by Sunday to let army doctors and nurses
to take over since government failed to address their problems.
Dr Ekwaro Obuku, the UMA president that spearheading the strike, said government should not bury its head in the sand.
“There should be efforts to sidestep legalese and instead look at the legitimate issues that are being raised,” he said.
“Government, for example, has an issue
when it says it has no money. I think also having a comprehensive review
of the salaries of all public servants is a good thing so that you
don’t sort this group then the other comes up. But in the interim, there
must also be identification of critical issues raised by the doctors so
that they are worked on and the rest await the outcome of the committee
on salary review.”
Jane Ruth Aceng, the Health minister,
told The Observer on Saturday: “I have nothing else to discuss on the
subject just wait for a communication from the prime minister.”
Museveni is a very condescending man. At times, he treats citizens like a
herd of cattle receiving whistling commands to move to where the master
He brooks no opposition, especially from
those he considers younger than him. He believes he never makes
mistakes; it’s the people below him that flounder.
In 2006, while addressing Movement
supporters who had turned up at Kololo ceremonial grounds to celebrate
20 years of Uganda’s liberation by National Resistance Army (NRA),
Museveni seemed surprised that NRM had been infiltrated by corrupt
He promised to fight corruption head-on
using guerilla tactics. We are still waiting for those tactics.
Corruption is one of the reasons doctors are striking today.
Still in 2006, I had an exclusive
interview with Museveni and asked him whether – as a person and
president for 20 years – he had made some mistakes. In his
characteristic way of rolling his eyes and beaming up his face, the
president told me that it was only NRM which had made mistakes, and it
was only him who corrected them!
He is never devastated because he is visionary and revolutionary. Revolutionaries are not amenable to such romanticism.
It is important also to remember that
even if the president has gone through several elections during which he
asked the citizen to trust him with the votes in order to serve them
better, he declared early this year in Masindi that he is not anyone’s
“…I hear some people saying that I am
their servant; I am not a servant of anybody. I am a freedom fighter;
that is why I do what I do. I don’t do it because I am your servant; I
am not your servant. I am just a freedom fighter; I am fighting for
myself, for my beliefs; that’s how I come in. If anybody thinks you gave
me a job, he is deceiving himself…”
That is how Museveni holds himself!
So, the striking doctors should remember that the visionary is not their servant and he will deal with them as he wishes.
He has already threatened to fire them
and replace them with those willing to work for the abysmal pay and
dreadful working conditions.
Ironically, the president claims he went
to the bush to fight for better working conditions of all Ugandans. The
working conditions were not good for politicians because the ground was
not level; there was no forum to express dissatisfaction with the
government’s delivery of service.
The president is not used to being in a
poor bargaining position; in fact, he never bargains: he commands,
orders and arbitrarily decides for whoever comes for a bargain.
But the president should not take the
doctors’ strike as an affront on his person. He should take it in good
stead, drop his arrogance and listen to them.
The doctors are not asking him to divert
his personal fortune to improve working conditions in public hospitals
and health centres. They are only saying that the country’s resources
could be organized in such a way that their pay and working conditions
Remember, Mr President, that during the
presidential campaigns, you presented yourself as the best top servant
of this country. You are not expected to take offence when Ugandans
mount pressure on you to deliver those promises.
You are not expected to take umbrage
when Ugandans remind you to organise the country according to the law
and Constitution. Even if you deny being our employee, the fact that you
contested for the top job in the country and won it makes you our
Through the taxes, Ugandans have improved your working conditions. You are better housed. You earn a tax-free salary.
You are the only person who cannot be
sued or prosecuted in the competent court of criminal or administrative
jurisdiction while serving as president.
You are the only Ugandan with a fully
maintained jet at your disposal. You are the only Ugandan with authority
to assent to any piece of law. You are the only Ugandan entrusted with
security of this country.
We cannot all defend ourselves against
internal and external enemies, but that duty was bestowed on you. You
are the most protected person in the country. And all this is borne by
the taxpayers to ensure that you have no excuse whatsoever for not doing
If Uganda were a limited liability
company, as the chief executive, you would be expected to account to
shareholders annually and prove to them that you still merit that job.
Well, Ugandans can only ask you to account after every five years.
Whereas, Mr President, you have powers
to sack the striking doctors through your other agents, this should be
handled with caution.
You ought to remember that a doctor’s
job is not like that of a nut fixer, who only needs a screwdriver and
spanners to turn the nuts. Just like in the army, one cannot rely on
mercenaries to achieve a country’s strategic security concerns.
So, don’t think of deploying mercenary
doctors. They can’t be relied upon. Kindly listen to the doctors and
save the country and yourself from embarrassment.