HEALTH WORKER EXODUS! WHO Clears Uganda to Export Nurses, Midwives as Brain Drain Fears Mount

The World Health Organization’s decision to remove Uganda from its list of countries facing severe health worker shortages has attracted mixed reactions, with stakeholders divided over the opportunities and risks that come with exporting Ugandan health professionals.

The WHO’s Health Workforce Support and Safeguards List, updated every three years, identifies countries with critical shortages of health workers where active international recruitment is discouraged.

The measure is intended to protect vulnerable health systems from losing essential medical personnel to countries offering more lucrative employment opportunities. The current criteria include countries with a Universal Health Coverage service index below 55 per cent and a health workforce density of fewer than 49 doctors, nurses and midwives per 10,000 people.

According to Christabel Abewe, the Technical Officer for Health Financing at the WHO Uganda office, Uganda’s indicators have improved sufficiently for the country to be removed from the list. She says Uganda is now producing more health workers in some cadres than the domestic health system can absorb, while shortages persist in others.

This, she says, means the country can safely consider exporting some categories, particularly nurses and midwives.

Uganda has previously received requests from countries such as the United Kingdom and Germany to facilitate the recruitment of its health workers.

However, Abewe says bilateral arrangements could not be pursued while Uganda remained on the WHO safeguards list. With the country now removed from the list, she says there is an opportunity to formalise health worker exports, particularly given the mismatch between the number of professionals being trained and the number being recruited locally.

Abewe says health worker exports could potentially become a significant source of foreign exchange for Uganda if properly organised. The prospect of exporting health professionals is, however, not new.

Dr Ekwaro Obuku, a former President of the Uganda Medical Association, says discussions about labour export among medical professionals began about a decade ago, after it became apparent that the government could not absorb all graduates from medical schools.

Obuku claims that efforts to establish a labour union and an exclusive labour export company for health workers were blocked by the government. He says this left some trained health professionals struggling to find employment, with some eventually taking up petty jobs in downtown Kampala.

For Uganda to benefit financially from exporting health professionals, Obuku argues that the initiative should be driven by the private sector. The debate comes shortly after researchers at the Makerere University-based Economic Policy Research Centre released findings from an assessment of Uganda’s potential for health service exports.

The researchers found that reliable data on Ugandans providing health services abroad remains limited. However, available data indicates that the largest share, 27.8 per cent, works in countries within the East African region. Those working in Europe account for 26.2 per cent, while 19.8 per cent are employed elsewhere in Africa.

Asia accounts for 16.7 per cent, while only 3.2 per cent of Ugandan health professionals working abroad are in North America. Within the East African region, Kenya is the leading destination, accounting for an estimated 71 per cent of Ugandan health workers who have migrated within the region. Burundi accounts for just three per cent.

Philemon Okillong, a Research Analyst at the Economic Policy Research Centre, says the researchers also found limited information on Ugandans who have established health facilities abroad, as well as Ugandan health facilities setting up campuses or subsidiaries in other countries.

Okillong says better data will be essential if Uganda is to properly understand and maximise the potential of health service exports.

Brenda Kabasinguzi, Manager for Export Marketing Services at the Uganda Free Zones and Export Promotions Authority, says Ugandan health professionals have significant opportunities in international markets if they are properly positioned.

She says Uganda needs to package its health services and provide clear information about the expertise and services available if the country is to compete effectively in the global market. However, Dr Frank Asiimwe, President of the Uganda Medical Association, says opening up the sector for labour export will require greater coordination among stakeholders.

He says that while the removal of Uganda from the WHO safeguards list presents an opportunity, the country must also ensure that it does not undermine its own health system by exporting professionals prematurely. Asiimwe proposes that health workers should have at least three years of professional practice in Uganda before being allowed to take up jobs abroad.