By Tom Oniro Elenyu
The future of medicine in Uganda remains uncertain as government proposes increasing the doctors’ training duration from five to six years. This is despite the August 2024 President Yoweri Museveni’s yet added painful ill-health to the country’s health sector by proposing that medical interns should pay for their internship. Uganda grapples with a dilapidated, weak and fragmented healthcare system described as “unhealthy.” Medical interns are qualified doctors, pharmacists and nurses on apprenticeship subjected to a one-year mandatory placement in hospitals to get permanent practising licences from their respective professional regulatory bodies.
The medical professions’ bodies for nurses, pharmacists, dentists are stiff that government is making proposals without duly consulting with them. “I have been vice president of the Uganda Medical Association (UMA)…I have been the President of the Uganda Medical Association for the last four years now. I have no knowledge of being consulted. I don’t have it on record on being consulted. What I know, they want to dodge paying for internship,” UMA President, Dr Frank Asiimwe, told Pan African Visions on 23 March interview. He is a Consultant urologist, Consultant General Surgeon and lecturer at Mulago National Referral and Teaching Hospital in Kampala. He is also chairman of the Urology and Organ Transplant at the national health facility from where they have so far done 15 organ transplants under strenuous working conditions and tight budget. According to Dr Asiimwe, Mulago National Referral Hospital runs on 10% of the required budget.
Appearing before the Parliamentary Accounts Committee on 19 March, the Executive Director of Jinja Regional Referral Hospital—whereupon the source the world’s second-longest river—The Nile—rests, Dr Alfred Yayi, said that the hospital has a staffing level of 32% given the facility’s 410 staff out of the required 1,261 members. Dr Yayi revealed that the hospital receives Shs1.9 billion (about US$278 million) in place of the required Shs4 billion (nearly US$1.1 billion). Jinja Regional Referral Hospital serves a catchment area of 11 districts and one city; constituting a population of 3,703,535 people, according to the May 2024 National Population and Housing Census.
Government is always complaining that there is no money to fund other sectors of the economy, especially health and education. “One mistake government is making is the excuse on policy issues [that government doesn’t have money]. These are policy issues. RDCs [Resident District Commissioners’] remuneration is currently Shs4 million (about US$1,111) to a proposed Shs9 million (US$2,500) per month,” dentist Dr Judith Nalukwago told heart of Kampala-based Radio One’s Spectrum talk show programme on 18 March. RDCs are the eyes and ears of the president in a given district or city.
According Dr Asiimwe, the US President Donald Trump’s 28 January 2025 Executive Order freezing USAID funding to poor countries, including Uganda, is not to blame for the ill-health in Uganda’s health sector. “But the money is there…where did you get the money to do the [January] elections? Where did you get money for the elections when the results are known?” Dr Asiimwe asked at the talk show. Museveni’s First Item Budget priority is defence and security. At the height of the high cost of living occasioned by sky-rocketing commodity prices in May 2022 following Russia’s full-scale invasion of Ukraine on 24 February that year, opposition doyen Dr Kizza Besigye was arrested for protesting against State House alleged daily expenditure of Shs2.8 billion (about US$ 556 million) amidst citizen biting poverty, halt-grinding government facilities and service delivery.
In May 2025, the State-owned New Vision newspaper reported mid-wives in Palam Health Centre II in far-eastern Katakwi district enduring challenging conditions of relying on the flashlights of their mobile phone torches to assist expectant mothers give birth due to persistent power outages and no stand-by generator at the facility. Vice-President Jessica Alupo is Katakwi’s District Woman Representative in Parliament.
Media reports have also exposed Tororo Referral Hospital doctors and nurses using torches and candles in the night attending to patients because government did not pay electricity bills and the would-be stand-by generator did not have fuel to power it on. A similar scenario was reported in the Lake Victoria Island district of Kalangala where nurses have had to use phone torches and candles at night to execute their duties. “It [doctors and nurses using phone torches and candles] happens in some places; but I don’t know how widespread it is,” Dr Asiimwe told Pan African Visions.
In Uganda’s government health facilities, expectant mothers are required to buy for themselves black PVC polythenes upon which to contain the bloodbath. It is also common to find patients and their care-givers sleeping on pot-holed health facility floors because there are no beds and mattresses. “I tell you, for us in Mulago, before we go to operate a patient, we first check with the nurses, and ask ‘what is there’. So, we go to the patient and say, ‘for us we’re ready to operate on you, but find out this and that…’ We need a more constructive engagement with His Excellency the President because we’ve not been listened to,” Dr Asiimwe decried on Spectrum. Some government health facilities have decried lack of incinerators to dispose placentas after delivering mothers.
In Childbirth in Uganda: Stories from women and health workers– a collection of 10 stories by Save the Children International about birth experiences from the perspectives of women as mothers and healthcare workers—mostly midwives— Eva Nangalo, shares her story having dedicated herself to saving mothers’ and babies’ lives in a district hospital in Uganda and is a strong national and global voice for midwifery.
According to Nangalo, it is a fact that the presence of a trained health-care worker, along with basic medicines such as antiseptics and antibiotics, vital equipment and a clean environment to work in, can save the lives of nearly-born and new-born babies on their first day. However, she recounts, recent estimates indicate that only 57% of births in Uganda take place with the support of a skilled health-care worker and many health facilities are under-equipped and under-staffed.
“Every day, 15 women die in Uganda from pregnancy and childbirth-related causes…and 81 new-born babies die. This equates to 695,701 deaths each year due to complications during pregnancy, childbirth and in the first month.” She says many of these deaths are from causes that are largely preventable, with mothers’ deaths caused by four major factors – haemorrhage/bleeding, hypertension, unsafe abortions and sepsis. Babies die due mainly to complications of prematurity, complications at birth and neonatal infections.
Nangalo reminisces: “Another incident I remember is of a mother called Berna, who came into the labour ward after visiting a traditional birth attendant (TBA) to induce labour with local herbs. The mother was in a lot of pain and bleeding, so the doctor quickly decided to undertake a caesarean section. She had twins, who were premature and not breathing. I grabbed the babies and ran out of the theatre towards the labour ward where our resuscitation table was, leaving the doctor with the bleeding mother on the operating table.
“Midway to the labour ward, there was a power cut and with no reliable standby generator, the hospital was engulfed in darkness. To ensure that I completed my task of resuscitating the babies, I called out to a student midwife to use the ‘torch’ on my mobile phone to provide light. With no reliable source of power generation,” she goes on, “we transferred the babies to a nearby private hospital, which had a standby generator. Since the hospital ambulance did not have fuel, the babies had to be transferred on a boda-boda [motorcycle taxi] by their father.” Nangalo says many such challenges make her job difficult. “We also face frequent stock-outs of essential drugs, power outages and lack of the necessary equipment to assist mothers and new-borns during delivery and afterwards,” she adds for good measure.
According to Dr Nalukwago, sometimes there are no gloves, but “when you tell patients to improvise, patients become emotive that ‘equipment are there and the doctor just doesn’t want’ to work on them”.
“Because institutions here don’t stand on their own, everything is referred to General Museveni; that’s where the problem is,” says the dentist.
Sought for a comment, the Health Ministry’s Senior Public Relations Officer Emmanuel Ainebyoona refused saying he does not know this publication.
“Associations for nurses, pharmacists, dentists… should be consulted. Challenges are everywhere in all different sectors in Uganda; not only medical/health sector,” says Dr Nalukwago.
Medical Interns
“If you say you pay for yourself, what if the money runs out?” asks Dr Asiimwe, consultant urologist, on 7 September 2024. “That also leaves the children of the poor to suffer; the children of the rich will be doing internship while the children of the poor stay at home. To avoid those temptations, it’s better those interns are paid for by government. Internship is mandatory,” he explains. A urologist is an organ transplant surgeon.
Museveni, on 25 August 2024, controversially asked: “who pays for the internship?” a Government of Uganda responsibility. “Some people are saying that the government must pay, but I think that’s risky because the government would pay but it doesn’t have enough money since it has got a lot of things to do like roads, security, etc. I don’t think it’s okay to tie the future of our young doctors with government funding because it may delay or it may not be there.”
Medical interns are frontline workers shouldering about 75% of daily operations of 74 government hospitals in the country. With a work-load of 36-48 hours, Museveni, in 2021, ratified a net monthly salary of Shs2.5 million (about US$694) per intern, but the amount was slashed to Shs1 million (US$278) with plans afoot to erase it altogether. “Interns are paid Shs1million, but others get zero, currently about 300 of them,” Dr Asiimwe told this publication. “I don’t know, but zero,” he answers on how zero-paid interns survive and yet expected to execute their duties. Medical internship is a one-year training that post-university graduates of medicine and surgery, pharmacy, nursing and mid-wifery take after completing their bachelor’s degrees. The internship training is done under supervision, and a certificate is issued on completion; after which one can seek a medical licence to practice medicine and surgery, pharmacy, nursing and mid-wifery.
Parliament Speaker’s budget is bigger than that of Mulago National Referral Hospital. Parliament’s Shs300 billion (over US$83 million) food and entertainment budget alone can pay medical interns for about four years. The in-coming 556 12th Parliament lawmakers are to get Shs315 million (US$87,500) each for car allowances and yet some MPs are already grumbling that it is little money. “Government prioritising things that are not important; poor planning by government,” Dr Nalukwago fumes.
Sub-Saharan Africa makes up 11% of the world’s population but accounts for 24% of the global disease burden, according to the International Finance Corporation. The region commands less than 1% of global health expenditure. A McKinsey 2008 study reported that in Ethiopia, Nigeria, Kenya and Uganda, more than 40% of people in the bottom 20% income bracket received their healthcare from private, for-profit providers.
Nearly 80% of Uganda’s healthcare budget is donor-funded. The health ministry’s funding gap in 2024 was nearly $275 billion in the ministry’s total budget of approximately $1,081 billion, but given only nearly $270 billion in the 2024/2025 fiscal year where $10 million was earmarked for medical interns.
Museveni’s proposal frustrates over 1,000 medical interns stuck over government’s delay to release money that facilitates their internship. “Why don’t we agree that a person who has qualified as a medical doctor after five years in the medical school continues with the internship but with sponsorship from the person who sponsored him in the first place? What is the problem? If someone was sponsoring you for five years, why does he stop now? There’s another demand from the government: I’ve been told that these interns need a supervisor…What I propose is that on sponsorship, we maintain the one who has been sponsoring you during the undergraduate; let him sponsor you…” the president’s proposal insists.
It costs rich parents about $2,000 per semester to educate a student on medicine; equating to $4,000 per year for five years. According to Dr Asiimwe, Interns have a life to live; they need something to eat, they must sleep somewhere. Internship in the first rotation, according to Dr Asiimwe, takes about six months.
Now in a country where poverty is chasing citizens faster than they can run away from it, this means only the affluent very few parents can ensure the future of the medical profession in Uganda where doctor-to-patient ratio is 1: 25,000. The World Health Organisation recommends 1:1,000. “[Doctor-to-patient ratio]: In Kenya it is 1:10,000; Rwanda is 1: 8,500; South Sudan 1: 65,000 and Tanzania it is 1: 12,000 to about 15,000. So, in the East African region, we’re the ones doing so badly,” Dr Asiimwe tells this publication on 23 March.
Covid-19 intern doctors were not duly-paid their arrears but shortly after which government suddenly, “surprisingly” got money to buy cars and make back-dated payments for still-alive former vice-presidents, Parliament speakers, deputy speakers and prime ministers.
In July 2023, the health ministry deployed 1,900 medical interns at its 58 intern centres across the country following rampant strikes and police arrests. The interns had not received their allowances for four months.
“Health service delivery is an essential service and it should be put in the priority list. Telling these parents to take care of internship is to take the service from the priority list. These medical interns need to go back to school so that they can continue serving their nation,” Dr Asiimwe proposed, then.
But, according to opposition members Uganda faces a challenge of a government interested in its survival in power. That for Museveni, it is better to survive in power than to have drugs in hospitals. Prioritisation in Uganda, they claim, “is a scam”. Half of Uganda’s national budget is classified expenditure with lion-share security being Museveni’s first-line item.
Controversially yet again, in the Appropriation Bill 2024 rejected by Museveni, Parliament had allocated about $83,000 to the health docket for ambulances’ procurement. The amended Bill which the president assented to transferred the ambulance monies to Roko; a private construction company whose ownership remains misty. Staffing levels at the health ministry stand at 35% with Referral Hospitals operating on budgets meant for General Hospitals.
Medical equipment donated to Uganda are reportedly not assembled and those assembled broken down. Intensive Care Unit beds are said to be dysfunctional because nurses are not enough to operate them. Some districts don’t have medical facilities; neither doctors nor medical interns, but have the president’s representatives with their deputies and assistants fully-facilitated with cars, body guards, motor cycles, allowances and all the requisite social amenities.
But what is the future of medicine in Uganda? According to Dr Asiimwe, in 2024; “They [medical interns] should be happy. As the Medical Association, we’re doing something about this [internship sponsorship]. The regulators must be listened to. Medical doctors who’re dealing with people’s lives; opening people’s abdomen, removing babies…they need to do these under supervision.”
Asiimwe’s recommendation to government in 2026: “Please treat our interns with dignity. Interns are not students. They should increase the internship centres and decrease the doctor-to-patient ratio.”
