Pay the doctors closer to what they want and then deploy artificial intelligence to replace them

By Denis Jjuuko

Over a year ago, the skin on my fingers started to change becoming more brown than the rest of my body. There were changes on my nails too looking as if they were poorly painted. I was concerned so I went to see a physician who ordered very many tests — about 20 of them. When they all turned negative, he advised me to see a particular dermatologist who has a private clinic in Kampala.

I arrived at the clinic around 10.00am and I was registered as patient number 25. I was told I don’t have to wait for so long. Instead of Shs40, 000 as consultation, I could pay Shs70,000 and when whoever is seeing the ‘senior consultant’ comes out, I would be the next to enter. This wasn’t a bribe. It was even inscribed above the cashier’s desk in bold letters.

I had a full battery on my smartphone and like usually the norm, I had a book so I decided to wait and learn a little more about this place. I kept on reminding myself how I was in a wrong profession. This guy at an average of Shs40, 000 per a person had already grossed Shs1m. And it was just 10.00am! The clinic itself has nothing really to write home about. It looked even somewhat dingy. However, the dermatologist is one of the most sought after in Kampala, hence the long queue. A few people who had their Shs70, 000 would come in and see the guy ahead of us.

When I got to the consultation room, I explained to the doctor my problem and gave him my results from the lab. He examined them and asked me to put my hands on his desk. He gave them a disinterested look for a minute or two. He stood up and pulled out a very big book. He opened the page and asked me to read a paragraph. It was written that this could be hereditary or something. So he told me to go look at my relatives or talk to them as this may regularly happen to them and then he read for me another paragraph — his job now was to reassure the patient that all is fine. And that is all what he did. My Shs40, 000 was gone. I know doctors who Google during consultations to find out what to tell their sick clients.

So a doctor working in a not very busy privately owned facility from 3.00pm to about 8.00pm or four hours a day could be consulted up to 15 patients on average each day. Each patient on average pays a consultation fee of Shs40, 000. That translates to Shs600, 000. Such doctors usually work six days a week, which comes to Shs3.6m a week or 14.4m a month. And usually, it is cash (or at worst insurance).

So Shs14.4m a month working only four fours a day! If they worked for another four hours a day, they could double that gross income. And usually, these doctors are not even handling very complicated stuff. If you have school going kids, you are paying Shs40, 000 many times during every academic term so your child is treated of flue and cough! And by the way I don’t want to talk about the profit they are making on drugs.

So I understand why doctors now are holding for higher pay from the government. They are making lots of money treating malaria in private clinics. Doctors spend their day moving from one hospital to another to see clients who are paying lots more money. There is no senior doctor in this town who is really concerned when government says it will fire them if they don’t return to work. Working only four hours a day like we have seen can gross for them upwards of 14m.

And the doctors who aren’t in private clinics and hospitals are in NGOs doing the work of social workers. They spend their time designing strategies on how to distribute condoms and mosquito nets and are being paid as much as what the doctors are asking government to pay them. I once visited the regional referral hospital in Kabale where a registered nurse was managing the children’s ward. In the same hospital, there was ‘project’ by some NGO and they had a pediatrician on their books whose job was to manage village health teams. And these NGO doctors actually drive around in fancy SUVs and that may explain why doctors in public hospitals are also asking for such vehicles. They have seen their colleagues living the life.

If I were the Minister of Health, I would pay these doctors closer to what they asking for and then deploy the technology and maybe security to ensure that they actually work for the hours being paid for. I would bring private sector seriousness to the public sector regarding the hours they put in. I would ensure they aren’t moonlighting in private clinics during official working hours.

And then I would spend the next decade or so collaborating with Makerere University and global companies and institutions developing appropriate machine learning and artificial intelligence technologies that would eliminate most of the jobs doctors and health workers are doing today. I would push the government to spend more on ensuring that people don’t become sick in the first place. And in Uganda, a lot of diseases that kill people are actually due to lack of clean water and poverty. So by ensuring every home has access to clean piped water, have enough to eat and generally good living conditions, we would significantly reduce the number of people who need to go to public health facilities for treatment. How difficult is that?