Can Uganda afford to export its healthcare workers

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Rosemary Nankabirwa- photo credit :NTV Uganda

Rosemary Nankabirwa was talented, young, beautiful and had everything to live for but her life was cut short by adrenocortical carcinoma cancer.

According to news reports out of Uganda, the 35-year-old and former news anchor had been battling the illness since 2010 and was under the care of cancer specialists at Mulago Hospital in Kampala.

By early April 2015, it became apparent that the cancer specialists at Mulago Hospital could not do any more for her. The sort of care Rosemary needed was not available at Mulago Hospital and her best chances of survival hinged on being able to live the country to access care in nearby Kenya.

The cost of getting Rosemary to Nairobi, Kenya’s capital was high and beyond her parents’ means.

On learning her plight, the Ugandan public stepped in with various fundraising activities, including car washing, crowd sourcing via social media and the hashtag #HelpRosemary. Yoweri Museveni Uganda’s president joined in too and donated 5 Million Ugandan Shillings (£1250.

And by April 11, over 90 million Ugandan shillings (£22,500) had been raised and Rosemary was on her way to the Agha Khan Hospital in Nairobi. Unfortunately, Rosemary could not be saved and she lost the battle to cancer on April 12.

Exporting Healthcare workers

Rosemary’s death was sad at several levels and compounded the spotlight on Uganda’s healthcare system that had started a few months earlier.

In January 2015, we learned that the Institute of Public Policy and Research (IPPR), a Ugandan think-tank was suing the government of Uganda because the government was due to export 283 healthcare workers to Trinidad and Tobago.

The IPPR’s central argument was that Ugandans need these healthcare workers more than Trinidad and Tobago and that the government’s actions amounted to a violation of the constitutional rights of Ugandans.

For its part, the government argued that the exporting of healthcare workers was part of its foreign policy, aimed at improving bilateral relations between the two nations.

But why would Uganda want to export healthcare workers to countries if its citizens cannot access the care they need?

According to Jeffery Haynes, my former lecturer on globalisation, the odds are stacked against small, landlocked and resource poor countries and that the best hope such countries have is to “export” people to work and send money back.

This “exporting” of people, has its merits as far as the government is concerned. Statistics indicate that remittances to Uganda are valued at $732.83M annually and this is reportedly higher than Official development Assistance, for instance European Aid to Uganda for the period of 2008-20013 was €439,000, 000.

For the healthcare workers involved, it is a good deal too. They can expect better wages, working conditions as well as a better quality of life.

It would appear that although the government lost funding from some donors over the issue, it worn the broader argument and it is now free to export the healthcare workers. Justice Elizabeth Musoke argued that this was not a matter for the courts.

But the exporting of skilled people has downside. As Rosemary’s (RIP) case demonstrates, when skilled people leave the country, their skills are not available to the citizens of country that exports them.


Rosemary’s case exposed something else about Uganda’s healthcare system. Something that is to do with inequality and access, the sort of access that makes a difference with respect to outcomes that citizens can expect from the country’s healthcare system and is only available to the rich and elite.

As Rosemary was in the public eye, the public rallied around her and were able to raise the money she needed to access better care elsewhere, even if the help came too late. But we have to ask, what happens to the poor and or those without the necessary connections to enable them to access better healthcare.

As one Twitter user put it

Happy for Rosemary! We really do need better-equipped hospitals though. This approach is not sustainable.

 I agree with these sentiments in their entirety. I would also add that, there is a need to get a position where hospitals are at a standard where the political elite and the rich are confident in Uganda’s hospitals and turn to such hospital fore their medical needs.

My hypothesis is that because Uganda’s political elite do not use the country’s healthcare system, they have no incentive to invest or even improve the system for the masses.

This therefore means that, those that can afford to, will seek medical care elsewhere and by implication there is no one to take the political elite to task about the state of the healthcare system.

Finally, I  have to ask the question whether well of countries should take healthcare workers from poor nations.  I would especially like to hear your views on this last point.

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