Health

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

Published

1 year 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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Call for Apllication: The James M. Ntambi Postdoctoral Fellowship

Published

1 day ago

August 1, 2025

Mak Editor

Professor James M. Ntambi, a professor in the UW–Madison Department of Biochemistry. Photo: wisc.edu

The James M. Ntambi Postdoctoral Fellowship offers an exciting opportunity for early-career scientists who have completed their Ph.D. training at a university in Africa. Fellows will be able to expand their existing research experience in biochemistry related to human metabolic diseases, continue their career development, and make impactful contributions to the scientific community upon their return to Africa.

The selected fellows will work in a cutting-edge research lab led by a faculty member from the University of Wisconsin–Madison Department of Biochemistry who will mentor and support the fellow throughout the duration of the fellowship.

The Department of Biochemistry is built on a commitment to excellence in basic research, established when it was founded in 1883, and continuing to the present day. Contributions by our researchers have dramatically changed our understanding of life and rank among the highlights of biochemistry to date. You can learn more about the Department’s history on our About page, and about the University of Wisconsin–Madison on the university’s main website.

Madison, Wisconsin is located northwest of Chicago, Illinois, an approximately 2.5 hours drive or bus ride from O’Hare International Airport.

Application materials must be uploaded by August 31, 2025.
Accompanying recommendations must be uploaded by September 15, 2025.

Visit the website to learn more, including eligibility details and how to apply: https://biochem.wisc.edu/the-james-m-ntambi-postdoctoral-fellowship

Health

Partnering for Health: Makerere and AHF Uganda Cares Unite Against HIV/AIDS

Published

2 days ago

July 31, 2025

Nancy Atwenda

National Medical Director-AHF Uganda Cares, Dr. Lubanga Augustine hands over condom dispensers and condoms to the 91st Vice Guild President-H.E. Kadondi Gracious as officials witness on 30th July 2025. Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares meeting to collaborate on HIV/AIDS prevention and care services for the University’s student population, 30th July 2025, Main Building, Kampala Uganda, East Africa.

Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares on July 30, 2025 held a meeting focused on establishing and strengthening collaboration between the two institutions in the fight against HIV/AIDS. The collaboration will particularly focus on prevention and care services for the University’s student population.

Speaking at the event, the Deputy University Secretary, Mr. Kizito Simon who presided over the meeting mentioned that Makerere University is involved in human capital development, aiming to create a healthy population alongside an educated one. “It’s not only good to have an educated population, but a healthy population as well,” he noted.

Mr. Kizito stated that the government supports various interventions in HIV prevention, care, and treatment, with the Makerere University Infectious Diseases Institute (IDI) playing a leading supportive role. On this note, he encouraged AHF Uganda Cares to equally come on board in order to strengthen the fight against HIV/AIDS.

The Deputy University Secretary outlined the Makerere University strategic plan’s prioritization of engagement and partnerships with various sectors, including ministries, departments, agencies, international organizations, civil society, and the private sector in order to strengthen its research-led aspirations. He therefore encouraged Uganda Cares to support HIV AIDS services, including prevention, care, and treatment, and to collaborate in research and innovation, especially with faculty members already engaged in HIV AIDS-related research.

However, he highlighted the demographic vulnerability of Uganda’s young population, with 73.2% aged between zero and thirty years old, making them a high risk group for infections. “This is more than just a time bomb for all of us here, because this is the population which we are hoping to be productive in the later years,” he pointed out.

Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares meeting to collaborate on HIV/AIDS prevention and care services for the University’s student population, 30th July 2025, Main Building, Kampala Uganda, East Africa. — ***The meeting in session.***

Mr. Kizito expressed appreciation for the wellness clinic initiative, which is poised to provide accessible sexual reproductive health services to students at no cost. On this note, he stressed the need to publicize these services to ensure students are aware of the available resources and are supported to overcome shyness and reluctance to seek help.

The 91^st Guild President Makerere University, H.E. Ssentamu Churchill James with concern noted the increasing levels of irresponsible behavior among young people, which has led to the high risk of contracting STDs, and welcomed initiatives proposed by AHF Uganda Cares.

He further highlighted the recent concluded HIV awareness campaign with Guild Leaders and the Director of the Makerere University Hospital. The campaign was aimed at educating students about HIV and other STDs, emphasizing the importance of knowledge and awareness.

H.E. Ssentamu pointed out that the first year students who are soon arriving on Campus are a key target audience for these awareness efforts. He stressed the importance of abstinence but also emphasized the need for protection in case of emergencies.

The 91^st Guild President suggested the possibility of counseling for those who have already contracted STDs. “I hope we can have an attachment of counselling for people that have already contracted diseases,” he stated.

He took note of existing efforts such as the government’s stock of contraception and the presence of health ministers at every hall of residence. In this regard, he proposed a linkage between the initiative and these health committee members through the Guild Minister of Health Affairs to ensure continuity.

National Medical Director of AHF Uganda Cares, Dr. Lubanga Augustine. Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares meeting to collaborate on HIV/AIDS prevention and care services for the University’s student population, 30th July 2025, Main Building, Kampala Uganda, East Africa. — ***National Medical Director of AHF Uganda Cares, Dr. Lubanga Augustine.***

The National Medical Director-AHF Uganda Cares, Dr. Lubanga Augustine expressed gratitude for the opportunity to discuss collaboration with Makerere University. He particularly noted previous collaborations and the need to seize opportunities for future collaboration.

He highlighted that AHF Uganda Cares provides cutting-edge medicine regardless of the patient’s ability to pay and advocates for conducive policies to increase access to HIV and STI services.

Dr. Lubanga emphasized the importance of addressing the gap in young people’s access to health services particularly for sexual health issues. He noted that even parents and guardians often avoid discussing sexual issues contributing to a lack of education awareness among young people.

He pointed out that funding for HIV prevention has shifted towards treatment despite the need for continued prevention efforts. In this, he called for increased advocacy and partnerships to secure funding for health services particularly for young people. He appreciated past interventions such as installing condom dispensers in hostels and the need for renewed partnerships with university leaders.

Dr. Lubanga expressed willingness to collaborate with the University Hospital to ensure that no one is left behind in HIV and STI services. As a sign of their commitment, AHF Uganda Cares handed over condom dispensers and condoms to the university.

Dr. Byamugisha Josaphat, Director at the Makerere University Hospital emphasized the importance of prevention in health, through programs such as STI prevention, HIV early treatment, and health education “Prevention is better than cure,” he said. He highlighted that the hospital has got satellite clinics at the Makerere University Agricultural Research Institute Kabanyolo (MUARIK) and the Jinja Campus, serving a significant number of students, staff and the public.

The Director discussed the need for health education and information materials, including pamphlets and WhatsApp messages, to educate students and the public about HIV. “The university is already running health education programs for students and surrounding communities,” he stated.

Prof. Josaphat Byamugisha (Right) makes his remarks as Dr. Lubanga Augustine (Left) and Mr. Simon Kizito (Centre) listen. Makerere University and the Aids Healthcare Foundation (AHF) Uganda Cares meeting to collaborate on HIV/AIDS prevention and care services for the University’s student population, 30th July 2025, Main Building, Kampala Uganda, East Africa. — ***Prof. Josaphat Byamugisha (Right) makes his remarks as Dr. Lubanga Augustine (Left) and Mr. Simon Kizito (Centre) listen.***

Dr. Byamugisha further highlighted the importance of male circumcision as a preventive measure against HIV, which is already being offered at the university hospital. “We are aware that safe male circumcision can prevent about 60% of male HIV,” he explained.

He talked about the need for supplies and human resources for screening, emphasizing the importance of protecting the university community and surrounding areas. “The university hospital aims to go beyond just serving students but also help the broader community,” he added.

The Hospital Director emphasized the importance of peer-to-peer interaction between students and staff to enhance health education and support as this could help the students open up more on sexual issues which may not be the case with a person who is older than them. He further explained students undertaking internship at the Makerere University Hospital already have the advantage of easily talking to the staff about these issues.

Dr. Byamugisha highlighted the need for post-exposure prophylaxis (PEP) drugs and counseling, ensuring that people understand the importance of taking these drugs. He suggested specific targets for collaboration, such as supporting a medical officer and providing services rather than cash. “Many a time we don’t need cash, we need in-kind support through a person or provision of a service,” he stated.

In his final remarks, he appealed for support to make services more accessible to students and reiterated the importance of collaboration to protect students and the broader community.

The Deputy Principal, College of Engineering, Design, Art and Technology (CEDAT)-Prof. Kizito Maria Kasule, highlighted that 75% of young people contracting HIV are between the ages of 14 and 24, indicating a need for targeted prevention efforts.

He pointed out the poverty among girls as a significant issue contributing to the spread of HIV because they look at the sexual related practices as means of earning a living which has led to the high spread of these infections.

Prof. Kasule emphasized the importance of involving different religious institutions to sensitize people about the organization’s work and counteract negative perceptions. He suggested that the organization should collaborate with various religious institutions. “Even Born Agains are involved in the sexual relationships but cannot come out to express themselves,” he added.

He stressed the importance of open discussions about gender and sexuality free from fear and trouble, and he raised the need for sensitization within and outside the institution.

Coordinator of the HIV program at AHF Uganda Cares, Mrs. Mbabazi Martha, introduced the girl’s act program which aims to empower young women to address issues affecting them at various levels, from primary school to national policy. “The program encourages young women to raise their voices and influence policies that affect their lives,” she commented.

She highlighted the success of the program in engaging young people and influencing policy changes at different levels of governance, such as the distribution of sanitary pads in schools and communities.

Mrs. Mbabazi emphasized the importance of skilling centers for young girls to gain economic independence and avoid exploitation. She highlighted the success of webinars and dialogues in raising awareness and influencing behavior change. In closing, she called for continued collaboration with various stakeholders to support the empowerment of young people and address the root causes of HIV infection.

Mr. Amojong Trevor, a representative from AHF Uganda Cares, introduced the “Boys to Men” initiative program to address poor health seeking behavior and lack of testing among boys. He emphasized that the need to empower girls should go hand in hand with focusing on boys to prevent the spread of HIV.

He mentioned the low demand of female condoms and suggested demonstration on how to use them to increase awareness and usage.

About AHF Uganda Cares

Aids Healthcare Foundation (AHF) Uganda Cares an NGO based in the USA operating in 47 countries, including 14 in Africa. AHF Uganda Cares started in 2002 in the Masaka region and now operates in 32 districts with over seven health facilities. The organization supports over 203,000 lives on HIV treatment and has tested over 7 million Ugandans for HIV.

The organization offers HIV prevention services, including the ABC (Abstinence, Be Faithful, Condom) approach, and provides about 6 million condoms annually.

Health

CHS Annual Report 2024

Published

1 week ago

July 23, 2025

Zaam Ssali

Left to Right: Mr. Evarist Bainomugisha, Mr. Deus Tayari Mujuni, Mr. Simon Kizito, Prof. Damalie Nakanjako, Prof. Bruce Kirenga, Dr. David Patrick Kateete (Rear), Prof. Henry Alinaitwe, Dr. Richard Idro (Rear), Mr. Patrick Akonyet and Prof. Annettee Nakimuli at the handover ceremony on 2nd December 2024. Handover of Principal Office by Prof. Damalie Nakanjako to Assoc. Prof. Bruce Kirenga, 2nd December 2024, College Boardroom, College of Health Sciences (CHS), Makerere University, New Mulago Hospital Complex, Kampala Uganda, East Africa.

It is with great honor that I present to you the Makerere University College of Health Sciences Annual Report 2024. On behalf of the entire College of Health Sciences Community, I express my sincerest thanks and gratitude to the college management team that delivered the work led by Principal Professor Damalie Nakanjako.

The reporting saw several significant achievements that you will be able to read in this report. Notable among these achievements included kick starting the activities to celebrate 100 years since the medical school was started (CHS@100). The College of Health Sciences led and participated in a number of conferences, research dissemination and collaborations notably the college flagship scientific conference, the Joint Annual Scientific Health Conference (JASH) under the theme, “Global Health Security: Partnerships for Epidemic Response and Control in SubSaharan Africa”. Other activities included: hosting Dr. Yin Ye, President of the BGI group in China, a leading institution in genomics research and a manufacturer of whole genome sequencers (alongside illumina Inc. in California), several research dissemination activities of key studies and a symposium on parenting, a ground breaking initiative of our Child Health and Development Centre.

Our faculty continued to engage in research along teaching and providing clinical care and other services in our teaching site. About 400 publications were published and I congratulate all those who made a contribution to this scholarly achievement.

In the area of teaching and learning, I thank all staff academic and non-academic who ensured that our students were taught and examined. I congratulate the School of Biomedical Sciences for having the Biomedical Sciences programme accredited. Two clinical fellowships were also approved by the Uganda Medical and Dental Practitioners Council.

The College of Health Sciences has achieved a lot in this reporting year and the previous years. A lot remains to be done. My team is ready and prepared to take on the challenges of the college in our administration period of 2024-2028.

I wish you all a nice and enjoyable read.

Assoc. Professor Bruce J. Kirenga
PRINCIPAL

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