Need for new approaches to global health system reform: The case of health care worker migration in Uganda

Background: Migration of healthcare workers from developing to developed countries and from rural to urban centers within developing countries is a phenomenon of substantial importance to efforts to improve health systems. This study sought to identify views from stakeholders at different levels of the health care system about what they think causes health worker migration in Uganda. It explores views of Ugandan healthcare workers, students in training and healthcare policy makers and implementers. Methods: The cross-sectional study employed questionnaires administered to Ugandan health care workers in central and western Uganda. Participants (n=62) were selected starting at the village level moving up to the national level according to the Ministry of Health referral system. Descriptive analysis of demographics, and knowledge and attitudes surrounding healthcare worker migration were done using SPSS. Results: Reasons given for international migration included the search for better remuneration (79.7%), better training opportunities (44%), stable work environments (20%) and corruption free systems (18%). Reasons given for rural-urban migration included the search for better amenities (42.4%), more ‘moonlighting' options (20%), further training opportunities (17%), and work in NGO funded projects (5%). Existing understaffing in healthcare was given as the major challenge (>70%) fueling worker migration. Lack of essential medicines (57.6%) and poor hospital infrastructures (16.9%) were identified as challenges suffocating job satisfaction. Conclusions: The study shows that reforming the Ugandan health care system requires improving working conditions, ensuring timely supply of medicines and diagnostic equipment, and providing accommodations for workers in rural areas, in addition to increasing salaries.