In August of this year, the government finally deployed medical interns after a series of protests by the interns due to the delayed deployment.
Furthermore, the government decided to reduce their allowance by more than 40%, a matter that is currently under dispute by the Federation for Medical Interns in Uganda (FUMI).
During an interview with the Nile Post, FUMI President Bill Adrati expressed his frustration with the government’s failure to address their demands.
He stated that this has had a significant impact on their well-being but emphasized their commitment to continue advocating for improved conditions for all medical interns in the country.
Adrati firmly believes that only President Museveni can address their concerns.
He noted, however, that some officials from the Ministry of Health have been obstructing their attempts to meet with the head of state. He added that they even proposed that interns work for free, a proposition he deemed highly unfortunate.
Who is Bill Adrati?
I am Bill Adrati, one of the medical interns. My attachment site is Anaka General Hospital, in Nwoya district. I currently lead all the interns in the country. I am the President of the Federation for Medical Interns in Uganda(FUMI).
How are the current conditions for medical interns in terms of their welfare?
I think, at the moment, we are not satisfied with the welfare needs being provided by the government. Welfare concerns are narrowed down to one thing: facilitation in terms of allowances provided to medical interns.
So, recently, we were deployed with an allowance figure that was reduced by over 40%, which shows how the welfare needs of medical interns at the moment are compromised. This is also coupled with delays in payment, which we are still facing. In general, the welfare of medical interns is not good. I believe the government, through the Ministry of Health, has not properly addressed the welfare of medical interns.
Do you believe that your concerns can be resolved through protests, given the substantial number of protests this year?
I don’t think protests are the only way for the government to listen to us, but experience shows that it’s an approach that can yield quick results, and it’s dictated by the manner in which we are not being listened to in the negotiation process. It all starts with negotiation, and it’s in our interest, as well as in the interest of medical interns and the Ministry of Health, to avoid a harmonized internship period. We prefer engagements as the priority option.
Why do you believe the government is unwilling to address your issues?
I think the biggest problem lies in the occupation of offices or positions of influence by people who have lost touch with reality. Decision-making spans from the Minister of Health, Ministry of Finance, to the cabinet and Parliament.
So, the entire system has elements involved in key decision-making processes, and most of the time, they lose touch with the realities on the ground and the actual contributions that medical interns make to healthcare and service delivery. When they make decisions, they don’t put themselves in the shoes of medical interns; they view medical interns as students.
This is part of the problem. Certain elements deliberately promote these views to sabotage efforts to advance the welfare of medical interns to the higher centers of power in the country.
There have been promises made to address the ongoing demands of interns in the country. You have insisted on meeting the President. Do you think that only the head of state can effectively address your concerns, in your opinion?
It is an obvious yes. I think Uganda is one of the few countries where institutions are not very independent, where decision-making doesn’t stand, and at the end of the day, any major decision in this country must pass through the president or those close to him. It’s one of the broader challenges in our country. Meeting the President can resolve our grievances, and that seems to be the only way out. Before we were deployed, despite all our efforts in the four months to ensure the government deployed us, we didn’t meet the President. Every channel to meet the President was blocked.
Were the individuals who prevented your meeting with the President officials from the Ministry of Health?
Yes, I can say that some of the officials within the Ministry of Health, Ministry of Finance, and other stakeholders on the matter of medical interns have frustrated our efforts to meet the President.
I could tell you the story of incidents that happened during the pre-internship period before we were deployed. All the efforts we made were blocked, either by the principal personal secretary or through every channel. During the pre-internship period, they viewed us as very radical. They wanted us to do internships for free, which was the most unfortunate thing. Working for a full year from morning to evening for free is inhumane.
Do you believe that a lack of clear regulations from admission through internships, up to the licensing of medical students has contributed to the challenges faced by medical interns and the reasons behind strikes?
Focusing on our policy question, the lack of policy is one of the major contributors. First of all, the Ministry of Health wants to roll out this policy, but it reflects the interests of people who have never been in the medical field or medical internship process.
In 2017, the policy was introduced, but it was struck down by the Court. They attempted again in 2020, but it didn’t succeed. Recently, the permanent secretary made statements on pre-internship exams, a policy that is coming, but it doesn’t reflect the actual interests of medical interns. This is a policy intended to address medical internships.
This is one of the major reasons why the policy has not come into existence. We don’t know what is in the policy; our views have not been considered. We need to discuss and be involved in the policy process for it to become acceptable. The policy currently addresses the interests of people we don’t understand.
There was a suggestion of deploying medical interns who can afford to pay for their medical internships. What is your perspective on this proposal?
I think that portrays inexperience in leadership and insensitivity. When making important decisions, you must consider whether the decision is fair to everyone. Look at the most vulnerable persons whose parents cannot afford the money.
I found that suggestion to be a significant error, reflecting inexperience in handling dynamic situations. It was a rushed, irrational decision and is regrettable and unfortunate. I hope such mistakes should not happen again. It is also illegal because you cannot discriminatively deploy those who can afford. Medical internship has not been classified based on socioeconomic status. Everybody must be given the privilege and opportunity to pursue their dreams and careers without the system impeding them.
What distinguishes medical interns from medical students?
Medical interns are medical doctors, pharmacists, graduate nurses, midwives, and dental surgeons who have attained bachelor’s degrees from university. It’s like when you finish your journalism degree and graduate; you are no longer a student.
So, medical interns are young professionals who have completed their education. While we were still at the university, we also did internships, but we called it rotations. We started doing them from year three until we finished. We did everything other students do during their internships and even worked on patients, as it was part of our curriculum.
However, it didn’t provide us with enough exposure and experience to start working independently immediately after graduation. That’s why we have a full one-year internship, which allows us to focus on hospital work and gain experience.
There was a suggestion of exporting interns due to an increasing number, which has been attributed to funding gaps. What are your thoughts on this?
The number of medical interns has been portrayed as increasing significantly. Let me provide you with the actual figures from the Parliamentary report of the Committee of Health. I want to compare the numbers during the time of Dr. Musa Lumumba, (the former FUMI president), and our cohort. During Dr. Musa Lumumba’s time, there were 1690 interns. Our cohort had 1901, a difference of less than three hundred interns.
Right now, we have confirmed that about 1877 people are doing internships, which is a difference of less than two hundred. Talking about the number of interns doubling is a narrative that is being painted to make it seem like a burden, which is not true.
One factor we must appreciate is that the population will continue to increase, and when the population increases, the pressure on social services, including healthcare, will also increase. This pressure must be met by the human resource workforce or the healthcare system, which needs to be expanded to absorb this pressure.
There is public concern about the declining quality of medical interns from educational institutions. What measures do you believe should be taken to address this issue?
The issue of the quality of medical interns was also mentioned by the permanent secretary (Dr Diana Atwine). However, the discussions we are trying to have to inform public policy must be based on a clear study. I needed to find out exactly who conducted that study and who came to the conclusion that the quality of medical interns is deteriorating.
Quality is an aspect that is inherent in a person. When did the National Council for Higher Education, which is mandated to regulate the training in universities that train healthcare workers, conduct a study? This council is part of the government, and they are the ones who accredit these institutions that produce medical interns. If the government is now saying that there is a deteriorating quality of medical interns coming from institutions, (they are accepting their failure to regulate these institutions)
Could the introduction of pre-internship exams help improve the quality of medical interns, addressing concerns about their competence?
These exams can be passed by anyone who has prepared for them or has access to leaked information or is well-connected. There can never be integrity in these kinds of exams that are administered.
In my view, these exams can be introduced to regulate numbers, not for quality assurance. There has been a lot of emphasis on numbers, but quality is not something that can be tested; it is built into a person. The Ministry of Health has not conducted a study to assess the quality of medical interns. Who has concluded that the quality is deteriorating?
In my view, regarding the aspect of quality, there are concerns in the training process that can be addressed through supervision. The government also needs to address the issue of long working hours, and there is a need for more specialists in the health facilities where interns practice. Most of our health facilities lack equipment and medicine, which limits interns in their practice, so the government needs to address that.
What is the most effective way to address the grievances of interns, given that these issues appear to persist?
I want to give you an example from Kenya, where we have colleagues who go to Kenya to do internships because the four months we spent before being deployed were so frustrating that it forced them to go to Kenya. In Kenya, a medical intern like us is paid a net amount of 3.9 million Ugandan shillings with 1.2 health insurance cover. It’s the same in Tanzania. The 1 million Shillings introduced by the Ministry of Health was done under unclear circumstances, which, in our view, is illegal and a breach of a presidential directive that formed a policy for medical interns. Therefore, as medical interns, we are committed to challenging the current payment position.
We believe it should be reinstated to the presidential directive, which recommended that medical interns be paid 2.5 million Shillings. The only person who can reverse this decision is the president.