Health

Poorly implemented COVID-19 incentives eroded health workers’ motivation in Africa – Study

Published

10 months ago

April 23, 2024

Staff from IDI and the Ministry of Health engage in Personal Protective Equipment demonstrations after a two-day progam to spearhead the rollout of COVID-19 Infection Prevention and Control (IPC) guidelines on 27th April 2020 at the IDI-McKinnell Knowledge Center, Makerere University, Kampala Uganda.

_{By Okeya John & Davidson Ndyabahika}

As the COVID-19 pandemic swept across Africa, it brought with it a wave of unprecedented challenges, impacting economies, social dynamics, and political structures. National healthcare systems were particularly strained, prompting governments to implement various strategies to combat the virus and its repercussions. Among these measures were the introduction of incentives, both financial and non-financial, aimed at boosting the morale of health workers and bolstering the capacity of healthcare systems to respond to health emergencies.

Due to COVID-19’s increased risks and demand on healthcare workers working in already overburdened health systems, incentive packages must be strengthened. Researchers conducted a multi-country qualitative study in DRC, Nigeria, Senegal, and Uganda with funding from the Bill and Melinda Gates Foundation and Gates Ventures/Exemplars in Global Health. The study examined pandemic-related workplace incentives. In 60 virtual interviews via phone and Zoom, ministry officials, policymakers, and health care providers provided important viewpoints.

Entitled “Health Workforce Incentives and Dis-Incentives During the COVID-19 Pandemic: Experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda,” the research conducted by healthcare experts delved into the realm of incentive mechanisms, their allocation, and the inadvertent dis-incentives experienced by the health workforce amidst the pandemic response efforts.

The researchers were from Makerere University School of Public Health (Uganda), University of Kinshasa (DRC), University of Ibadan (Nigeria) and University of Dakar (Senegal). The research team comprised Suzanne Kiwanuka, Ziyada Babirye, Steven Kabwama, Andrew Tusubira, Susan Kizito, Rawlance Ndejjo, Marc Bosonkie, Landry Egbende, Berthold Bondo, Mala Ali Mapatano, Ibrahima Seck, Oumar Bassoum, Mamadou Leye, Issakha Diallo, Olufunmilayo Fawole, Segun Bello, Mobolaji Salawu, Eniola Bamgboye, Magbagbeola David Dairo, Ayo Steven Adebowale, Rotimi Afolabi, and Rhoda Wanyenze,

In their work, the scientists authoritatively note that: “Health worker incentives during the COVID-19 response were mostly unplanned, predominantly non-financial, and invariably implemented. Across these countries, there were neither guiding frameworks nor standard pre-determined packages of financial and non-financial incentives for health workers during emergencies.”

Before the outbreak of the COVID-19 pandemic in December 2019, “Africa already had weak health systems,” they note, citing that the pandemic exposed this challenge, increasing work overload for health workers, mental stress, infections and deaths, who in turn, needed incentives to adequately work to respond and deliver good health outcomes during the emergency.

However, due to the dire working conditions, the Word Health Organization (WHO) had warned that frontline healthcare workers were most at risk of acquiring the deadly COVID-19 virus. In their report, WHO highlighted that between January 2020 and May 2021 alone, over 80,000 to 180,000 health and care workers respectively, had died of COVID-19 globally, calling for urgent need to reverse the tide.

From this study, Senegal faces a doctor and nurse shortage with only 0.38 healthcare workers per 1,000 people, well below the WHO recommendation. By December 2021, Senegal had recorded 75,055 COVID-19 cases and 1,890 deaths, including five health workers. Similarly, Uganda, with approximately 2.58 healthcare workers per 1,000 people, reported 146,030 COVID-19 cases and 3,306 deaths, including 37 health workers.

The researchers also noted that the DRC had 1.05 healthcare workers per 1,000 people, with 79,632 cases and 1,225 deaths, including 35 health workers. Nigeria faced a similar challenge, with 2.0 healthcare workers per 1,000 people, 243,450 cases, and 3,031 deaths by December 2021, including seven health workers. These findings stressed the strain on Africa’s fragile healthcare systems in responding to the COVID-19 pandemic.

“These challenges and consequences resulted in health workers either absconding from duty or in extreme circumstances, resigning from the health profession and opting for alternative professions,” the researchers note in their review of the COVID-19 response in Africa. They state that elsewhere by this time, measures had already been mounted to motivate health workers, necessitating a similar response in the continent.

In the countries where the study was conducted, the strategies adopted by governments and development partners to counter declining health worker motivation included offering financial rewards like allowances and salary increments, and non-financial incentives like adequate provision of medicines and supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support and increased supervision.

The researchers found that the financial rewards were a big motivating factor for the health workers in these countries in sustaining the health systems and COVID-19 efforts, while the non-financial incentives also contributed to improved health worker determination.

The incentives, although a success, however in their strength lied the weaknesses. The multi-country study reveals that the incentives had the double effect of creating disincentives and demotivating healthcare workers. This was occasioned by the lack of personal protective equipment, transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access and adequacy of the rewards.

The study got its findings from virtual key informant interviews with the staff at ministries of health, policy makers, and health workers. In the study report, health managers and workers in DRC, Nigeria, Senegal, and Uganda confirmed that health workers received monetary benefits as a means of motivation for their effort towards the continuity of health services.

In Senegal, incentives were reported to mostly be financial. However, in DRC, although the salaries of the health workers involved in COVID-19 testing were reported to be similar to all other staff in response committees like epidemiological surveillance, case management, and communication, the government moved to temporarily waiver taxes to bait the COVID-19 health workers during the pandemic.

“Since financial incentives were mostly administered in an ad-hoc manner, some health workers felt they were unfairly distributed and complained about the lack of transparency in the allocation of these incentives. In Nigeria, it was reported that payments did not meet the health worker expectations, while in Uganda, it was reported that allowances were given selectively to some health workers such as those involved in contact tracing, COVID 19 testing, and COVID 19 isolation units but not to others.” The study report reads in part.

Respondents also revealed that although allowances were availed, there was dissatisfaction caused by delays and non-payment. In Uganda for example, the recruitment of additional 700 staff on contract although initially perceived positively, their irregular dismissal following budget shortfalls created discontentment and immense pressure for the government.

Accordingly, the authors observe that the incentive packages in the four African countries were inconsistent, lacked transparency, adequacy, and equity. “Therefore, there is a need to develop guiding frameworks within which governments and partners can deliver incentives and reduce dis-incentives for the health workforce during emergencies.”

The study suggests that during health emergencies like COVID-19, increased risks and workloads should mandate the provision of safety gear and adequate supplies. However, the researchers caution that both financial and non-financial incentives can have unintended consequences if perceived as unfair in their implementation.

They also call for incentives to be pre-determined, equitable and transparently provided during health emergencies ‘because arbitrarily applied financial and non-financial incentives become dis-incentives’, while still holding that the financial incentives are only useful in as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments.

“Governments need to develop guidelines on incentives during health emergencies with careful consideration of mitigating potential dis-incentives. The harmonization of roles across state and non-state sector players in incentivizing the health personnel during health emergencies is paramount.” The study affirms.

Find the detailed scientific study here.

View on MakSPH

Related Topics:Africa COVID-19 efforts financial Global Health healthcare Incentives MakSPH morale pandemic policy PPE response Risk study Uganda virus WHO workload

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Health

Exciting PhD Opportunity in Health Innovation – Starting 2025

Published

2 weeks ago

January 22, 2025

Mak Editor

The NTU-Mak delegation posing with some of the community health workers at the field office in Nakawuka, Wakiso district.

We are happy to share this exciting PhD studentship opportunity through the NTU-Makerere University partnership under the theme Health Innovation. Starting in 2025, this project will focus on One Health drivers of antibiotic-resistant bacterial infections in rural Ugandan communities.

The research will combine microbiological and public health approaches to explore the prevalence, transmission, and contributing factors of antibiotic-resistant bacteria in these communities. Key research questions include:

What human, animal, and environmental factors contribute to the spread of antibiotic-resistant bacteria?
How can Community Health Workers (CHWs) help mitigate their spread?

Requirements:

Essential: Willingness to spend time in both Uganda and the UK during the project and proficiency in Luganda.
Desirable: Wet lab microbiology skills.

For full details, visit:
<https://www.ntu.ac.uk/study-and-courses/postgraduate/phd/phd-opportunities/
studentships/health-innovation-phd-studentships/one-health-drivers-of-antibi
otic-resistant-bacterial-infections-in-rural-ugandan-communities> NTU Health Innovation PhD Studentships.

Application Deadline: Friday, 14 February 2025.

For inquiries, contact Dr. David Musoke at dmusoke@musph.ac.ug or Jody Winter at jody.winter@ntu.ac.uk.

Health

75th Graduation Ceremony of Makerere University: MakCHS presents Graduands

Published

3 weeks ago

January 14, 2025

Zaam Ssali

Graduands jubilate during the Mak75thGrad Ceremony. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

The Makerere University College of Health Sciences (MakCHS), College of Natural Sciences, and College of Business and Management Sciences presented graduands for conferment of degrees on the 14^th January, 2025 which was the day 2 of the 75^th Graduation Ceremony of Makerere University that commenced on Monday 13^th January 2025.

MakCHS presented a total of 886 graduands including (23) Doctor of Philosophy (PhD), (456) Masters and (407) Bachelors. For the second year, MakCHS produced the researcher with the biggest number of publications, Prof. Moses Kamya and he received an award for the achievement.

PhD recipients on Day2 of the Mak75thGrad Ceremony. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***PhD recipients on Day2 of the Mak75thGrad Ceremony.***

Speaking to the congregation, Professor Barnabas Nawangwe – Vice Chancellor, Makerere University welcomed everyone to Makerere University’s 75^th Graduation. He congratulated the 13,658 graduates, including 143 PhD recipients, 53% female graduates and 47% male graduands who will be awarded degrees through the graduation week. He commended the efforts of staff, parents, and sponsors in supporting the students’ journeys. Professor Nawangwe praised the achievements of Makerere’s Colleges and Schools, he commended MakCHS for the leadership in research and innovation flying the Makerere flag globally. He noted, ‘The College of Health Sciences is our flagship college for research and community engagement. This college accounts for 50% of all research grants won and also 50% of all the publications by the University. The College celebrated 100 years last year, making it the oldest college at Makerere University’.

MakCHS Principal Assoc. Prof. Bruce Kirenga (2nd left) with MakCHS Faculty. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***MakCHS Principal Assoc. Prof. Bruce Kirenga (2nd left) with MakCHS Faculty.***

Prof. Barnabas Nawangwe speaking during the Graduation. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Barnabas Nawangwe speaking during the Graduation.***

Prof. Nawangwe reiterated Makerere’s transformation to a research-led institution supported by the government funded Makerere University Research and Innovations Fund (Mak-RIF). “We are addressing national priorities, such as improving the Parish Development Model and advancing e-governance,” he stated. The Vice Chancellor also congratulated Dr. Crispus Kiyonga on his appointment as Chancellor and urged graduates to leverage their education to create solutions for societal challenges.

Professor Nawangwe advised the graduands thus, ‘We have equipped you with the knowledge and skills that will make you employable or to create your own businesses and employ others. Do not despair if you cannot find employment, instead reflect on the immense opportunities around you and raise them as an entrepreneur.’

Professor Puleng LenkaBula, Principal and Vice-Chancellor of the University of South Africa (UNISA) delivered the commencement speech where she called on the graduands to remain resilient and emancipate Africa’s people. Her address titled “The Power of Resilience – African Woman, Find Your Generational Mission and Redefine Your Worth”, Professor LenkaBula highlighted the critical role of African women in shaping the continent’s destiny.

Prof. Puleng LenkaBula, Vice Chancellor of the University of South Africa delivering her commencement lecture. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Prof. Puleng LenkaBula, Vice Chancellor of the University of South Africa delivering her commencement lecture.***

Professor LenkaBula expressed gratitude for being invited to such a significant occasion and extended greetings from South Africa, including from UNISA’s Chancellor, former South African President Dr. Thabo Mbeki. She praised Makerere University for its legacy of academic excellence and contributions to the African continent, emphasizing its role in anti-colonial struggles, post-colonial development, and its steadfast commitment to African unity. She called for a renewed focus on gender equity in academia and leadership, noting the disproportionate burdens faced by women in society. Citing the achievements of Makerere University in gender mainstreaming, she expressed optimism about the role of young leaders in dismantling patriarchal systems and fostering inclusive development.

Professor LenkaBula concluded her address to graduands with a call to action: “Your graduation is not merely a personal achievement but a contribution to Africa’s collective progress. History has thrust upon you the task of creating a future defined by resilience, innovation, and equality.”

In his remarks, Dr. Crispus Kiyonga – Chancellor, Makerere University congratulated graduands upon making it to the 75^th Graduation Ceremony of Makerere University. Dr. Suruma expressed his appreciation of His Excellency the President and First Lady/Minister of Education and Sports for giving him the opportunity to serve Uganda and for the continuous support extended to Makerere University, requesting the congregation to join him and give them a warm applause. Dr. Kiyonga reiterated President Museveni’s directive to Makerere University to integrate the teaching of political economy across all courses to enhance students’ understanding of the country’s socioeconomic conditions. The directive, welcomed by the university’s top management, will be incorporated into the curriculum to align education with the needs of the people and the nation.

Hon. Dr. Crispus Kiyonga addresses the congregation. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Hon. Dr. Crispus Kiyonga addresses the congregation.***

He expressed appreciation that the government has pledged to bolster Makerere’s research funding and he encouraged the University to strengthen partnerships with the private sector to commercialize innovations developed at the institution.

The new Chancellor pledged support to the University management in saving its land and urged that an agro-industrial park be established. “This park would serve three purposes: teaching, generating income, and acting as a demonstration site for communities across the country,” Dr. Kiyonga noted. He also emphasized the urgency of addressing Uganda’s food insecurity, highlighting that 40% of children in the Rwenzori region are stunted, with malnutrition affecting most regions of the country.

Dr. Kiyonga also pointed out Africa’s underperformance despite its vast resources, describing it as a contradiction. “It is our responsibility to change the conditions of our people and ensure Africa rises to its potential,” he urged.

The ceremony was graced by Hon. Joyce Moriku Kaducu, Minister of State for Primary Education, who represented the First Lady and Minister of Education and Sports, Hon. Janet Kataaha Museveni. Other dignitaries included members of Parliament, the judiciary, the diplomatic corps, and academics.

The Minister lauded Makerere University for its dedication to academic excellence and innovation. “Today reflects the resilience, hard work, and commitment of our graduates, supported by the university staff, management, and parents,” she said. The Minister commended the Vice Chancellor and management for fostering research and innovation while urging them to maintain robust quality control systems to uphold the institution’s integrity.

Min. Kaducu representing the Minister of Education. 75th Graduation Ceremony, Day 1, CoCIS, CEES, CoVAB and School of Law. 13th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***The Minister of State for Primary Education Hon. Dr. Joyce Moriku Kaducu represented the Minister of Education and Sports, Hon. Janet Kataaha Museveni.***

She also reflected on Makerere’s recent milestones, including the commissioning of a new the launch of the School of Graduate Studies and Research. “Your achievements stem from hard work, transparency, and accountability. They set Makerere apart as a leader in higher education,” she noted. Addressing the graduates, Hon. Kaducu encouraged them to apply their skills to solve societal challenges. “Makerere has equipped you with critical thinking and creativity. Use this to seize opportunities, make a difference, and shine wherever you go,” she concluded. During the 75^th graduation ceremony held from the 13^th -17^th January, 2025, a total of 13,658 graduands were awarded degrees and diplomas in various disciplines. Of these, 143 received PhDs, 1,813 Masters Degrees, 243 postgraduate Diplomas, and 11,454 Bachelor’s Degrees. 53% of the graduands are female and 47% are male. 44% of the PhD graduands are female. A total of 491 graduands received first class degrees.

Health

Certificate in Water, Sanitation and Hygiene 2025

Published

2 months ago

December 17, 2024

Mak Editor

The Head, Department of Epidemiology and Biostatistics-Prof. Nazarius Mbona Tumwesigye (6th L) and the Head, Department of Disease Control and Environmental Health-Dr. Esther Buregyeya (4th L) pose with 25 graduands of the WASH Short Course on 20th July 2018, MakSPH, Mulago Campus, Makerere University.

Course Objectives

The course is intended to strengthen the capacity of practicing workers to successfully identify and manage Water, Sanitation and Hygiene (WASH) opportunities and problems by facilitating the acquisition of adequate knowledge, development of skills and attitudes through understanding and use of the 6 essential services of WASH. These are to:

Monitor WASH status to identify and solve community environmental health problems.
Diagnose and investigate WASH problems and health hazards in the community.
Inform, educate and empower people about WASH issues.
Mobilise community partnerships and actions to identify and solve WASH problems.
Evaluate effectiveness, accessibility and quality of personal and population-based WASH services.
Research for new insights and innovative solutions to WASH problems.

Course Structure

The course is an 8-weeks programme of study. Participants will spend 3 weeks (full-time) at Makerere University School of Public Health (MakSPH) while 4 weeks will be spent at suitable workplaces / field sites. The final week of the course will be spent at MakSPH for presentation of project / field work, final examination, and the certificate awarding ceremony. This is a day programme and will run from 26^th May to 18^th July 2025.

Course Modules

Water Resources Management
Environmental Sanitation
Hygiene Promotion
WASH Policy, Planning and Financing
Field / Project Work

Mode of delivery of the course includes lectures, tutorials, seminars, practicals and field work.

Dates	26^th May to 18^th July 2025
Fees	Ugandans	Internationals
	UGX 900,000	USD 500

Dates and Fees for the Certificate in Water, Sanitation and Hygiene 2025

Who should apply?

Practicing officers in the WASH sector including those working in local government, non governmental organizations (NGOs) or the private sector.
Environmental Health workers who wish to broaden their knowledge and skills as a form of Continuous Professional Development (CPD) so as to be better equipped to implement WASH activities.

Entry requirements for admission to the course are Uganda Advanced Certificate of Education (UACE) or its equivalent with at least 1 year working experience in WASH.

How to apply?

Application forms and procedure can be obtained from the Department of Disease Control and Environmental Health, Makerere University School of Public Health, New Mulago Hospital Complex or from the website below:
https://sph.mak.ac.ug/academics/water-sanitation-and-hygiene-wash

The deadline for receiving applications is Wednesday 26^th March 2025.

For further details, contact:

Course Administrator
Ms. Irene Nassazi
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: inassazi@musph.ac.ug Tel. +256771671354

Course Coordinator
Dr. David Musoke
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: dmusoke@musph.ac.ug Tel. +256788572129

Co-Course Coordinator
Mr. Allan Ssembuusi
Makerere University School of Public Health
New Mulago Hospital Complex
E-mail: assembuusi@musph.ac.ug Tel. +256759955067

Makerere-SPH-WASH-Course-2025-Poster Download