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

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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.
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.

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Davidson Ndyabahika

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SIHI Uganda Turning Community-Led Solutions into Better Health

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July 17, 2026

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Providing Opportunities for Women in Entrepreneurship and Reproductive Health (POWER) is a Young Women Social Entrepreneurship Accelerator Program that nurtures and empowers women to lead, innovate, and build sustainable startups in SRHR/FP. SIHI, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.

Community-led innovations across Uganda are improving access to healthcare, reducing financial barriers and responding to needs that conventional services do not always reach. The Uganda Case Compendium 2026, published by the Social Innovation in Health Initiative (SIHI) Uganda Hub at Makerere University School of Public Health, documents these solutions, their results and opportunities for scale.

Established in 2017, SIHI Uganda identifies, studies and supports locally developed health innovations. By 2026, the Hub had documented 42 projects through research examining their impact, enabling factors and scalability. It has also convened seven national stakeholder workshops and established a fellowship programme that equips innovators with skills in project management, research, entrepreneurship, communication, fundraising and environmental impact assessment.

The compendium presents evidence of reach and impact. The Ishaka Health Plan has enrolled more than 5,000 people in community-based health insurance, enabling over 4,000 members to access healthcare annually. In Kiryandongo, the Opit Kic Widows Group trained 402 volunteers who have provided health information to more than 6,030 refugee and host-community households. Among people living with HIV who received group support psychotherapy, 98% were depression-free after six months. In Mayuge, two sickle cell clinics have been established, 12,500 children screened and 282 enrolled in continuing care, contributing to a reported 53% increase in enrolment.

Spanning maternal and child health, HIV, mental health, disability, gender-based violence, health financing, diagnostics and palliative care, the compendium provides evidence to inform investment, policy uptake and the responsible scale-up of locally grounded solutions.

Read the full report:

SIHI-BOOK_CASE-COMPENDIUM_2026Download

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John Okeya

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Call For Applications: ACT-PREP Postdoctoral Research Fellowships (2)

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July 17, 2026

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Kickoff training for teams tasked with collecting data for the Uganda Population-Based HIV Impact Assessment (UPHIA) 2024-2025, held 19th May 2025, Makerere University School of Public Health (MakSPH) Auditorium, Main Campus, Kampala Uganda, East Africa.

Background

Makerere University School of Public Health invites applications for two postdoctoral research fellowships under the ACT-PREP Project, a five-year, Africa-led initiative funded by the Global Health EDCTP3 Joint Undertaking. The project seeks to strengthen sustainable, context-responsive research capacity for epidemic preparedness and response across sub-Saharan Africa.

Responsibilities

  • Each fellowship is a full-time, 18-month appointment based at MakSPH in Kampala. Applicants must apply for one position only. Eligible candidates should be early-career researchers who are nationals of, or based in, sub-Saharan Africa and hold a PhD in a relevant discipline or have completed a post-Master’s Field Epidemiology Training Programme. Applicants should demonstrate a record of peer-reviewed publication and research dissemination. Experience in policy review, qualitative or mixed-methods research and stakeholder engagement is an advantage. Successful fellows will receive mentorship from senior researchers, collaborate with an international consortium of African and European institutions, and contribute to policy-relevant research on epidemic preparedness. A stipend commensurate with qualifications and experience will be provided. Applications should include a motivation letter of up to two pages, a two-page research concept, a detailed curriculum vitae with a publication list and contacts for at least two referees, and at least one recommendation letter.

Qualifications and Desirable Qualities

  • Eligible candidates should be early-career researchers who are nationals of, or based in, sub-Saharan Africa and hold a PhD in a relevant discipline or have completed a post-Master’s Field Epidemiology Training Programme.

How to Apply

Submit applications to recruitment@musph.ac.ug by 7 August 2026, quoting “ACT-PREP Postdoc – Position 1 or 2” in the email subject line. Interviews are expected around 14 August 2026 in Kampala.

Qualified women and applicants from under-represented groups are strongly encouraged to apply.

Download the full call for detailed requirements and application guidance.

Application Deadline: August 07, 2026

Makerere-SPH-ACT-PREP-Call-for-PostDoc-applications-2Download

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John Okeya

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College of Health Sciences Inspires Future Health Professionals at Career Fair

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July 13, 2026

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Prof. Bruce Kirenga addresses the senior six students and their teachers on 10th July 2026. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.

The Makerere University College of Health Sciences (MakCHS) on July 10, 2026, welcomed senior six science students from Ngora High School and Wiggins Secondary School to an inspiring Career Fair aimed at guiding them on careers in health sciences and introducing them to the wide range of academic programmes offered by the College.

The event brought together students pursuing Physics, Chemistry, Biology (PCB) and Biology, Chemistry, Mathematics (BCM), providing them with a unique opportunity to interact with the College leadership, tour laboratories and teaching facilities, and learn first-hand about careers in medicine and other health science disciplines.

Welcoming the students, the College Principal, Prof. Bruce Kirenga, described the College of Health Sciences as one of Africa’s oldest and most distinguished medical schools, with a legacy spanning more than a century.

“We started in 1924, making us one of the oldest medical schools on the continent. You have made the right decision to visit Makerere, and we are delighted to welcome you,” he said.

Prof. Kirenga commended the school administrators and teachers for organizing the visit, noting that exposing learners to university environments early helps them make informed career choices. He explained that the College introduced the Open Day concept after receiving numerous requests from schools seeking career guidance visits.

Prof. Bruce Kirenga. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Bruce Kirenga.

He congratulated the students for choosing science subjects, describing science as the foundation for solving society’s most pressing challenges.

“You have already made one of the most important decisions by choosing to become scientists. Even more importantly, you have chosen life sciences—a field dedicated to preserving and improving life,” he remarked.

The Principal emphasized that careers in life sciences extend far beyond medicine, encouraging students to remain open-minded as they consider their future.

“Everything that has life requires professionals to keep it healthy—from human beings and animals to crops and the environment. The opportunities are immense, including agriculture, veterinary medicine, biomedical sciences, public health and many other emerging fields.”

A section of senior six students and their students at the career fair. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
A section of senior six students and their students at the career fair.

He also advised students not to limit themselves to only one academic programme during university applications, recalling instances where highly qualified students narrowly missed admission because they selected only one course.

“Remain open to the opportunities available. Medicine is an excellent profession, but there are many other programmes that are equally rewarding and are shaping the future of healthcare and scientific innovation,” he said.

Prof. Kirenga further encouraged the students to embrace lifelong learning, reminding them that scientific knowledge remains valuable regardless of the career path they eventually pursue.

Addressing the students, the Dean of the School of Medicine, Prof. Annette Nakimuli, acknowledged the growing competition for admission into medical programmes and urged learners to work hard while keeping an open mind about the diverse opportunities available within health sciences.

Prof. Annettee Nakimuli. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Annettee Nakimuli.

She explained that admission into the Bachelor of Medicine and Bachelor of Surgery (MBChB) programme has become increasingly competitive due to the rising number of high-performing applicants.

“This year we witnessed unprecedented competition for government sponsorship, with many applicants scoring triple A at Advanced Level and outstanding grades at Ordinary Level. That tells you that you must prepare yourselves to excel academically,” she said.

Prof. Nakimuli noted that while many students aspire to become medical doctors, the health sector today offers numerous innovative programmes that are equally important.

“There are many programmes that parents, teachers and students are still not familiar with. Biomedical Engineering, for example, is one of the exciting fields driving the future of healthcare, yet many students overlook it because they focus only on medicine.”

Students and Teachers pose for a group photo with CHS staff. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Students and Teachers pose for a group photo with CHS staff.

She encouraged students to explore emerging disciplines that combine medicine, engineering, technology and research, noting that the future of healthcare increasingly depends on multidisciplinary professionals.

The Dean also introduced students to the structure of the School of Medicine, explaining that it comprises twelve academic departments and two specialised units covering a broad spectrum of clinical disciplines, including Internal Medicine, Surgery, Obstetrics and Gynaecology, Orthopaedics, Ophthalmology, Ear, Nose and Throat (ENT), Family Medicine, Anaesthesia and Critical Care, among others.

She explained that students are trained by specialists across these disciplines to become competent general practitioners before pursuing further specialization.

Prof. Erisa Mwaka, the Chair of the Department of Human Anatomy, shared with the students about the School of Biomedical Sciences (SBS). He said the school is one of the four schools that make up the Makerere University College of Health Sciences (MakCHS). As the foundation of medical education, the School provides students with a comprehensive understanding of the biological and molecular sciences that underpin modern healthcare, disease prevention, diagnosis and treatment.

Prof. Erisa Mwaka with students in one of the teaching spaces. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Erisa Mwaka with students in one of the teaching spaces.

The School comprises several departments, including:

  • Human Anatomy
  • Biochemistry
  • Physiology
  • Pharmacology and Therapeutics
  • Pathology
  • Microbiology
  • Medical Illustration

The School offers undergraduate programmes such as the Bachelor of Science in Biomedical Sciences, which equips students with strong laboratory, research and analytical skills, and the Bachelor of Science in Biomedical Engineering, an interdisciplinary programme that integrates engineering, medicine and technology to develop innovative healthcare solutions.

At postgraduate level, the School offers a wide range of master’s and doctoral programmes, including Human Anatomy, Physiology, Pharmacology, Bioinformatics, Immunology and Clinical Microbiology, Health Bioethics, Medical Illustration, Pathology and other biomedical specializations that prepare graduates for careers in research, academia, diagnostics, biotechnology and the pharmaceutical industry. The school also offers a wide range of diploma courses.

Dr. Isaac Magulu Kimbowa from the Department of Pharmacology and Therapeutics (Right) and colleagues interact with the students. Makerere University College of Health Sciences (MakCHS) Career Fair for Ngora High School and Wiggins Secondary School guiding senior six science students on careers in health sciences and introducing them to the wide range of academic programmes offered by the College, 10th July 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. Isaac Magulu Kimbowa from the Department of Pharmacology and Therapeutics (Right) and colleagues interact with the students.

Throughout the Career Fair, students interacted with faculty members, toured laboratories and learning facilities, and received guidance on university admission, academic programmes and career prospects within the health sciences.

The Career Fair forms part of the College’s broader outreach programme aimed at nurturing the next generation of healthcare professionals by exposing learners to university life and equipping them with the information needed to make informed academic and career decisions.

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Betty Kyakuwa
Betty Kyakuwa

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