Dr. Silvia Awor, an obstetrician and gynaecologist at Gulu University, followed an academic track at Class A institutions. High school at Mt. Saint Mary’s Namagunga; Medical school at Makerere University; and Postgraduate fellowship in obstetrics and gynaecology at McMaster University, Hamilton, Ontario, Canada.
Hers was the kind of education that prepared her to effectively compete for appointments to coveted jobs in many parts of the world. Had she chosen to stay in Canada to practice and teach learners in her specialty, she would have earned a starting salary of at least US$15,000 (Sh.53m) per month.
Instead, this doctor with highly sought after knowledge and skills, returned to Uganda to serve her people. Yet Dr. Awor would like to change her career. In a letter to the New Vision Newspaper, Dr. Awor wrote: “ On August 22, I read with shock about the proposed salary structure of the executive director and support staff of Kampala Capital City Authority (KCCA). It is proposed that a driver should earn a salary of Sh.7m ($2,000 per month) and yet lecturers at Gulu University earn a paltry Sh.1.5m ($428 per month)!
“But after thinking about it, I got interested in the post. I would like to apply even before it is advertised. I believe I have the best qualification to be the personal driver of the director, Jennifer Musisi Semakula, who has proposed Sh. 43.7m ($12,500 per month) for herself.
“I am a female Ugandan, single mother of two, a medical doctor with a Master of Medicine (obstetrics and gynaecology). I am a lecturer in the department of reproductive health, Gulu University. I have no criminal record. I have six years’ experience in driving and I can change tyres, check the water, oil and brake fluid levels. I can also change the engine oil and do minor repairs on a car. I have never caused any fatal accident and I have ever driven long distance between Nairobi and Gulu.
“With my wealth of experience and medical training, the celebrated executive director is assured of safety. I pledge to respect my boss, carry her handbag(s) to and from office to the car and home. I also pledge to provide free medical consultation on health-related matters since she is definitely too busy to line up in most health centres. I pledge to be the best personal driver if only I get that proposed driver’s pay to put food on the table for my children. Give me a try and you will never regret it.”
Like the vast majority of Ugandan physicians, Dr. Awor is a grossly underpaid and severely overworked professional who provides a critically essential service. She is exposed to extraordinary risks with little protection in a very under-resourced environment.
The compensation for Dr. Awor’s investment in many years of excellent education and numerous sleepless nights and high risk endeavours pales in comparison to the emoluments enjoyed by politicians, for example. While Dr. Awor must make do with $428 per month, her member of parliament is paid over $8,000 per month. That she is attracted by a driver’s salary of $2,000 per month is a very sobering thought.
The tragedy is that should Dr. Awor, a young woman still in the reproductive age group, become pregnant or develop a gynaecologic illness, she cannot afford the high fees necessary to access the best care available in East Africa.
It bears repeating that one measure of how much a country values its doctors is to compare their salaries with those of the same country’s legislators. Uganda scores very poorly on this measure.
The Kenyan Government has woken up to the reality, but only after a prolonged strike and other forms of protest by Kenyan doctors. In March the Kenya Government agreed to pay doctors monthly salaries ranging from $3,119 to $5,161. However, this is still very low compared to a Kenyan MP’s salary of $12,900 per month.
The fact is that there are no shortcuts to better health service delivery. A society that desires good health care must consider it a priority service and be prepared to pay for it.
Central to good health care delivery is competitive remuneration for the multidisciplinary team that includes doctors, nurses, pharmacists, medical technologists, rehabilitation specialists, health inspectors and other health care professionals.
Whereas doctors are the central drivers of the health care system, they cannot do much on their own. They need all members of the multidisciplinary team in order to offer the care that patients are entitled to.
Therefore any discussion of better remuneration must include the salaries of all health care professionals. Furthermore, good salaries alone are not sufficient to retain physicians. But it is a good place to start.
Dr. Awor’s letter highlights the shockingly immoral disparity between the remuneration of Ugandan politicians and other favoured public servants on the one hand, and medical doctors on the other. It is a strong message from someone whose patriotism has not been reciprocated.
To change this requires a changed attitude towards doctors, plus a redistribution of the public pay envelope and a deliberate contraction of the size of the government in order to find the money to pay them.
Hopefully President Yoweri Museveni has the courage to redress this injustice and make it unnecessary for Dr. Awor to seek refuge behind Jennifer Musisi’s official car.