Health is a productive sector, not a consumptive one. Invest in it!

By Loice Epetiru, Key Correspondent for the Irish Forum for Global Health

The Fourth Global Forum on Human Resources for Health brought together stakeholders from around the globe to discuss the Human Resources for Health agenda with the aim of attaining universal health coverage, health security and achieving Sustainable Development Goals (SDGs). More than 1000 delegates gathered at the Royal Dublin Society in Ireland to discuss the Global Human Resources for Health agenda from 13^th to 17^th November 2017 under the theme: “Health Systems for the Future: 2030 and Beyond.”

Dr. Sylvester Onzivua is a senior pathologist at the national referral hospital in Uganda. As one of his day-to-day responsibilities, he examines biopsies for cancer and he is passionate about his job. In order for him to carry out his tasks well, he needs a microscope to aid the examination of the biopsy samples collected. Dr. Onzivua’s passion for his work deteriorated when the microscope he uses broke down more than a year ago.

“I wrote to the Ministry of health requesting for the microscope to be replaced more than a year ago, but the countless requests have not yielded any fruits.” Dr. Onzivua recounted in a televised interview during the Doctors strike in Uganda.

With a situation such as that faced by Dr. Onzivua, coupled with low pay, limited career advancement opportunities, and arrests by state operatives with no avenues for a meaningful mediation, the doctors have no option but to take to industrial action as the quickest remedy.

While the doctors in Uganda are striking, trainee doctors in Malawi are quitting their profession for more rewarding professions and jobs since medical practice is not as glamorous and rewarding as was hyped.

The love for the cause of saving lives alone will not keep doctors in the profession, but a deliberate investment in the cause by the leadership will!

Dr. Isabel Kazanga, a Lecturer at the College of Medicine in Malawi noted that eight intern doctors from the same ward in Malawi quit their profession in October 2017 when the economic challenges hit them. They realized that their love for saving lives alone could not keep them, but rather love coupled with support from leadership:

The intern doctors that are quitting the profession are mostly youth who are starting their career and need to be supported by the top leadership especially at a point when many have lost the impetus to work in the sector.

Does anyone care?

Whereas individuals in other professions are taking home big sums of money, doctors in Malawi are paid 500 dollars per month with a risk allowance of 2 dollars. Whereas in Uganda, a senior consultant gets 950 dollars, a consultant doctor gets 730 dollars and a medical doctor gets 306 dollars with an intern doctor taking home 267 dollars per month with a lunch allowance of 17 dollars per month and no risk allowance. This amount is inclusive of the cost of: rent, school fees for children, housing, feeding, dressing and treatment. One thing that they forget though is that the lives of the populace are at the mercy of the health workforce who put their lives on the edge to save lives of others at the expense of theirs. Losing one doctor can be tantamount to losing a thousand lives of health service users.

Dr. Fredrick Oluga, the leader of Doctors Union in Kenya likened the topic of investment and leadership in the health system to that of a family setting. He noted that in a family, parents take responsibility over their children, and the feeling of being responsible gives them the incentive to look for jobs to be able to provide for their families. In the situation of the health system, mothers and fathers represent governments of countries with no connection to their children, that represent the citizenry left without food, clothes and shelter, representing tools, equipment and supplies for work. Parents in such an aforementioned family setting will not feel any form of remorse in the absence of food at home because they eat from high-end restaurants meaning they get treatment in countries where health service is not a priority and such parents will therefore not be pushed to provide food in their own homes. The uncles and aunties, who represent the development partners, do not see anything wrong with such family set ups and continue to dine with such irresponsible parents.

The State Minister for Finance of Uganda, Eng. Dr. Gabriel Ajedra Aridru acknowledged that the political leadership has not prioritized training of the health workforce in Uganda, making it impossible to find specialized treatment in the country. For the aforementioned reason, the country bears the burden of spending 250 million dollars annually in finding specialized treatment abroad for its citizenry, which is not sustainable.

Eng. Dr. Aridru pledged while speaking at the forum on financing the health workforce:

The need for training health workforce … touched my heart when my wife needed a specialized operation that could not be done in Uganda and after this experience my attitude towards allocating finances for training of the health workforce changed. I pledged to be a crusader for the health care agenda at the Ministry of Finance.

At the closing ceremony, speakers from different constituencies pledged their commitments to help curb the HRH crisis in the different contexts. One thing that was expressly re-echoed was that all the commitments made would only be possible if development partners provide funding for their implementation.

Professor Francis Omaswa, the Executive Director of ACHEST, speaking at the Closing Plenary applauded the message communicated by Agnes Soucat of the WHO: that the UN High-Level Commission on Health Employment and Economic Growth has demonstrated that Investment in health workers has a positive impact on economic growth. Prof. Omaswa noted that originally development partners like World Bank and IMF taught our leaders in Africa that health is a consumptive sector and a bottomless pit. He called for a big effort to reverse and “un-teach” this outdated message which partly explains why investment in health in Africa is not yet at the desired level. “For instance in Uganda the health workers are on strike because there is no money to pay them, which places an urgent need for Africans to unlearn the prior teaching that health is just consumptive.” Prof. Omaswa recounted

The biggest thing that could come out of this Forum is that all the thousands of us who are here will go back home as individuals who care for those who need health workers and do not even know that they can do something about it.

The rhetoric message that came from the different speakers at the Forum was that governments the world over should take ownership over their health sector, and prioritize it in their national budgets before looking outwards to development partners. The realization that health is a profitable investment will change perceptions and attitudes of governments and development partners, thus helping the realization of the Workforce 2030 agenda.

November 24th, 2017

Loice Epetiru is a Development Communicator who recently completed a Post Graduate Diploma in Project Planning and Management at Uganda Management Institute in Uganda after graduating with a Bachelors of Arts in Mass Communication. Loice loves communicating development related issues with a keen eye on health: human resources for health, leadership, governance and financing for health. She is currently working as a Communications’ Specialist at African Centre for Global Health and Social Transformation (ACHEST).