Our Side of the Story - Ugandan health workers speak up - VSO

Our Side of the Story: Ugandan health workers speak up
The way forward
Work overload, poor infrastructure and the lack of medical equipment, supplies
and medicines frustrated and distressed health workers. They felt unrewarded
for the work they do and undervalued. Their accounts show that working
conditions were the root causes of bad practices and unethical behaviour, and
that health workers bore the brunt of the blame for system failures. The research
revealed a vicious circle: impoverished working environments, along with low
pay, affected the quality of patient care; patients blamed the health workers; the
wider community then distrusted health workers, whose level of stress increased.
The situation was made worse by negative media stories and political leaders’
criticisms of health workers, which fuelled public distrust, damaged the standing
of the health profession, added to workers’ distress and, most importantly,
raised the barriers to access to healthcare.
Raising the voices of health workers
The view of civil society organisations, and of some managers,
was that frontline health workers are not empowered to speak
up. Indeed the concept of ‘voice’ was unfamiliar, and the idea
that they might speak out and gain support to improve poor
working conditions and the quality of care was new to many
frontline health worker participants. The research identified
barriers to individual health workers voicing their concerns and
their preferences for advocacy by representative organisations.
There were views among frontline workers that responsibility
for improvements lies with facility managers, district
management or the Ministry of Health. Stakeholders noted
that where decisions are made with no staff involvement
“the staff are afraid for their jobs, they fear to speak up”.
Anxiety about reprisals was a barrier to speaking out in public.
It was explained that “in Uganda there is a lot of fear of being
pinpointed if you talk out about your problems.” The low
esteem accorded to health workers was a further barrier.
It was said that nurses do not speak out because of the stigma
attached to the profession: “The moment you stand up and
say you are a nurse, people see you as a person who kills
patients, they assume you are a bad nurse, a failure.”
A lack of respect from management undermined nurses.
Those with experience in large urban hospitals told of senior
nurse managers and administrators who “sat on”, “barked
at” and “belittled” them in front of patients. They also
spoke of doctors who publicly ignored and disparaged their
“We never show why we should
be valued”
knowledge and contributions as “mere nurses”: “I have quite
often heard doctors tell a nurse she is stupid.” Such behaviour
coloured patients’ respect for nursing staff and damaged their
reputation in the wider community: “They think a nurse barked
at is nothing.” They said management blamed nurses unfairly,
failed to investigate problems and made their lives “miserable”.
Oppressed and voiceless in the workplace, it is not surprising
that nurses had little appetite for championing their profession.
This report has shown that rural workers in government
facilities have faced disappointed, distrustful and sometimes
angry patients, interfering and bullying local politicians and
politically engineered attacks on health workers’ credibility.
Hostile environments and impoverished workplaces drained
any will they had to do more than meet patients’ needs the
best they could.
Moreover, health workers had few chances to meet with
people from other healthcare facilities to exchange experiences
and build solidarity. Nurses spoke enthusiastically about a
forum organised by a health sub-district which discussed
solutions to common problems.
Speaking through professional associations,
unions and regulatory councils
Health worker participants favoured channelling concerns to
the Ministry of Health, Government or Parliament through
bodies that spoke for them as, unlike individual health workers,
such bodies “know the way”. Awareness of professional
organisations and trades unions was not widespread and there
was some confusion over their names, how their status differed
and which body did what.
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