Health ministry plots heavy punishments for absenteeism, TikTok medics

IGANGA - Health workers who abscond from duty will face disciplinary action, says Health Permanent Secretary Dr. Diana Atwine.

Dr. Atwine faulted health workers who think that being on call means being called into the health facilities for emergencies only.

“We took the Hippocratic oath that we shall be available for patients no matter the conditions,” she noted.

Dr. Atwine said the Health Ministry will also deal with health workers who report for duty but spend a lot of time on social media instead of attending to patients.

She urged facility heads to focus on monitoring and measuring performance of staff.

The current Uganda Public Service Standing Orders, which were revised in 2021, outline the framework for managing public service employees, including health workers. These orders cover areas such as conduct, discipline, and terms of service.

Key aspects include professional conduct, patient confidentiality, and prohibitions against bribery. The Ministry of Health also has specific service standards and a comprehensive health service manual, guiding service delivery and quality.

“If every health worker stayed at the facility and worked as per the standing orders and job description as well as conducted community health outreach, the country would experience immense transformation even with limited resources,” Atwine said.

The Health Ministry’s director of Public Health, Dr. Daniel Kyabayinze, said the Health Ministry will look into individual performance and key performance outputs for every health worker.

“In this regard, every supervisor must at the end of the month give a report to the Director General of Health Services on their outputs (days worked) and any challenges.”

The commissioner for Institutional and Health workforce development, Dr. Alfred Driwale, said absenteeism in local governments is the responsibility of the chief administrative officers. He warned local governments not to tempt the central Government to initiate action against absenteeism in the office.

"Ideally, the lower health facilities should have at least two clinical officers on duty at the same time to reduce the patient waiting time. Instead, they draw a duty roster where a clinical officer appears for two weeks and disappears for the same period of time.”  

In addition, Dr Atwine faulted senior medical officers who relegate very sick patients to junior health workers who cannot make serious decisions, resulting in irrelevant referrals.

“Why would a health centre IV with a theatre and doctor refer a mother with a third-degree, severe tear to a bigger hospital? By the time the mother gets there, she has lost a lot of blood.”

Dr Atwine urged health workers to ensure effective referral systems based on strong reasons.  

This was during the commissioning of the refurbished Bulamagi HC III in Iganga district, and closure of the health systems strengthening project for improved reproductive, maternal, newborn, child and adolescent health service delivery in Busoga region on Friday.

Bulamagi HC III in Iganga district was refurbished with support from the Ministry of Health, World Health Organisation and Government of Korea.

The five-year project cost sh$10m, and was implemented in the five districts of Busoga region, including Bugiri, Kamuli, Iganga, Mayuge and Buyende.

WHO representative in Uganda, Dr. Kasonde Mwinga, said the refurbished health facility will help to save mothers when they come to deliver and will also help to save newborns.

The Health Ministry's Permanent Secretary, Dr Diana Atwine, commissions Bulamagi Health Centre III, flanked by WHO and KOICA officials. Credit: Agnes Kyotalengerire)

What became of the Biometric instruments?

Dr. Alfred Driwale said the Biometric machines are not in all health facilities. 

He said that although technology can solve problems to a smaller extent, more interventions are needed to back up the implementations, monitoring, rewards and sanctions.

“Our intervention right now is investing in the infrastructure, which includes biometric machines and computers. However, more is needed with the national coverage and other packages with which it should be implemented,” he noted.

A biometric machine is a device that uses unique biological characteristics (biometrics) to identify and authenticate individuals. These machines capture and analyse physical or behavioural traits such as fingerprints, facial features, iris patterns, or voiceprints to verify a person's identity. They are commonly used for security, access control, and attendance tracking.

Health workers speak out

Kamuli district health officer Dr. James Wako, said they use the duty roster, which is tallied with daily attendance records. “Every month, an analysis is done and fed into the human resource management system. Health workers who are not performing to expectations are invited for a hearing. In addition, effective supervision is done to monitor them to ensure they improve,” says Dr Wako.

Errant workers are sanctioned, and when they persist, the issue is escalated to the Chief Administrative Officer. Usually, the indiscipline case results to no pay.

Dr. Wako said they are using the manual registration system because the clock-in Biometric finger machines were not installed in the health facilities.

The district Health Officer for Iganga, Dr Patrick Kitimbo, said the biometric machine, which was installed at Iganga General Hospital, has not been functional for the last six months.

In the meantime, the health workers use a book to sign in and out of their duty attendance.

Dr. Wako said that although biometric machines are good, to make them more effective, they should be set to capture fingerprints as well as faces.

“Considering that the current Biometric machines only capture people’s fingerprints, health workers manipulate them to register people who are not on duty,” he said.  

Lira district Health officer, Lira, Dr. Patrick Buchan Ocen, said the Biometric machines are only at the Lira regional hospital, and not in the lower health facilities.

He noted that the attendance rate in the district has improved because of the human resource management attendance system, which was introduced by Ministry of Health.

According to Dr. Buchan, the system is a module where each health facility uploads the duty roster, and the daily duty attendance is recorded by the in-charge of the facility.

“This enables the district health officers to know the people who worked for the day. By mid-month, they are able to see who has worked for at least 15 days. As punishment, the salary is withheld for those who worked for less than 15 days in a month.  In addition, they are sanctioned to answer why they absconded from duty,” he said.

Dr. Buchan further noted that once salary is withheld, the attendance of health workers improves the following month.

Prior to the situation, it was dire. Dr. Buchan said some officials would work for just two days a week. “On days the district health team would go for monitoring and supervision, everyone would be present,” he said.