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Stop medical brain drain and improve health outcomes in Uganda by focusing 15% of the national budget on the health sector. #Focus15ForHealth

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We respectfully address this petition to President Museveni and the Government of Uganda as concerned citizen of Uganda and the world, to sound our voices regarding the low government spending on the health of the Ugandan people.

We are signing this petition in solidarity with patients across Uganda –family members, friends and, sometimes, ourselves – who have received substandard health care in Uganda due to, among other reasons, the significant health care worker shortage in the country. We are also signing in solidarity with the overworked and under-paid health care workers who choose to stay and practice in Uganda, as well as the many Ugandan health care workers who have felt it necessary to leave their home country in search of better working conditions. In order to arrest this medical brain drain and improve health outcomes in Uganda, the government needs to make health care a priority in 2015. 

We do not wish to imply that Uganda has not made strides in recent decades in addressing some of the structural issues that determine health outcomes - the strong response to the HIV epidemic and the institution of mandatory primary education are two clear examples. However, in signing onto the Abuja Declaration in April 2001, the Ugandan government committed itself to furthering these efforts by agreeing to designate a full 15% of its budget towards tangible health sector improvement. As of 2013 this spending totaled less than 9%.

In order to meet the WHO International Sustainable Development Goals, we advocate for a strong push towards the 15% budget allotment outlined in the Abuja Declaration - especially in the areas of healthcare worker recruitment and retainment. The lack of support for health care providers in areas such as health facility infrastructure, access to medical resources and remuneration remains a significant problem in Uganda. In 2012, a cross-sectional study of Ugandan health students indicated that 63% of students left Uganda within five years of graduation and 84% intended to pursue post-graduate studies abroad. Seventy percent of nursing students surveyed at one Ugandan institution intended to practice out of country. The Uganda Medical and Dental Practitioners Council found that of the 4,200 physicians registered in Uganda in 2013, only 1,200 were actively practicing clinical medicine. An estimated 2,000 of those physicians, or nearly 50% of those registered, left the country over the past 10 years.

These numbers are extremely concerning, especially given the current health care worker to patient ratio of only 1:1,298. To meet basic healthcare needs, the WHO recommends a health care worker to patient ratio of 1:439. Of these physicians who do choose to remain in Uganda, a 2011 study performed at 18 Ugandan hospitals indicated that 63% of physicians are dissatisfied with their work, while 47% are considering leaving their jobs or the country. Reasons cited include poor compensation, lack of medical resources, poor quality of facility infrastructure, and patient overload.

Ultimately this medical “brain drain” costs Uganda deeply: In addition to the estimated $13 million lost annually to emigrating health professionals, loss of health professionals in Uganda dramatically reduces access to health care for Ugandans. Unacceptably common are the dramatic and tragic stories reported by exhausted health care professionals in which shortage of providers and/or resources resulted in preventable patient injury and death.

By examining health sector financing in other countries it becomes clear that increased government spending has huge positive impacts on the health outcomes of its citizens - and this, by extension, positively impacts the country’s economic environment as a whole. Two stand-out examples are Sri Lanka and Rwanda. In Sri Lanka, the government spends $189 per capita on the health sector, which has resulted in a life expectancy of 75 years and a physician retainment rate of 87%. Rwanda has become a health care model for countries around the world; they currently spend $144 per capita and have an average life expectancy of 69 years. By comparison, the Ugandan government only allocates $108 per capita and continues to lag behind other countries in outcomes, with a life expectancy of only 56 years on top of the previously noted poor retention of health care workers.

These results cannot come as too much of a surprise to the government, as less than half of the healthcare workers (3,037 out of 6,839) were able to access their payroll in 2013/2014. Poor government funding of public health sector has resulted in a shift of focus towards privatized institutions, often at the expense of public ones. In addition to that, over 85 percent of health care sector spending is obtained from outside funding and international donors. If our goal is to continue to strengthen and improve the health of the Ugandan people in a sustainable fashion, increasing the government’s investment in the public health sector, particularly in the areas of recruitment and retainment of Ugandan health workers, is absolutely key. 

We realize that making national budget decisions is complex and difficult; however, the health of Ugandans should take national priority. We believe that designating a greater proportion of the national budget towards the health sector would both support the basic human right to healthcare as well as demonstrate the government’s commitment to the health of the people it serves. Thank you for your commitment to Uganda and for taking time to hear our voices.

Sources are available on request.

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