Health worker education, practice and migration: mechanisms for enhancing management and regulation in Uganda: policy brief

Health worker education, practice and migration: mechanisms for enhancing management and regulation in Uganda Policy brief Applying competency-based education in Uganda will ensure that its health workers are trained using curricula that are rooted in health and health system needs towards improved individual and population health, and efficient management and organization of the health sector. Uganda should use competency-based curricula informed by the essential service package, national norms, standards and guidelines, occupational roles and scope of practice for health worker categories, local epidemiology, mortality and morbidity, and all-hazards emergency risk assessments, in training a fit-for-purpose workforce to address the population’s health needs. Policy-makers should strengthen legal frameworks that guide the regulation and practice of health workers across the public and private sectors to ensure adequate registration and tracking of all health workers, monitoring of their emigration, and enforcement of licence renewals to ensure quality health care delivery. Uganda should consider entering into bilateral health worker mobility agreements to negotiate better deals from destination countries for needs-based national health workforce development and health systems strengthening. 1 2 3 4 Key Messages 2Health worker education, practice and migration: mechanisms for enhancing management and regulation in Uganda This brief provides insights into the context of education, regulation and migration in Uganda and mechanisms for Government and partners to improve health workforce education and practice and manage emigration. The health workforce is crucial for achieving the health-related Sustainable Development Goals (SDGs). Attaining the SDGs by 2030 requires a health workforce equipped to provide the full range of essential health services. This entails having health workers with the education, support, and supervision necessary to deliver people-centred and integrated health services. Competency-based education forms the foundation for training health workers to meet population health needs. Competencies, defined as a person’s ability to integrate knowledge, skills, and attitudes demonstrated through behaviours in performing tasks in a given context, make competency-based education the most effective approach for ensuring preparedness for practice.1 The response to and recovery from the COVID-19 pandemic and other public health emergencies such as Ebola, and the drive towards building resilient health systems, afford Uganda a unique opportunity. Investing in strengthening competency-based health worker education will yield significant benefits in health, job creation, global health security, economic opportunity, and gender equity. Therefore, Uganda needs to transform the education and training of health workers across the public and private sectors. This will equip them with the competencies, knowledge, skills, and attitudes required to provide quality, effective, efficient, equitable, inclusive, integrated, people-centred, safe, and timely health care. Using competency-based curricula developed on the basis of the essential service package, relevant legislation, policies, regulations, guidelines, occupational roles, and scope of practice for health worker categories, local epidemiology, mortality, morbidity, and all-hazards emergency risk assessments, Uganda can train a fit-for-purpose and fit-to-practice workforce to address the population’s health needs. It will also ensure that resources are channelled to develop priority skills for Uganda’s health system. With the education of the health workforce in Uganda managed by the Ministry of Education and Sports and its entities, and regulation of practice placed under the Ministry of Health and the professional regulatory councils, synergistic action is needed to ensure that trained and licensed health workers are fit for purpose. Similarly, intersectoral regulation of education is vital, considering that 78% of the health training institutions in Uganda are privately owned. Ownership of 210 health training institutions in Uganda Private not for profit Private for profit Government 47 133 30 Uganda needs to transform the education and train- ing of health workers across the public and private sectors. This transformation will equip them with the competencies, knowledge, skills, and attitudes required to provide quality, effective, efficient, equitable, inclusive, integrated, people-centred, safe, and timely health care. What is this policy brief about? Why is it necessary to equip health workers through competency-based education? Beyond training and education, regulation of education and practice is essential to achieving universal health coverage and ensuring patient safety Uganda should develop and implement interventions aimed at registering and tracking all health workers, monitoring their emigration, and enforcing licence renewals to guide workforce planning and ensure quality health care delivery. 3Health worker education, practice and migration: mechanisms for enhancing management and regulation in Uganda Effective regulation of the health workforce, managed by the Ministry of Health and functional professional regulatory bodies established through legal frameworks, ensures that health workers are adequately trained, certified, licensed and adhere to ethical guidelines and standards of care. This oversight guarantees quality service delivery and protects patients from malpractice and substandard treatment, thereby enhancing trust in health care systems. However, these guarantees and protection are currently suboptimal, with the functionality of the professional regulatory bodies undermined by various factors. Consequently, mandatory registration and licensure of health workers is not enforced, while information on qualified and practising health workers is not readily available, especially for those in the private sector. Likewise, tracking the attrition and migration of health workers is weak and this hampers evidence-based planning and management of the health workforce. To address these issues and ensure quality service delivery and patient safety, Uganda should develop and implement interventions to register and track all health workers, monitor their emigration, and enforce licence renewal procedures to guide workforce planning and ensure quality health care delivery. Furthermore, intersectoral collaboration is needed to regulate the training and education of the health workforce. Currently, mechanisms for tracking the migration of Uganda’s health workers are weak, mainly due to limitations in health workforce information systems at various levels, including the professional regulatory bodies. Consequently, the state of brain drain in Uganda is not known and this has the potential of impeding Uganda’s progress towards achieving UHC. The World Health Organization (WHO) Global Code of Practice on the International Recruitment of Health Personnel2, adopted in 2010 at the Sixty-third World Health Assembly, established principles and practices for the ethical international recruitment of health workers, and serves as a reference for Member States to strengthen their legal/institutional framework. WHO has also produced guidance for bilateral agreements on health worker migration and mobility.3 Uganda is one of the countries identified in the 2023 WHO support and safeguards list for protections from active international recruitment and should be prioritized for health personnel development and health system-related support.4 This is explained by the fact that it has a UHC service coverage index that is lower than 50, and a density of doctors, nurses and midwives that is below the global median (that is, 48.6 per 10 000 population). To ethically manage the migration of its health workers, Uganda should consider entering into bilateral health worker mobility agreements to negotiate better deals from destination countries for needs-based national health workforce development and health systems strengthening. Evidence from the Uganda Health Labour Market Analysis demonstrates the dynamics between supply, need and demand for the health workforce. Specifically, it highlights the fact that in 2023, the supply of jobs could not cater for the available health workers within the prevailing circumstances. This situation will get worse unless actions are taken to expand the financial space to recruit more health workers. This policy brief was based on the Analysis of The Health Labour Market of Uganda: Findings from a descriptive and predictive analysis report. It was prepared by Sunny C Okoroafor, James Avoka Asamani, Paul Marsden, Giorgio Cometto and Yonas Tegegn Woldemariam Managing the migration of Uganda’s health workers ethically through bilateral agreements Uganda should consider entering into bilateral health worker mobility agreements to negotiate better deals from destination countries for needs-based national health workforce development and health systems strengthening 4© WHO African Region, 2024. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence Reference number: WHO: AFRO/UGA:2024-02 1. Global Competency and Outcomes Framework for Universal Health Coverage. Geneva: World Health Organization; 2022. 2. WHO Global Code of Practice on the International Recruitment of Health Personnel: National Reporting Instrument. Geneva: World Health Organization; 2012. 3. Bilateral agreements on health worker migration and mobility: maximizing health system benefits and safeguarding health workforce rights and welfare through fair and ethical international recruitment. Geneva: World Health Organization; 2024 4. WHO: Health Workforce Support and Safeguards List. 2021. The Change We Need The management and regulation of health worker education, practice and migration in Uganda need to be enhanced, in order to ensure that health workforce development and management efforts result in the achievement of national goals and the SDGs. The following five strategies need to be implemented by the relevant ministries, entities and stakeholders to improve the functionality of Uganda’s health labour market and foster health workforce development and management: 1. Mechanisms and interventions aimed at ensuring that all trained health workers are registered and tracked irrespective of sector of employment and employment status should be developed, implemented, monitored and reported to decision-makers annually. 2. Tracking of the emigration of health workers should be strengthened and routinely reported to the relevant ministries and entities to guide planning for the training and employment of health workers. 3. Regulatory frameworks for renewal of practising licences for health workers providing health services to the population in public and private settings should be developed and enforced. 4. Develop and/or review and implement pre- service training standards and curricula to ensure they align with the disease burden and clinical service delivery modalities, and ensure that resources are channelled to training priority cadres for Uganda’s health system. 5. Strengthen oversight to ensure quality in the training and education of health workers across the public and private sectors in line with competency-based education curricula. Call To Action Policy-makers should: • Improve coordination of the line ministries and entities in health worker education, training, regulation and management of migration. • Request and use evidence on health workforce supply and migration in policy dialogue, advocacy and planning for employment of trained health workers. • Strengthen the legal and regulatory frameworks of regulatory bodies to enforce registration and routine tracking of all cadres of health workers irrespective of sector of employment and employment status. • Implement policies guiding regulation and practice of health workers to ensure enforcement of licence renewals to guarantee quality health care delivery. • Sign and implement bilateral health worker mobility agreements and negotiate better deals from destination countries for needs-based national health workforce development and health systems strengthening. References