17th October, 2017

In the recent past, the media has been awash with reports attributed to UMA led by Dr. Ekwaru Obuku listing therein a litany of demands on government. Among the list of demands is the call to action of all doctors employed in the public service to lay down their tools if their salary demands are not met within a specific period. In addition, a veiled threat was made to government and its law enforcement bodies to desist from “arresting” doctors and instead make recourse to their professional bodies for disciplinary or other action for those caught engaging in professional malpractice.
As the Health Monitoring Unit, we would like to state categorically that while we associate with the plight of doctors and have actually been at the forefront in urging the government for better remuneration, we find some of the actions of UMA leadership as grossly misleading, frivolous and undermine public confidence in the health care sector and by implication – the medical profession.
The UMA was formed as a private association of medical doctors and therefore is not a statutory body that is authorised to speak on behalf of doctors. The legally constituted body charged with regulating the affairs of doctors and such incidental issues is the Medical and Dental Practitioners Council established under the Medical and Dental Practitioners Act, Cap 272 laws of Uganda. As far as we are aware, the official body of doctors has not called for any industrial action by its members.
The usage of the name Uganda Medical Association has led the public to perceive the said UMA as the official body representing doctors which is not the case at all. We are not aware if indeed this body is registered as a labor union. Even if it were, the salary demands of raising the emoluments of a doctor up to a tune of Shs. 48 million is simply unsustainable for a developing country like Uganda. While we are sure of government’s commitment to increase the pay of its doctors, Dr. Obuku and his team should be mindful of the country’s resource capacity and not hold the treasury at ransom.
The said actions of UMA fall short of the ethical and professional standards and any negative attributes that may arise out of their threatened strike if their exorbitant demands are not met, will greatly affect the cherished reputation of the medical profession built over the years. Ultimately, the patients will suffer worse. We believe there are more appropriate avenues of engaging government through their legally established body to lobby for fair and reasonable terms of payment – which we are sure government is agreeable upon.
The notion that medical doctors are beyond reproach and somewhat immune from prosecution is grossly misleading. We have noted with concern that whilst a good number of medical professionals are doing a commendable job, there is also a rise in cases of professional malpractice, often leading to rash and negligent deaths. Whereas the professional council has the locus to investigate the administrative issues involved in these cases, this does not take away the jurisdiction of police and courts of law to handle the criminal aspects involved. We therefore call upon UMA to urge its members to uphold professional ethics and code of conduct, rather than trying to oust the mandate of law enforcement bodies.
On the other hand, I would like to appreciate Uganda Medical Association (UMA) for trying to bring together doctors within Uganda and those in the diaspora under one umbrella to pursue delivery of quality health care and promoting welfare of doctors.
The vision of UMA is to see that "All the people in Uganda have access to quality health and health care" and the mission is “to advocate for quality of health care and improved welfare of medical Doctors in Uganda.
In its health sector barometer of 20th Sept, 2017 for assessing implementation of key policy concerns in Uganda; UMA does recognize the immense achievements of NRM in the health sector since 1986. Some of these successes include but not limited to the numerous infrastructures built across the country e.g. numerous Health Centre level IV with operating theatres and general hospitals including three in KCCA alone, Naguru Reional Referral Hospital, Kawempe and Kiruddu); a completely new hospital for Women, and the elevation of Mulago National Referral Hospital to a super-specialized, supra-national referral;  government tripled the health budget from 3% in 1987 to below 10 today, a gesture of steady progress. Uganda Medical Association further acknowledges being aware of the pronouncement of 2001 when H.E. the President abolished cost sharing and Ugandans ushered in free health care.  Quite interestingly, UMA is also aware of the Presidential orders of 23rd June 2016, when H.E President Yoweri K. Museveni directed Cabinet to address, inter alia, corruption in the heath sector; and UMA reiterates this call and is prepared to work with His Excellency to exterminate all forms of corruption in the health sector”.  My observation is that UMA is very much aware of the corruption in the health sector but doing nothing about it though it claims to be working with the State to exterminate all forms of corruption. This is a blatant and naked lie. To exemplify this false claim, UMA Executive recently made demands that Health Monitoring Unit which is fighting corruption amongst other vices in the health sector, should be disbanded.
If one of UMA’s roles is to fight corruption and Health Monitoring Unit is doing the same, then why do you want HMU disbanded???? UMA executive especially the UMA president, then Secretary General Dr Obuku is usually quick to go on media attacking HMU whenever errant health workers are apprehended red handed in possession of government stores i.e. having stolen medicines, medical supplies, medical equipment or investigated to have misappropriated government funds. Is this the way UMA is exterminating corruption by protecting wrong doers??? Please don’t be deceptive to the State; you are not fighting corruption in the health sector. I strongly appeal to UMA executive to always dig into the width, depth and roots of the reason for the apprehension of those errant health workers. When you act and speak defensively in favour of health workers that have cases to answer then you are construed to be a conspiracy and connivance in defrauding government of health resources. Leadership and being a good shepherd is not about shouting, you first of all need to assemble facts before issuing statements, otherwise, one is considered superficial, unkempt and hollow just like an empty tin which sounds loudest. UMA executive should first reach the ground whenever they get reports of arrests. They may be appalled and stunned with fact surrounding arrests of particular health workers for example, a health worker has stolen medicines worth millions or misappropriated billion of shillings, has stolen equipment from hospital thus incapacitating service delivery in the facility, has caused negligent death, just to mention a few of the vices. Should UMA defend such culprits – the 1% bad apples that is tarnishing the image of the whole health work force? Recently, HMU carried out medicines audit in Fort Portal Regional Referral Hospital and discovered that from July 2015 to March 2017 (one year nine months), all user departments put together have medicines and medical supplies worth about 300 million unaccounted for.  When such information was relayed to UMA executive, it was as expected, fire spitting, scathing, scolding and venomous attack on HMU and calling HMU all sorts of names instead of condemning and denouncing the health workers’ act. It is all due to misinformation and not being patient as a leader to first find out the facts before issuing any statement.

Indeed I would like to concur with UMA executive that majority of health workers (99%) are good apples and only 1% constitutes bad apples. If this is applied to the 2,100 doctors available in the country then only about 21 doctors are the bad apples and are therefore tainting the image of the noble profession. HMU records depict that since inception in 2009 to date averagely about seven doctors per year have cases ranging from theft of medicines, theft of medical equipment, having cases of negligent deaths, causing financial impropriety and loss to government, or involved in other malpractices. The fact is that UMA executive is misrepresenting the views of many doctors who are not condoning corruption and other unprofessionalism. Actually, UMA is not a statutory body mandated to be mouth piece of the health workforce, because it is not registered as a labour union, let alone being an association of only doctors and not all health workers.

No Disbandment of Health Monitoring Unit: One of the recent demands by UMA executive is disbandment of HMU. This is just a shear joke and waste of precious effort and time. Health Monitoring Unit rebranded from Medicine and Health Service Delivery Monitoring Unit was established in 2009 by His Excellency the President under the provisions of articles 171 and 172 of the Constitution of the Republic of Uganda. This was in response to country wide public outcry about the poor state of health service delivery mainly due to massive stock out of medicines in all health facilities. The HMU main objectives are: (1) To monitor and support health care system of Uganda (2) To strengthen the health sector and make it is more responsive, accessible, of quality and more affordable by the people of Uganda (3) To improve citizens’ ownership of the health care system.
If UMA is serious, dedicated and committed to amongst other roles, exterminating corruption in the health sector then it should work very closely, brotherly, intimately and lovely with HMU the brain initiative of His Excellency the President. Uganda Medical Association should note that Health Monitoring Unit is working well with all other arms and organs of the State notably the very line Ministry of Health, National Medical Stores, the professional bodies (Uganda Medical and Dental Practitioners Council, Uganda Allied Health Professional Council, Uganda Nurses and Midwives Council, the Pharmacy Council, National Drug Authority);  Office of the Prime Minister, Ministry of Security, Internal Security Organisation (ISO), External Security Organisation (ESO), Auditor General, IGG, the Police, Ministry of Education and Sports (jointly monitoring and closing  mushrooming illegal health training schools, etc), the Resident District Commissioners, Development Partners, NGOs, CSOs, majority of health workers who don’t condone corruption and other vices in the health sector and the general public and individuals who are ever hurt, worried and haunted by corruption in the health sector. It is only UMA executive and in particular Dr Obuku that is in isolation unnecessarily, fruitlessly and vainly complaining about the operations of HMU and should therefore desist forthwith.

Government has good will to work together with the Uganda Medical Association; the testimony of which is that government gave UMA SACCO 1 billion Uganda shillings in August this year to support its credit facilities to doctors. HMU was at the fore front of supporting the idea and lobbying for this request. Is there a lesson to learn from this? HMU is equally mindful and passionate about the welfare of doctors and health workers in general and will continue to advocate, lobby and support the dialogue with government to improve the welfare and working conditions of the health workforce in this country.

Let me take this opportunity to highlight the achievements of HMU since inception. They are as follow:  
    Recoveries from thefts and embezzlement (2009 to date) - recovered medicines, health supplies, equipment plus cash embezzled summing up to UGX 15,862,457,254 of which hard cash recovered amounts to Sh. 3,000, 000,000 that was remitted to the consolidated account.
    LLIN Campaign (Jan – Aug, 2017) – HMU participated in five (5) waves of monitoring of registration of households and LLINs distribution campaign, supported by GFATM, AMF, DFID, USAID / PMI.

    A total of 22,348,728 nets were distributed to total of 42,156,197 people in 7,912,026 households in 111 districts
    HMU participation in LLIN campaign enabled detection, arrests and recoveries of Sh. 37,213,000 that was stolen by mainly sub-county supervisors during the LLINs distribution campaign (Waves 1, 2, 3, 4a and 5).
    Remaining districts are Mbarara, Sheema, Kasese, Bundibugyo, Kagadi, Wakiso and Kampala where registration of households and distribution of nets will be done by Dec, 2017
    Capacity Building (Dec, 2016 to March 2017 ): With financial support from UNICEF, HMU carried out training of health unit management committee (HUMC) members and supervisors in all government health facilities in 32 districts in West Nile, Acholi, Lango and Karamoja sub-regions.
    Funds recovered (during 2016/ 17) - Followed up and recovered GAVI funds worth UGX 846,396,203 which was unaccounted for from 80 districts and UGX 13,266,848,127 meant for Polio and measles vaccination programs.
    Funds recovered (August 2017): Recovered unaccounted for Baylor funds worth Ugx 13,058,981 in the Teso Region (i.e. Pentecostal Assemblies of God in Kaberamaido, Serere DLG, Vision Terudo in Ngora, and Kumi DLG)
    Investigations and legal actions (2009 to date) – While conducting its routine operations, HMU registered total of 610 cases of which 249 have been prosecuted, 93 convicted, 14 acquitted, 42 cases dismissed, 36 handled administratively and 36 cases still pending.
    Pay roll interventions (2009 to date) - HMU intervention enabled 7,586 health workers to access their full remuneration on pay roll, further testimony that HMU is very mindful and passionate about the welfare of health workers
     Followed up and ensured salary payment of 50 staff of Mbarara RRH
    Biometric Systems Study (2016 to 2017): HMU conducted a pilot study on effectiveness of Biometric Machines in addressing absenteeism in Naguru RRH, Iganga hospital, Luweero HC III and Mukono HC IV. Findings revealed an enhanced attendance of health workers and increase in the number of deliveries and major surgeries as a result
Infrastructure (2015 to date)
    Recovered eleven (11) stolen hospital beds worth Shs.18,700,000 for Mulago Hospital;
    Recovered stolen hospital beds worth Shs.19,250,000 for Kayunga district;
    Recovered a fibre boat worth Sh.120,000,000 donated to support referral of maternal and child emergencies in Namayingo district;
    Recovered a MoH vehicle worth Shs. 30 million;
    Recovered an ambulance belonging to Wakiso HC IV;
    Intervened and supported reconnection of water to Kiira HC III after 30 years of no water at the facility;
    The list of achievements is much longer than this.
With these few achievements highlighted here is UMA executive still not yet convinced HMU is doing a good job!!  UMA ought to be patriotic, walk the talk in fighting corruption and to promote delivery of quality health care and professionalism by observing and implementing rewards and sanction strategies.
Finally, HMU recommends thus:
•    The UMA to work together with HMU just as the latter is working very well with all organs and arms of the State and UMA to take note that all sectors have a stake and roles to play in the health sector  
•    The UMA should desist from inciting its members to strike without consultation with the medical and Dental Practitioners Council. In the same vein, UMA should desist from passing off as the official body of doctors mandated by law, no it is not a labour union, UMA should not over step its jurisdiction
•    Government is already working on a proposal to harmonize all civil servants pay, including doctors. As such HMU appeals to our esteemed health workers to exercise more patience and continue to carry out their duty to treat Ugandans bearing in mind the Hippocratic oath; as government works around the clock to address their demands.
•    UMA should work hand in hand with other statutory bodies to ensure the highest ethical and professional standards.
Dr. Jackson Ojera Abusu