DR IAN CLARKE: Why Health-workers in Uganda need to be motivated

Over the past few years I have not been involved in IHK at an operational level, but have continued to sit on the board. As Chairman of the Uganda Healthcare Federation (representing the private health sector) and being on the boards of Kiwoko Hospital and IHK, plus the Covid fundraising committee, I have gained a broad overview of the health sector and come to the conclusion that the most important factor in the whole system is the motivation of the health-workers.

The first healthcare project in Uganda in which I was involved was Kiwoko Hospital in Luweero, and recently I was invited to be the guest speaker at the thirty-year anniversary of the hospital. Kiwoko Hospital is a faith-based hospital that has continued to go from strength to strength since I worked there all those years ago. Today Kiwoko is no longer run by whites, but by a team of young Ugandans who are doing great work. Among many achievements, the hospital has developed one of the best neonatal intensive care units in Uganda.

It is often difficult to attract Ugandan leadership to a rural hospital since Ugandan doctors earn more in the city, but Kiwoko has been fortunate in attracting two excellent Ugandan doctors who provide the leadership of the organization. The other aspect of such hospitals is that in order to maintain subsidized prices they rely heavily on outside donations. Many such hospitals are now struggling because funding from churches abroad has dried up, and the grant given by the Ministry of Health amounts to only a few percentage points of their budgets.

Kiwoko Hospital has worked closely with its main donors over the years, and built up strong relationships. One of the donor organisations was set up many years ago in Northern Ireland when I was working at the hospital, and this organization, known as Friends of Kiwoko Hospital has continued to raise funds for over thirty years. I attribute this longevity to the close working relationships between the staff of the hospital and the funders, many of whom have spent time at Kiwoko, and built lasting friendships with the Ugandan staff. Also, all the money that is raised goes to the hospital with no administrative expenses.

Another organization that has been invaluable to supporting Kiwoko is known as Adara, based far away in Australia. Adara is run by a remarkable lady called Audette, who visited Kiwoko over twenty years ago, and then adopted the hospital as one of her projects. Since that time Adara has raised millions of dollars for the maternity work, the neonatal intensive care unit (NICU), and community outreaches. Through this support Kiwoko has been able to develop cutting edge solutions for premature babies. The NICU has an excellent survival rate of these tiny premature newborns, some weighing as little as 800 grams.

One reason that Kiwoko is still running today is in large part because of these partnerships. The other reason is that the hospital came into being just after the civil war and at the height of the AIDS crisis, so it was a pretty desperate situation which drove the health-workers to do all they could to help the community. That sense of purpose has never departed from Kiwoko, and it is this sense of vocation that has given motivation and meaning to all that has happened since.

During the early stages of the Covid epidemic, I listened in awe to a senior registrar working under the National Health Service in the UK. The lady had hardly slept in weeks, but just kept going back. She had such a sense of dedication and was putting herself at risk, yet she was working in a government hospital. Unfortunately this spirit is often lacking in health professionals working in government in Uganda, so what is the difference? Most doctors and nurses enter the profession as a vocation and work above and beyond the call, but it is hard to maintain such dedication in a system where other people don’t seem to care. In the UK people would actually get out at a certain time every week and applaud health workers, but in Uganda we criticize ours. Over the years we have seen doctors and nurses in government service receive improved wages, and we have spent millions of dollars on capital works and equipment, but we have not paid much attention to their level of motivation. Well motivated health-workers are fundamental to making a healthcare system work, and if we miss this we will never fix the system.