Dear Tingasiga:
The ease with which the Uganda Government spends money on self-congratulatory celebrations, gifts to religious groups, and all manner of luxury spending is mind-boggling. The ease with which the same government dismisses the worth of medical interns who have spent five long years learning to keep us alive speaks volumes.
A nation’s budget is a moral document stating what-and whom-a society values most. Uganda’s current spending priorities reveal a deeply disturbing paradox.
Members of Parliament take home massive car grants, extensive travel stipends, and millions of shillings daily. Meanwhile, medical interns-the literal backbone of our public healthcare infrastructure- are paid small change, if paid at all, and they are forced to strike just to secure basic food, housing, and frequently delayed allowances. This spending model reflects a critical public health failure that directly threatens ordinary citizens.
This paradox is amplified by the rapid expansion of medical training. Over the last two decades, the number of accredited medical schools in Uganda has ballooned to roughly 12 institutions. Where once Makerere University stood alone, Uganda now features public facilities like Mbarara, Gulu, and Busitema, alongside private setups like Kampala International University. While the state celebrates this institutional growth, the healthcare system meant to absorb these graduates is collapsing under fiscal neglect.
Can Uganda truly afford the high cost of running medical schools if it refuses to pay its medical interns competitive, liveable salaries? When a government funds the production of a highly specialized asset but starves its operational maintenance, it engages in economic self-sabotage. Training a single doctor is the most expensive undertaking in tertiary education, requiring heavily subsidized tuition, high-end laboratory equipment, and vast clinical training networks.
For five years, scarce national resources have been poured into every student. The true return on this investment is only realized when these graduates begin practicing. However, the state’s current framework treats these graduates as disposable labour, even irritants, leading to massive friction. Persistent official attempts to strip away or aggressively slash medical intern allowances have sparked continuous nationwide strikes.
The national budget allocation to the health sector remains highly volatile, hovering at roughly 8 percent of total spending. This falls significantly short of the 15 percent baseline mandated by the 2001 Abuja Declaration, to which Uganda is a signatory. By starving the frontline clinical workforce, the country effectively writes off its own multi-million-shilling educational investments.
To understand why this compensation structure is backward, one must look at the gruelling reality of a public hospital ward. A medical intern in Uganda is not an apprentice quietly shadowing a senior consultant. Because of severe, chronic staffing shortages across the health care system, these young professionals function as the primary clinical engines running our medical system. Interns routinely work exhaustingly long shifts, managing overcrowded maternity wards, performing emergency surgeries, and monitoring dying patients under immense pressure.
Contrast this with the daily schedule of a Member of Parliament. A politician’s week consists of flexible committee meetings, plenary debates, and caucuses. While writing laws matters, a temporary pause in parliamentary sessions does not cause immediate fatalities. Conversely, if medical interns stop working for even a single morning, emergency rooms stall, treatable labour complications become fatal, and preventable deaths spike instantly. The proximity of an intern’s work to the immediate survival of our citizens justifies premium compensation that surpasses that of politicians.
Furthermore, the extreme physical environments where medical interns work demand financial protection. Frontline clinicians handle acute traumas, highly contagious pathogens, and complex bodily fluids daily in under-equipped public wards that frequently lack basic personal protective equipment (PPE). This regularly exposes them to life-threatening infectious diseases. They absorb this intense occupational risk while completely sleep-deprived and without any robust institutional safety nets.
MPs experience no comparable physical hazards, working inside secure, legislative chambers and committee rooms. Compensating politicians with lavish vehicle grants and high salaries while leaving frontline medical workers exposed to poverty and disease is an unjustifiable policy. Premium pay for interns is necessary hazard pay for those who regularly jeopardize their own health to protect us.
This structural failure triggers an immediate, aggressive brain drain. Deprived of basic amenities and predictable pay, newly graduated doctors realize their expertise is completely undervalued domestically. This financial neglect turns Ugandan medical schools into heavily subsidized recruitment pools for our neighbours and wealthier nations. Foreign regional and international healthcare networks gladly absorb these highly trained assets. Uganda bears the steep, front-end cost of academic production, while foreign economies reap the lifelong operational benefits. A developing country cannot afford to act as a free training academy for the rest of the world.
The standard official defence is that Uganda simply lacks the fiscal space to offer competitive salaries to its medical interns. Yet, this narrative of absolute financial scarcity is flatly contradicted by the cost of medical tourism for select citizens. Uganda spends $150-$175 million annually to export select citizens for medical treatment in India, Turkey, Italy, Spain, Thailand, South Africa, and Europe. This means the state spends far more on sending a privileged few to overseas clinics than it would cost to properly pay every single medical intern running the nation’s domestic hospitals.
This capital flight inflicts a double wound. It actively drains foreign currency reserves that could otherwise stabilize the domestic health budget, and it demonstrates a complete lack of institutional trust in the very healthcare infrastructure the state is supposed to manage. If the hundreds of billions spent on favoured people’s medical evacuations were re-routed internally, the funds would easily secure competitive salaries for interns, eliminate regional medical shortages, and properly supply public wards. The money is clearly there. The state has simply prioritized political privilege over public health survival.
Ultimately, building new medical universities to pump more graduates into a toxic, underfunded hospital system does not improve public health. It simply increases the volume of frustrated, underpaid professionals waiting for their first opportunity to leave.
A medical school is not just a collection of buildings or a factory for printing degrees. It is the starting point of a covenant between a doctor and their country. Uganda cannot afford the prestige of medical schools if it refuses to invest in human capital for the long haul.
Until the state stops exporting its capital to foreign hospitals and its best medical minds to foreign shores, expanding medical education will remain an expensive exercise in futility.