Is Tech the Solution to Health Worker Recruitment Challenges in Uganda?
What is the state of health worker recruitment in Uganda?
Uganda faces Human Resources for Health (HRH) challenges that undermine its ability to achieve universal access to health care for all of its citizens. Nationwide, only 73% of the available health worker positions, and only 52% of approved Ministry of Health positions are effectively filled.
The World Health Organization (WHO) recommends a density of 2.28 health workers per 1,000 people in order to make good progress towards universal health coverage, indicating that about 23 health workers should be available at all times to serve 10,000 people. Uganda’s density is well below that. There are less than 10 health workers available for 10,000 people. This does not take into account challenges such as absenteeism and demotivation. Simply framing the problem of workforce in Uganda as absenteeism is not sufficient to successfully address the challenge of continued workforce shortages and inadequate skill sets, poor motivation, and labour market dynamics.
The health workforce is an important factor in the delivery of quality health care and is critical for achieving the UNAIDS 90–90–90, and attaining good health outcomes. Despite challenges such as health workforce shortages, high workload, poor work climate, and limited technical supervision and opportunities to update one's knowledge and skills — which hinders the country’s ability to manage the health system and provide adequate leadership — health workers continue to diligently provide health services and save lives.
What are the risks of inefficient recruitment?
Without hiring committed health workers, and ensuring that the they are present, Ugandan citizens will not receive timely, high-quality services, and therefore suffer poor health outcomes, including a high prevalence of HIV and preventable illnesses.
Delayed efforts to have the right workforce hired will render most, if not all our past efforts futile because improving the health system requires a multifaceted approach. If one of them is not in sync, then the rest will be dysfunctional.
On a good note however, the Ministry of Health as well as districts in partnership with IntraHealth International, have addressed other major challenges to health workforce availability, like absenteeism, by implementing an automated absenteeism tracking system and sanctioning non-compliant health staff in 758 health facilities, including 14 Regional Referral Hospitals in the country.
How does manual recruitment contribute to the health worker shortage?
One key factor that contributes to the shortage is the manual recruitment system for health workers. This system is not efficient, cost-effective, or responsive to health workers, health institutions, nor public expectations. For instance, during a typical recruitment cycle, there is a three month gap from the time an advert is run in the media, to when the Health Service Commission conducts its first round of interviews.
Over the years, the national health system has attempted several solutions, although it has done so with substantial implementation insufficiency, considerable shifts in direction and, most importantly, with dysfunctional governance and coordination of the workforce sub-sector.
The Uganda Health Service Commission is responsible for recruiting health workers at the central level and recently designed an online recruitment system to simplify the process. It promotes efficiency in the government recruitment process by allowing users to apply online without incurring costs associated with the manual system. The system allows the Health Service Commission to advertise for open positions online, to have applicants apply online, to shortlist candidates, and to conduct aptitude interviews using the automated system.
Since its launch, the system has been used for two rounds of adverts for 273 open positions for central institutions so far, resulting in 21,096 applications made by candidates online. It’s anticipated that this e-recruitment technology will result in recruiting a highly skilled and motivated health workforce, ready to serve the citizens which is central to the success of Uganda’s health system. It is only through prompt recruitment of the health workforce, that the health system can be positioned to deliver the desired health services to the population and accelerate universal health coverage in the country.
What are the benefits of e-recruitment innovation?
This innovation will ultimately contribute to better hires for health workers, and when motivated health workers are mobilized in adequate numbers and performing according to standards, the country will be closer to achieving the UNAIDS 90/90/90 target.
Technological developments in health services have saved numerous patients and are continuously improving our quality of life. Not only that, but technology in the medical field has had an immense bearing on nearly all processes and practices of healthcare professionals. In many countries, technology is replacing several processes that were formally manual and therefore outdated, such as shifting from paper records to Electronic Health Records (EHRs).
Likewise, these outcomes cannot be achieved nor can the overall health system be sustainably improved, without a strong health workforce recruited in an efficient and effective way.
What remains to be done?
Although the system is taking root in the country, there is a need to link the e-recruitment system with other human resource management systems in the Ministry of Health and Ministry of Public Service, to effectively facilitate information sharing and eliminate sharing hard copy candidate applications. This will streamline the recruitment drives and eventually reduce the backlogs and all other inefficiencies associated with the manual system.
I have confidence that the e-recruitment technology will be the solution to the health worker recruitment bottlenecks in the country pointed out as the major challenge undermining achievement of universal access to health by all citizens.
Douglas Serwada was a 2017–2018 Global Health Corps fellow at IntraHealth International in Uganda.
Global Health Corps is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. Want to get involved? Check out these great opportunities to support the health equity movement and consider joining us as a fellow or partner when applications open later this year! And don’t forget to connect with us on Twitter / Instagram / Facebook.
