The Uganda Medical Association (UMA) has rejected a government proposal to maintain full facilitation for government-sponsored medical interns while reviewing support for privately sponsored graduates, warning that the move could negatively affect healthcare service delivery.
The disagreement comes a day after the newly appointed Minister of Health, Dr Chris Baryomunsi, said Cabinet had agreed that government-sponsored interns would continue receiving full facilitation while the Ministry of Health assesses the financial implications of assisting privately sponsored graduates undertaking their mandatory one-year medical internship.
“Those who are on government sponsorship will proceed on internship with full support from the government. It will continue without disruption,” Dr Baryomunsi stated during the ministry handover ceremony on June 10.
“We are going to study the financial implications of providing lunch to those who graduate from private facilities, so they meet other costs themselves, but the government can provide lunch to enable them to work.”
However, UMA president Dr Frank Asiimwe criticised the proposal, saying it creates an unfair distinction between interns who perform the same duties under similar working conditions.
“All medical interns undergo the same mandatory training, work in accredited internship facilities and provide the same services regardless of how they financed their education. Interns account for between 70 and 80 percent of frontline clinical work in many public health facilities and therefore play a critical role in sustaining healthcare services,” he said.
Dr Asiimwe argued that privately sponsored interns face the same financial burdens as their government-sponsored counterparts, including accommodation, transport, meals and professional expenses.
He warned that uncertainty over facilitation could lower morale among young doctors, increase burnout and ultimately affect the quality of healthcare services available to patients.
“The bigger question is what happens to poor patients who depend on public hospitals when the people providing much of the frontline care are demoralised and unsupported,” he said.
In Mulago National Referral Hospital, Dr Asiimwe said interns are often told to eat food intended for patients, yet all interns deserve support regardless of whether they pursued their medical education through government sponsorship or private funding.
“Interns are officers on probation and should be paid at least 75 per cent of the salary earned by fully qualified medical officers. The effects of this will be felt most by low-income Ugandans who depend on local healthcare because they cannot afford treatment abroad,”
Dr Asiimwe further warned that prolonged disputes over intern welfare could worsen treatment delays, increase hospital backlogs and place additional strain on an already overstretched health system.
The Federation of Uganda Medical Interns (FUMI) secretary general, Dr Allan Okwir, said interns incur substantial costs before deployment, including purchasing medical equipment worth about Shs1 million.
“Why should interns be segregated in payment when we offer the same services and are subjected to the same expectations? Starting medical requirements are already at a high expense of about Shs1 million to be met by the interns,” Dr Okwir noted.
“This is a demanding calling that you never get time for a side hustle that can aid to support yourself and family. The unbearable emotional fatigue and mental frustration with financial constraints will rather cost the ordinary citizens when they go for healthcare,” he added.
Dr Okwir said pre-interns would not report for deployment under the proposed arrangement unless the government guarantees equal facilitation for all interns regardless of sponsorship status.
The medical internship program in Uganda has recently faced severe strain, characterised by delayed deployments and protests from pre-interns over allowance. Dr Baryomunsi attributed these persistent bottlenecks to a sharp increase in the number of medical graduates from both public and private universities.
To resolve sustainability, the minister acknowledged the need for long-term human resource planning to align health workforce training with the country’s future staffing requirements.
“Human resource needs in the health sector should be assessed to see how many doctors, nurses and laboratory experts we need in the next five, 10 or 15 years so that there is a planned arrangement between the Ministry of Education and us that handles training,” he explained.
Under the new guidelines in the National Education and Training for Health Policy beginning in August, the government scrapped the monthly upkeep allowances and mandated that medical students complete a compulsory one-year internship before they can be awarded their degrees.
Currently, medical interns receive a monthly allowance of Shs1million. This is a significant drop from the Shs2.4 million initially agreed upon following a 2021 presidential directive, which followed protracted strikes by medical workers over poor remuneration and working conditions.
Uganda’s doctor-to-patient ratio stands at 1 to 24,000, far below the World Health Organisation (WHO) recommended standard of 1 to 1,000.
During the 4th sitting of the 12th Parliament on June 10, the leader of Opposition Joel Ssenyonyi urged the government with immediacy to drop the “problematic” policy under the pretext of lack of funds, saying the Shs24 billion that had been passed for public holiday functions be allocated to that.
“Parliament had already passed that entire budget of about Shs24 billion, so that money is available, and is going to be saved since the government recently suspended public holiday functions to save money. Now that those functions are not going to be held, why don’t we channel that money to the medical interns?” Mr Ssenyonyi proposed.