I sat in the exam room staring at the paper and slowly it dawned on me, I couldn’t answer any of it. I could feel the panic rising and, as is normal in this situation, I was buck naked.
This is still a very young institution and for those in the UK, these numbers might seem quite small, but I think they are significant for these two reasons.
According to the WHO World Health Statistics Report 2011, Uganda has just 1.2 Physicians per 10,000 population and 13.1 Nurses/Midwifes. In the UK these same counts are 27.4 and 103 respectively. Uganda has a serious shortage of trained doctors and nurses.
In the last few months I have had discussions with directors of health service providers in Uganda who are finding it very difficult to recruit and retain such trained medical staff, especially for rural up-country settings. One of the challenges facing us is that Donors and NGOs are also actively recruiting such staff and they are willing and able to offer higher remuneration packages. This is somewhat ironic when you consider that the aims of these worthy organisations is to help strengthen the country’s health system. The positions being filled are most often programme design, implementation, management and evaluation, not clinical roles. So we see Clinicians being removed from clinical roles and appointed to programme management.
Wouldn’t it be so much better if these roles were filled by non-clinicians, trained and skilled in public health? That’s one of the ways in which IHSU is trying to make a difference to the delivery of healthcare in Uganda; by providing well trained, willing and able graduates who can implement and manage public health programmes, leaving the doctors, nurses and midwifes to continue treating and caring for our patients.
My second reason is that studying for your MPH involves a lot of relevant reading, discussion and, most importantly, critical analysis. It is my own personal experience that such exposure helps make us much more considered in how we approach the design, implementation and evaluation of required interventions. I think I’m a lot less naive than I was a few years ago. I used to wonder why we couldn’t just get on with it, to do it, to make it happen and quickly (whatever “it” was).
Some of my recent public health conversations have been about the reported unmet need of family planning; according to Guttmacher, 7 out of every 10 women in Uganda who want to avoid pregnancy, cannot easily and regularly access such services. I can hear you say, “surely that must be easy to fix, and it’s cheap, an IUD costs just a few pence.”
Of course it is much more complex and there might be many reasons why an unmet need exists. There will be numerous hurdles to overcome to ensure a sustained delivery of accessible and affordable service.
Those MPH students graduating last week are now well equipped to tackle such matters and better placed than they were before to now ensure successful achievement of the desired outcomes.
Hopefully I’ve now finished my exams and can move on to starting my research and learning some more. Many years ago I used to have the dream (nightmare) outlined above, thankfully it’s never been reality.