Mulago hospital in crisis of nurses, senior consultants

Patients, care takers, visitors, staff and non staff jostle for corridor space within Mulago Hospital impatient to get to their next destination. Time at Uganda’s largest referral hospital waits for no man because every day, more than 1000 patients are pouring in.

The emergency paediatric unit alone receives 200 patients daily whereas the Uganda Heart Institute (UHI) receives about 100 patients daily. The labour suite (5C) receives between 80 and 100 expectant mothers and of these, 35 need caesarean section. When I visited the ward, some women were sited on laid out lesus on the floor because the wards 20 beds were full. 

Women waiting to deliver at Mulago's labour suite

“There is a lot of advocacy ending in nothing because congestion and limited monitoring are still big challenges in the suite. There is need to address human resource challenges, skills and equipment,” Dr Eva Nakabembe, a gynaecologist said.

Dr Eva checks the health of a pregnant woman

Meanwhile, three to 10 children are received daily at the Mwana Mugimu clinic depending on the season.

The overwhelming number of patients is a great challenge to the hospital which is in need of 946 approved nurses. Dr Byarugaba Baterana, the hospital’s executive director says there are only 882 nurses currently.

In the Emergency pediatric unit, there are only four nurses per duty instead of the required eight.

“At night, there needs to be at least five nurses on duty but there are usually three and yet they have to handle 80 patients,” Dr Opika Opoka, the head of the unit told the observer in an interview.

The crisis is similar to what is in the Mwana Mugimu clinic where there are only 11 qualified nurses of the needed 25.

“There is a lot of work to do such as preparing therapeutic foods and feeding the children every two hours which cannot be done by only 11 nurses,” Sr. Julian Eyotaru, the incharge of Mwana Mugimu said.

At the Uganda Cancer Institute (UCI), more than double of the 52 nurses currently available is needed. This is because of the large number of in and outpatients the institute receives. Dr Jackson Orem, the director of the institute says that at any one time, the institute handles about 4000 patients.

Last year alone, UCI saw more than 34000 visits.

Human resource challenges;

Dr Byarugaba says there is need for government to recruit new senior consultants and increase their salary. Mulago hospital has only 30 and 15 more are needed.

“Although they are among the highly paid civil servants earning about Shs 2.1m, this is not commensurate with the number of years spent in school. They need at least Shs. 15m,” he said in an interview.

He adds that nurses should be paid at least Shs 530,000 a month.

The hospital has an approved structure of 2166 positions of which 1877 are currently occupied. It is only the medical officers that are full. Two senior medical officers and 283 health workers are lacking and more neurosurgeons, biomedical engineers and pharmacists are needed.

Dr John Omagino the head of the Uganda Heart Institute (UHI) attributes the shortage of human resource at the institute to the existing narrow structure.

“The structure does not allow for a mix of diverse skills and yet to carry out any operation, one needs these,” he says.

There is 192 staff (30 percent) at the institute currently and yet this is still below the bar. Dr Omagino says that the institute management is in the process of contracting other staff to bring the numbers to at least 60 percent

A child and his mother at the Mwana Mugimu clinic where he is being treated for malnutrition

He adds that there is need for government to recognize different specialities by approving them on the structure and their associated terms in order to enable management to attract retain and plan a decent exit. To have these, he urges on the need to build training capacity.

“As a country, we do not have facilities for training these specialists and are instead, we are sending them out at a very high cost. What we need is to build local capacity,” Dr Omagino urged.

Although UCI has 10 operating specialists currently compared to five that were there in previous years, Dr Orem says that it needs more than 100 specialists.

Dr Byarugaba attributes the challenges of inadequate human resource to the fact that Mulago Hospital is over centralized.

“The hospital is non-autonomous and because of over centralization, the appointed structure has no existent directorates with appointed heads,” he said.

Byarugaba adds that the hospital’s relationship with Makerere University is also not defined.

New developments;

Despite these challenges, new developments to upgrade the hospital have been made and others are underway. For example 40 CCTV cameras and electronic display boards have been installed within the hospital to beef up security.

Planned projects include construction of 100 units of staff houses and construction of a fully fledged women’s hospital.