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

MakSPH Newsletter Jan–Jun 2026

Published

1 day ago

September 11, 2026

John Okeya

What will it take for Uganda’s health financing to match the scale of its ambitions? How does a nation ensure that the systems it builds are ones the government can fully own, sustain, and grow? And who are the leaders being shaped today to carry this work into the future?

The inaugural issue of the Makerere University School of Public Health (MakSPH) newsletter follows these questions through six months of research, partnership, and institutional growth. Inside: MakSPH’s role in the national dialogue on sustainable health financing; the milestone handover of 16 MakSPH-METS digital health systems, built over 15 years, to Ministry of Health stewardship; and the research and academic investment shaping the School’s next phase of growth.

The edition also covers Vice-Chancellor’s Research Excellence Awards for MakSPH faculty, a new CARTA doctoral cohort, progress on the School’s new building, fresh leadership in the Department of Disease Control and Environmental Health, expanding partnerships in malaria, environmental health, and maternal care, and MakSPH students stepping into leadership across Makerere‘s 92^nd Guild Government.

Read the full newsletter:

Makerere-SPH-Newsletter-Jan-Jun-2026 Download

Health

From Evidence to Impact; How the MNCH Centre is Advancing RMNCAH in Uganda e-Post 135

Published

3 days ago

September 9, 2026

Mak Editor

Stakeholders that took part in the VectorCam Uganda Mid-Review Dissemination Meeting pose for a group photo on 27th August 2026. Makerere University School of Public Health (MakSPH) Auditorium, Kampala Uganda, East Africa.

Research has the greatest value when it moves beyond publication to improve lives.

At Makerere University’s Centre of Excellence for Maternal, Newborn and Child Health (MNCH Centre) housed at Makerere University School of Public Health, research, partnerships and innovation are being translated into action to strengthen reproductive, maternal, newborn, child and adolescent health (RMNCAH) in Uganda and beyond.

Welcome to the September MNCH Centre e-Post 135.

This month, we spotlight how evidence is informing action across reproductive, maternal, newborn, child and adolescent health (RMNCAH) at the centre.

Explore how Centre researchers and partners are advancing innovations to reduce early perinatal mortality, how Makerere University through the Centre and WHO are strengthening capacity to monitor health inequalities, and how the Centre and its partners are leveraging AI to strengthen health systems and improve malaria surveillance.

Discover what these innovations could mean for scale, stronger health systems and greater impact.

Explore the September edition here: https://mnh.musph.ac.ug/newsletter/

Health

The 92nd Guild Ministry of Health Back with the Annual Guild Medical Camp

Published

2 weeks ago

August 31, 2026

Philemon Akoragye

Participants visit the STI Screening Tent during the Annual Medical Camp in 2025. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

The 92^nd Guild Ministry of Health is set to host the Annual Makerere Guild Medical Camp, a three-day outreach that will bring free and essential medical services to students, staff, and the surrounding community. The camp will run from 17^th to 19^th September 2026, from 8:00am to 5:00pm each day, at the Freedom Square.

Themed around promoting student wellness for academic excellence, the medical camp is organised under the leadership of Hon. Wamezaya Ebenezer, the Minister of Health in the 92^nd Guild Government, in alliance with several partner organisations supporting the university’s health and wellness agenda. The initiative reflects a growing recognition within student leadership circles that academic performance is closely tied to the physical and mental wellbeing of the university community.

Comprehensive Range of Services

The medical camp will offer a wide range of services designed to address both routine and specialised health needs. On the general health side, attendees will have access to general and specialist medical consultations, allowing students, staff, and community members to seek professional advice on a variety of health concerns without the usual costs associated with private or even public healthcare.

A female medical personnel attends to a male client. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***A female medical personnel attends to a male client.***

Screening services will also be a central feature of the camp. Organisers have confirmed that sickle cell testing, malaria rapid diagnostic testing, and HIV screening will be available on site, giving participants the opportunity to know their status and receive guidance on appropriate next steps. Eye care services and laboratory diagnostics will round up this category, addressing common but often neglected areas of student health.

Beyond diagnostics and consultations, the camp will provide free essential medicines to those who need them, easing the financial burden that often accompanies treatment even after a diagnosis has been made. Reproductive health counseling will also be offered, giving students a confidential space to discuss matters that are frequently overlooked in general campus health conversations. Mental health counseling completes the list of available services, an inclusion that speaks to the increasing attention being paid to psychological wellbeing within the university community.

A Camp Open to the Wider Community

While the camp is organised by the Guild Ministry of Health and centred on student welfare, its reach extends beyond the student body. Organisers have made it clear that the free medical services will be available to students, staff, and members of the whole Makerere community, positioning the event as a broader public health contribution rather than a strictly internal university affair. This inclusive approach mirrors similar outreach efforts previously undertaken by student leadership and university departments, which have sought to position Makerere University not just as a centre of learning but as an active contributor to community welfare in the areas surrounding its campuses.

A male client gets his BMI checked. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***A male client gets his BMI checked.***

Freedom Square, long regarded as the symbolic heart of student activity and expression at Makerere University, was selected as the venue for the three day event. Its central location and historic significance make it an accessible and fitting site for an initiative of this scale, expected to draw considerable numbers of participants over the course of the camp.

Health as a Pillar of Academic Success

The organisers have anchored the medical camp around the message of promoting student wellness for academic excellence, a theme that underscores the connection between health and academic performance. University life often places significant demands on students, both physically and mentally, and untreated health concerns can quietly undermine academic progress long before they become visible crises. By bringing screening, treatment, and counseling services directly to students at no cost, the Guild Ministry of Health is addressing barriers that might otherwise prevent students from seeking care, whether due to cost, distance, or stigma, particularly around mental health and reproductive health matters.

The 91st Guild Minister of Health, Hon. Bbosa Sharif (L) poses by the event banner in the Freedom Square. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***The 91st Guild Minister of Health, Hon. Bbosa Sharif (L) poses by the event banner in the Freedom Square.***

The inclusion of mental health counseling alongside more traditional physical health services is particularly notable. It signals an evolving understanding among student leaders that wellness cannot be addressed through physical checkups alone, and that psychological support deserves equal standing within campus health initiatives. Similarly, the presence of reproductive health counseling reflects an effort to normalise conversations that many young people find difficult to initiate on their own.

What to Expect

Over the three days, participants can expect a structured environment at Freedom Square, with separate service points catering to the different categories of care on offer. Medical professionals will be on hand to conduct consultations and screenings, while counselors will provide guidance on reproductive and mental health matters in a setting designed to protect privacy and encourage openness.

Given the scale of services on offer and the open invitation extended to staff and community members in addition to students, organisers anticipate strong turnout throughout the three day period. Those interested in attending are encouraged to plan their visits within the stated hours of 8:00am to 5:00pm to take full advantage of the services available.

H.E. Bbosa Sharif receives female students at the Medical Camp. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***H.E. Bbosa Sharif receives female students at the Medical Camp.***

For any inquiries regarding the medical camp, members of the university community and the public have been directed to reach out to Hon. Wamezaya Ebenezer, the Minister of Health, through the contact provided by the Guild Ministry of Health.

Building on a Guild Tradition

The Annual Makerere Guild Medical Camp is not a new concept within student governance at the university. Successive Guild Ministries of Health have used the medical camp as a recurring platform through which they translate campaign promises around student welfare into visible action. Each edition tends to build on the lessons of the one before it, with organisers typically expanding the range of services offered as new partnerships are secured and as feedback from previous camps is incorporated into planning.

Sickle Cell Screening (Left Tent) was one of the services offered. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***Sickle Cell Screening (Left Tent) was one of the services offered.***

This year’s edition, organised under the 92^nd Guild Ministry of Health, appears to place particular emphasis on breadth of service, combining preventive screening, curative consultation, and psychosocial support within a single three-day window. The decision to bundle sickle cell testing, malaria and HIV screening alongside eye care and laboratory diagnostics suggests an intention to make the camp a one stop point for health assessment, reducing the need for participants to seek out multiple providers across the city for basic checks they might otherwise postpone indefinitely.

Why Timing Matters

The scheduling of the camp in September places it at a point in the academic calendar when many students are settling back into campus life after recess, a period during which health concerns accumulated over the break, whether physical ailments left unattended or emerging mental health pressures tied to academic anxiety, tend to surface. Offering free consultations and counseling at this juncture allow students to address these concerns early, before they compound into more serious complications that could interfere with coursework, examinations, or general campus participation.

A female medical personnel attends to a female client. The 91st Guild Ministry of Health Annual Makerere Guild Medical Camp, 3rd and 4th October 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa. — ***A female medical personnel attends to a female client.***

For staff members and residents of the areas surrounding the university, the timing also offers a convenient opportunity to access services that might otherwise require travel to distant health facilities or extended waiting periods within an already strained public health system. In this sense, the camp functions as a modest but meaningful supplement to existing healthcare provision in the vicinity of the university.

As the 17^th of September approaches, the Annual Makerere Guild Medical Camp stands as another example of the Guild Ministry of Health stepping beyond the boundaries of policy and advocacy into direct, hands-on service delivery, a model that continues to shape the character of guild ministries at Makerere University. Students, staff, and members of the surrounding community are encouraged to take advantage of the free services on offer and to look out for further communication from the Guild Ministry of Health as the event draws closer.

For more info, reach Hon. Wamezaya on +256784541248