Uganda sees health-worker exports opening, but local shortages remain

Some Ugandan health professionals have ended up doing petty jobs in downtown Kampala because they could not find work in their field, according to former Uganda Medical Association president Dr Ekwaro Obuku. Now, Uganda’s removal from a World Health Organization recruitment safeguards list is opening a debate over whether overseas jobs can turn unused skills into foreign earnings without draining the country’s own health services.

According to The Independent Uganda (direct), WHO has removed Uganda from its Health Workforce Support and Safeguards List, which identifies countries with severe health-worker shortages and discourages active international recruitment from them. The list is reviewed every three years. Its current criteria combine a Universal Health Coverage service index below 55%, a measure of health-service coverage, with fewer than 49 doctors, nurses and midwives per 10,000 people.

A jobs mismatch becomes an export opportunity

Christabel Abewe, WHO Uganda’s technical officer for health financing, says the country’s indicators have improved enough to warrant removal. Yet the picture is uneven: Uganda trains more workers in some professional categories than its health system can employ, while other categories remain understaffed. She says that creates scope to send some professionals abroad, particularly nurses and midwives, and potentially earn substantial foreign exchange — income in overseas currencies — if recruitment is properly organised.

The United Kingdom and Germany have previously asked Uganda to facilitate recruitment of its health workers. Abewe says bilateral arrangements, negotiated between governments, could not be pursued while Uganda was on the safeguards list. Removal now offers an opening to formalise that recruitment. Obuku says medical professionals began discussing labour exports about a decade ago, when it became clear that government hiring could not accommodate all medical-school graduates. He alleges that the government blocked attempts to create a labour union and a dedicated health-worker export company. In his view, private businesses should lead any initiative intended to generate financial benefits.

Overseas demand meets a data gap

An assessment by researchers at Makerere University’s Economic Policy Research Centre points to an existing overseas workforce, but also weak information about its scale. Available data places 27.8% of Ugandan health professionals working abroad in East Africa, 26.2% in Europe and 19.8% elsewhere in Africa. Asia accounts for 16.7%, against 3.2% in North America. Within East Africa, Kenya hosts an estimated 71% of those who moved within the region, while Burundi accounts for 3%.

Research analyst Philemon Okillong says information is also limited on Ugandans operating health facilities abroad and on Ugandan facilities establishing foreign campuses or subsidiaries. Better records are needed to understand the export opportunity, he says. Brenda Kabasinguzi, manager for export marketing services at the Uganda Free Zones and Export Promotions Authority, argues that the country must clearly present its expertise and available services to compete internationally.

Current Uganda Medical Association president Dr Frank Asiimwe urges greater coordination and warns that an export opening should not come at the expense of domestic care. His proposed safeguard is a minimum period of local experience before departure:

Health workers should complete at least three years of professional practice in Uganda before taking jobs abroad, Asiimwe proposes.

The next challenge is to turn the recruitment opening into a coordinated approach. The issues identified by stakeholders are how to organise overseas hiring, improve workforce data and protect local services while giving professionals who cannot find work at home a route into employment.