Health

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

Published

2 years 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

PhD Fellowship Opportunity: NETOMA Study

Published

1 day ago

October 12, 2026

Mak Editor

Dr. Henry Komakech (centre) stands with fellow MakSPH PhD graduands at Makerere University’s 76th Graduation Ceremony (L–R): Dr. Olivia Nakisita, Dr. Aber Harriet Odonga, Dr. David Lubogo, Dr. Samalie Namukose, Dr. Moses Ntaro and Dr. Jimmy Osuret. February 25, 2026, Freedom Square, Makerere University. Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Henry Komakech, “Effects of the Repatriation of Refugees on the Health Services of the Host Populations in the West Nile Districts of Arua, Moyo, and Adjumani,” Kampala Uganda, East Africa.

Makerere University School of Public Health invites applications for a PhD fellowship under the Wellcome Trust-supported NETOMA study, which examines the coexistence of health worker shortages and unemployment among qualified health professionals in Africa.

The successful candidate will undertake doctoral research involving ethnographic fieldwork and qualitative analysis of health workers’ professional identities, employment experiences and livelihoods. Applicants should hold a Master’s degree in Anthropology, Sociology, Development Studies, Political Economy or a closely related discipline, with training in qualitative research methods.

Application deadline: 21 October 2026

Full details and application instructions: https://sph.mak.ac.ug/careers/?view_job=21462

Health

Makerere-Mulago Host Oncology Specialist – Professor Dr. Thiha AUNG

Published

2 days ago

October 12, 2026

Elvis Lubanga

Professor Dr. Thiha AUNG during his interview with the Public Relations Office on 7th October 2026. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa.

Through a European Union (EU) funded initiative, Makerere University and Mulago Hospital are hosting a German oncology reconstruction specialist Professor Dr. Thiha AUNG. AUNG is a surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany.

With his international expertise in oncology and medical management roles at his home institution, his visit is a valuable addition to Uganda’s capacity building efforts in medical advancement.

Prof. Aung who arrived in Uganda in late September 2026 and has since then conducted free identified patient specialised surgeries and training for locals. These are expected to span two weeks. For the period, his service intersects medical expertise and humanitarian efforts.

This is not Prof. Aung’s first time in the country; his first major visit was in 2023, when he performed life-changing free surgeries on early patients. He then made medical history in June 2024 when he arrived to perform Africa’s first-ever lymph node transplant at Mulago Hospital.

It was against this background that the Makerere Public Relations Office engaged him in an exclusive interview to share his philosophy on medical service, his experiences in oncology reconstruction, and his unwavering belief that passion and dedication rather than just resources are the true drivers of sustainable medical progress.

Transforming Lives Through Oncology Reconstruction

At the heart of his mission through the ERASMUS – Oncology/Lymphedema project, is the treatment of lymphedema, a condition often referred to as elephantiasis.

In Europe, such surgeries can cost between 80,000 and 100,000 euros, making them inaccessible to many.

Thankfully, Professor and his team, including some of his post graduate students like Anna Friedrich (B.Sc) and Sophia Waser (B.Sc., PA) from the Institute of Medical Science and Engineering, have once again brought this specialised care to Uganda pro bono.

Professor AUNG with the article author. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa. — ***Professor AUNG with the article author.***

He highlights the story of a teacher who, after receiving surgery, regained her quality of life and returned to the classroom. For him, the impact is exponential. “You change one life, but this person changes a lot in the community.”

This shift from individual surgery to the long-term wellbeing of the community, reinforces the local impact of these services.

Professor AUNG’s Personal Conviction

The professor confessed that inherently, he commands himself that beyond knowledge, true progress is driven by passion and will rather than resources.

He does not agree with those that think money and resources are the sole prerequisite for change in the medical world, stating, “you cannot change with money only.” Rather, he upholds the importance of personal decision and commitment.

When discussing the challenges of working in resource-limited settings, he maintains a simple, direct explanation “it’s always beyond the money.”

Ultimately, the Professor believes that if he can provide the spark, his students and patients can carry through with the same flame for significant change.

Motivation to Serve in Uganda

When asked about his inspiration for entering the field and now volunteering to work in Uganda, he explained that his primary goal was always to serve others. “That’s why I finished my medical school to help as many people as possible with my skills.”

Professor AUNG gestures during the interview. Public Relations Office interview with Professor Dr. Thiha AUNG, German oncology reconstruction specialist, surgeon, trainer at the Deggendorf Institute of Technology (THD), and researcher on cancer from the Deggendorf Institute of Technology (DIT), Germany. 7th October 2026, Main Building, Makerere University, Kampala Uganda, East Africa. — ***Professor AUNG gestures during the interview.***

He views his medical expertise not as a tool for the privileged, but as a universal resource., “People are all the same, their anatomy is the same. So, I can help all these people pretty well,” Prof AUNG remarked.

His approach is motivated by a pay it forward dogma where treating a single patient creates a broader societal benefit. He illustrates this through his work with patients who, after surgery, are able to return to their professions like the teacher earlier mentioned.

Tips for Medical Professionals working in Uganda

As a foundation for professional growth, the Professor advised medical professionals working in Uganda to prioritise genuine interest in their work because he believes it is “the most important…” for “if you are interested, you will go far in the profession.”

He further reinforced the human capacity point, noting, “no matter what kind of equipment you have… it all depends on the people operating them and the patient.”

Professor AUNG concluded by encouraging doctors to overcome resource fears through action, stating, “If you want to create impact or change, you do.”

Dr. AUNG is part of the Lymphoedema Warriors Association (LWAU) in Uganda. He describes it as a grassroots organisation and commends them for “leveling the grond”. He reiterated his commitment to work with the organisation in reviewing patient reports to determine the best course of treatment.

Health

Makerere Public Health Showcases EU Funded Research

Published

5 days ago

October 8, 2026

Allan Ainematsiko

Makerere University’s School of Public Health (MakSPH) showcased research, training and international partnerships supported through European Union funding during the EU Uganda Research and Study Fair 2026 held at Makerere University.

The fair brought together students, researchers, academics, government representatives and development partners to explore opportunities in education, research, innovation and international collaboration, while celebrating 50 years of partnership between Uganda and the European Union.

Through its exhibition, MakSPH highlighted research and capacity building initiatives addressing public health challenges including infectious diseases, non communicable diseases, health systems, climate change and pandemic preparedness.

18 EU funded projects supported at MakSPH

Prof. Rhoda Wanyenze, Dean of Students, School of Public Health, said the School has benefited from 18 EU funded projects over the past five years, supporting research and training across several areas of public health.

Prof. Rhoda Wanyenze explains MakSPH research projects to Acting Minister of Education and Sports Dr John Chrysostom Muyingo during a tour of exhibition stands at the EU Uganda Research and Study Fair.

She said the projects have contributed to the training of PhD researchers and the development of research addressing infectious diseases and prevention, non communicable diseases, health systems, climate change and health.

Prof. Wanyenze also highlighted a new five year programme which started in 2021 that is aiming at strengthening capacity for research on pandemic preparedness and response, including outbreaks such as Ebola.

***Stella Kakeeto interacts with students during the EU Uganda Research and Study Fair***

Another programme being undertaken with the Ministry of Health and Karolinska Institute focuses on improving maternal health while also addressing adolescent pregnancy and the health of mothers and children.

She described partnerships as critical to advancing science and innovation, noting that collaboration allows researchers in Africa and Europe to share knowledge and strengthen the impact of research on communities.

Research partnerships strengthen innovation

Prof. Robert Wamala, Director of the Directorate of Research, Innovation and Partnerships at Makerere University, said the exhibition provided an opportunity to showcase EU funded projects across the University.

He noted that the School of Public Health alone has more than 18 such projects, while other colleges also have several EU supported initiatives.

One of the projects showcased was PREPARE TID, a partnership aimed at developing rapid diagnostic technologies for emerging and re emerging infectious diseases.

Prof. Julius Okuni, Associate Professor of Veterinary Pathobiology and Molecular Diagnostics at Makerere University, said the project brings together universities, industries and other organisations from Africa and Europe.

The project is working to develop technologies that can quickly identify pathogens responsible for outbreaks such as Ebola, Rift Valley fever and Crimean Congo haemorrhagic fever.

According to Prof. Okuni, Makerere is involved in field and laboratory work to test and refine the technologies before they can be delivered to end users.

Fair provides platform for research visibility

For researchers at MakSPH, the fair also provided an opportunity to increase the visibility of ongoing research and create new connections with researchers, policymakers and potential funders.

Dr. Raymond Tweheyo, Honorary Lecturer and Senior Research Fellow in the Department of Health Policy, Planning and Management, said such exhibitions allow researchers to share their work and identify others working on related challenges.

***Dr. Raymond Tweheyo and Assoc. Prof. Angelina Kakooza Mwesigye at the exhibition***

He cited the CONNECT for Health project, which focuses on transforming non-communicable disease care in Uganda through collaboration with partners across several countries.

Dr. Tweheyo said exhibitions can help researchers connect with policymakers, civil society organisations and other partners who can contribute to translating research into practical solutions.

Assoc. Prof. Angelina Kakooza Mwesigye, Associate Professor and Child Neurologist at Makerere University College of Health Sciences, also emphasised the importance of exposing young people to international research opportunities.

She said the long standing Uganda Europe partnership provides opportunities for the next generation of researchers to learn, build networks and prepare for future research collaborations.

The School of Public Health’s participation highlighted the role of international partnerships in strengthening research capacity, supporting innovation and developing evidence based responses to Uganda’s public health challenges.