Health Incentives and their Effects on HealthCare Workers in Sub-Saharan Africa: The Case of Uganda

Presenter: Charles Matsiko, Ugandan Ministry of Health

Abstract

Background: Since the introduction of Health Sector Reforms in the public provision of health care, Governments in Sub-Saran Africa have been trying to address issues of efficiency and effectiveness. This however, has been hampered by both the inadequate number of the required human resources for health and lack of critical skills for effective implementation of health programmes due to high levels of attrition among professional health workers. In Uganda, introduction of incentives attracted medical doctors to serve at the constituency level. In Karamoja region, the district assemblies introduced top up allowances of Ug. Shs 300,000 (US $ 200) for medical doctors. The Ministry of health introduced free housing and a vehicle for health sub-districts in the country and automatic scholarships for masters degree for medical officers in hard to reach areas. All the doctors were new graduates with one degree. This study explores the incentives introduced in the health sector and their effects on the healthcare workers in 4 districts of Uganda.

Methods: This was a longitudinal study that employed qualitative methods of data collection conducted between 2004 and 2007. Four districts were purposively selected namely Masaka and Kalangala in the central region and; Moroto and Nakapiripirit in the Karamoja region. The researcher interviewed 10 district managers in Karamoja region and 4 health managers in the central region. Out of these four districts only Masaka was considered easy to reach while the rest were hard-to-reach districts according to the criteria of the Ministry of health.

Findings: Findings indicate that, introduction of salary top-ups, automatic postgraduate training after serving for a period of two years, free housing and a vehicle for health sub-district managers resulted in retention of up to 80% of the medical doctors in Karamoja region and 60% of the medical doctors in other regions of the country for a period of 2 years. Despite Masaka district being easy to reach, doctors did not remain at health sub-district for long as expected. Kalangala district did not have top-up allowances so it remained with only one doctor while the rest left. Literature also revealed that 52% salary top-ups for professional health workers in Malawi encouraged retention of clinical and nursing staff at health centres.

Conclusions: Identification and provision of the right incentives for the professional health care workers is a crucial step in improving health outcomes as these incentives are likely to prolong the health workers’ stay on the job with resultant reduction in the vacancy rates. Retention of doctors in hard to reach districts can be associated with top-up allowances and automatic scholarships for masters degree.