Big Interview: Medical association almost collapsed after engaging in NRM event- Dr. Luswata

In a recent election, Dr. Herbert Luswata was elected as the new president of the Uganda Medical Association (UMA) after securing 57% of the votes.

In an interview with the Nile Post, Dr. Luswata discussed his priorities for his tenure and the challenges faced by doctors and medical interns.

He also committed to reviving and strengthening the association, emphasising the need for UMA to be the voice of doctors in the country, especially after the difficult tenure in the past two years.

Excerpts below

Congratulations upon being elected as the President of the Uganda Medical Association(UMA). How do you currently feel about this accomplishment?

Thank you very much. I am thrilled. It is gratifying that the members have entrusted me with another term as president, indicating their recognition and appreciation of my prior role as the secretary-general.

How would you assess the overall state of healthcare in Uganda?

Currently, the state of healthcare in Uganda can be considered fair. There is some commitment from the government to improve healthcare services, which is promising. We recently invited the First Lady of Uganda to our conference, and although she couldn't attend, she sent the Minister of Health to listen to our issues. This demonstrates willingness to collaborate and make improvements.

Working closely with the Ministry of Health enables us to identify gaps and work towards addressing them. One positive development is the increase in healthcare worker salaries. The least paid doctor now receives Shs 5.4 million, which is a significant improvement compared to previous earnings. Efforts have also been made to address human resource challenges in the sector. However, there is still work to be done to further enhance healthcare delivery and infrastructure in Uganda.

What inspired your involvement in the Uganda Medical Association?

When I completed medical school and started my internship, I noticed that the same issues we faced as interns were still affecting current interns. People wanted leaders who could address these issues and improve welfare conditions. Initially, I didn't aspire to be the president; I took up the role of chairperson for intern welfare.

During that time, there was a strike by interns due to delayed payments. We escalated the issue to Parliament, where I presented a petition alongside my colleagues.

The MPs discussed our petition and made recommendations, including increasing allowances for interns to 3 million Shillings. Although these recommendations were not immediately implemented, we later demanded incremental allowances of 2.5 million Shillings based on those suggestions.

Due to my active involvement, the UMA leaders added me to the National Governing Council. This was my first engagement with UMA in 2019. Despite being a public servant in Kasese, I actively participated in the governing council activities.

As the president of the Uganda Medical Association, what are your primary responsibilities?

As the president of UMA, my responsibilities are diverse. Firstly, I serve as the spokesperson for the association. I also chair various important meetings, including the National Executive Committee meetings, the national governing council meetings, extraordinary general meetings, and the annual general assembly. These gatherings involve all doctors within the association, and it is my duty to lead them.

Additionally, I represent UMA in external forums such as the World Medical Association general assemblies and meetings in other African national medical Associations. If these organizations require our support or collaboration, they reach out to me, and I am willing to visit their countries as they have also visited us before.

As the president, I am accountable for the strategic plan of UMA, which provides the strategic direction for our organisation. It outlines the activities that need to be accomplished within specific timeframes. I am answerable to the National Executive Committee, the National Governing Council, and all doctors in the general assembly. Therefore, I am involved in every aspect of UMA's operations.

Lastly, as the president, I am responsible for overseeing the association's finances. While we have a treasurer, I am a signatory to all the association's accounts. Any expenditure requires my signature along with the treasurer's to ensure transparency and accountability.

What priorities and goals do you have for the Uganda Medical Association during your tenure as president?

During my tenure, there are both short-term and long-term priorities and goals for the Uganda Medical Association (UMA). One urgent issue we are facing is unemployment among doctors in Uganda.

We are advocating for the operationalization of the new health service structure developed by the government, which would provide more positions for doctors in government hospitals and health center threes.

We are working with members of Parliament to push for the necessary funding in the budget for deploying doctors to health center threes and hospitals across the country and have promotions for officers already in government. Another strategy we are exploring is labour export of professional health services, which would allow Ugandan doctors to find employment opportunities abroad and generate revenue for U.M.A and the government.

We plan to participate in the completion of the internship and senior house officers’ policy, so that their pay and practice can be streamlined.

Do you believe strikes are the only effective method to make the government address your concerns, considering its historical use by doctors?

No, strikes are not the only means of negotiation with the government. Strikes should be considered as a last resort after all other negotiation channels have been exhausted. We prefer to engage in discussions and negotiations with the government to address our concerns. Strikes come with disadvantages, including a negative impact on patient care and potential loss of life. As medical professionals, we prioritize the well-being of our patients, and strikes are not a preferred option.

There is a perception that doctors demand too much compared to other sectors. Is it true?

We do not believe that doctors are demanding too much. Our demands are based on what we consider fair and necessary. It is encouraging that the government has recently increased our salaries, as Ugandan doctors were among the least paid in East Africa. However, there are still challenges in the healthcare sector, such as inadequate equipment and a shortage of doctors. We believe that addressing these issues, along with fair compensation, will lead to improved healthcare services for all Ugandans.

How do you envision the future of healthcare in Uganda, and what role does the association play in achieving that vision?

The future of healthcare in Uganda holds promise, especially with the consideration of alternative funding sources such as the national health insurance bill. Once operationalized, this bill will address the long-standing issue of low funding in the health sector. By pooling contributions from individuals, we can invest in healthcare infrastructure, employ more health workers, and provide essential services and treatments.

The Uganda Medical Association plays a crucial role in contributing to policy formulation and advocating for improvements in the health sector. Through conferences and discussions, we provide recommendations which influence policy to the government and work towards a better healthcare system for all Ugandans.

What challenges does UMA currently face?

One of the challenges we face is membership participation. Although all doctors in Uganda are supposed to pay annual membership fees, some members have been inconsistent in their payments. To address this, we are exploring collaboration with the Uganda Medical Practitioners Council, which requires doctors to renew their licenses annually. We aim to align the payment of UMA membership fees with the license renewal process to ensure a more consistent and active membership base, which will improve the association's financial stability.

How does UMA collaborate with other organizations and stakeholders to enhance healthcare delivery in Uganda?

UMA collaborates with various organisations and stakeholders to enhance healthcare delivery in the country. We have established partnerships with the United Nations Children's Fund (UNICEF) and other medical associations globally, such as the World Medical Association. Additionally, we maintain a strong relationship with the Ministry of Health.

We engage in regular communication with the Ministry of Health, reaching out to them through letters and discussions whenever there are pertinent issues to address. For instance, we provide recommendations and advocate for changes in human resource structures and bills related to healthcare.

One notable achievement is our contribution to the Public Health Amendment Bill. We organised a workshop funded by the Infectious Disease Institute, where we made recommendations. Subsequently, we presented these recommendations to the Parliamentary Health Committee. A significant portion of our recommendations was adopted in the Bill. Similarly, we provided recommendations for the Uganda Human Organ Transplant Bill, and more than 50% of them were adopted and led to the passage of the bill.

We also played a role in influencing the exclusion of organ transplants in children and prisoners due to their vulnerability. It is essential to protect the rights and safety of these groups.

We are writing proposals to obtain grants from partners to carry out research about some issues in the health sector and this will become public very soon to all doctors.

What were the factors that led to the near-collapse of UMA according to previous reports?

The near-collapse of UMA was attributed to an incident involving our former president. He was invited to attend an NRM (National Resistance Movement) youth event, but we, as the National Executive Committee, advised against his participation.

As a professional association, we strive to maintain neutrality as our members support different political parties.

However, despite our advice, the former president attended the event and mobilized young doctors to join him. They went to the event wearing their clinical coats, which was acceptable. They presented issues related to doctors' concerns, but the problem arose when they knelt in their clinical coats. Kneeling in coats is not permitted for doctors, as the coat carries professional respect and values. This act was seen as an abuse of our professional attire.

After the incident, there were calls for an apology from our members and the international community, as our uniform was misused. Unfortunately, our former president refused to apologize during a meeting called for that purpose. This refusal led to further conflicts, including legal actions, which caused significant disruption within the association.

How does UMA ensure that the voices and concerns of medical professionals across Uganda are properly represented?

UMA has a robust structure in place to ensure the representation of medical professionals' voices and concerns across Uganda. We have 14 branches, with each branch representing a region in the country. Each branch has a chairperson and a team working in their respective areas.

The branch chairpersons are responsible for gathering information and feedback from their regions. They then communicate this information to the National Executive Committee through the National Governing Council.

The National Governing Council includes representatives from the branch chairpersons and specialist associations, such as physicians and pediatricians.

Regular communication occurs through a WhatsApp group, where updates and information are shared among all members. During formal meetings of the National Governing Council and the National Executive Committee, chaired by myself, we discuss the updates and find solutions to the issues raised. This structure ensures that the concerns and voices of medical professionals from all regions are heard and addressed.

How can the issues surrounding internship interviews be resolved to prevent further protests?

Resolving the issues related to internship interviews requires the establishment of a comprehensive internship policy. Currently, we have a draft policy, but it needs to be finalized and enacted. The abrupt changes in the internship process, without proper policy guidance, have led to protests and dissatisfaction among interns.

Having a policy in place will provide clear terms and conditions for internships, allowing interns to understand their rights and obligations. It will also provide a legal framework for addressing any grievances. UMA will advocate for the completion and implementation of the internship policy during our tenure. We believe that a well-defined policy will promote transparency and fairness in the internship process, ultimately resolving the issues and preventing further protests.