I could begin every blog talking about the many countries, like Uganda, that find it challenging to  build and maintain the kind of health workforce needed to deliver high-quality health services, particularly when faced with inadequate funding for human resources for health. These challenges can lead to health worker dissatisfaction, attrition, and absenteeism and is exacerbated by not enough of the right skill sets among health workers or by poor geographic distribution of those skills. But what I want to focus on today is what countries are actually doing to respond to these challenges, employ more staff, improve the workplace, and create strong leadership and management in the health sector.

The Uganda Capacity Program has been collaborating with civil society organizations—including Group for Health Human Rights and HIV/AIDS, Uganda National Health Consumers Organization, Health Global Access Project, and many others—to advocate for more funding to support higher health worker salaries and to hire more health workers in Uganda to provide +much-needed health services.

By the most recent estimates, Uganda currently has 58,899 health professionals registered with the health professional councils: 31,675 nurses; 13,075 allied health professionals; 10,491 midwives; and 3,658 medical doctors or dentists. It might sound like a lot of health workers, but it is not enough to serve a population of 33 million people.

The Health Sector Strategic and Investment Plan has set the goal of growing the number of health workers to meet at least 65% of the national need, from its current level of 56%. To do this, the country needs about 5,000 additional health workers. Nurses, midwives, and clinical officers are in particularly high demand to care for the overwhelming number of patients in local health facilities in rural areas. The cost of recruiting and paying the salaries of 5,000 new health workers for one year is estimated at about $16.5 million USD or 43 billion Ugandan shillings.

In collaboration with other civil society organizations and the budget officer of Parliament’s budget committee, the Uganda Capacity Program successfully advocated for the reallocation of these funds from other areas of the health sector budget. The civil society organizations have also asked Parliament to allocate additional funds to cover the district recruitment process this year. The advocacy in Parliament is also being reinforced with local work on a district-by-district basis. For example, last week staff from the Uganda Capacity Program met with political leaders* at the Kamuli Youth Centre in the Kamuli District to discuss the need to allocate more resources for human resources for health. Out of this meeting, the following commitments were achieved:

• The Kamuli District staff agreed to recruit 10% more new staff this year.  

• District staff committed to brainstorm innovative ways to motivate medical officers, including additional bonuses on top of their monthly salaries, as well as ways to motivate and retain other health workers.
• Political leaders agreed to work more closely and more supportively with health workers.

• The chief administrative officer agreed to speed up the appointments of new members of the district service commission so the commission would have a quorum and could make decisions.  
• District staff agreed to prioritize the need to lobby the Ministry of Health and other funders for support to purchase an ambulance for the district hospital.
• The district staff will ask all sub-county chiefs to appoint members to the health unit management committees and figure out ways to train them, with support from IntraHealth International and another development partner.

• The district council agreed to consider allotting additional budget support to hard-to-reach areas in the district during the next financial year.
• The chief administrative officer will submit the names of those district staff not yet on the payroll to the Ministry of Public Service to ensure they are paid.

* The meeting was attended by the speaker of the district council, the resident district commissioner, the chief administrative officer and councilors representing various sub-counties and district health technical officers. The meeting was also attended by senior officials from the Ministry of Health, the Ministry of Public Service, and the Health Service Commission.