Uganda plans to phase out allowances for medical interns by July 2026, a move that has sparked concern among young doctors and hospital staff who say the change could deepen financial strain during one of the most demanding stages of medical training.
At Mulago National Referral Hospital, the morning rush begins long before sunrise. For medical intern Simon Kilama, it starts not with patients or prescriptions, but a quiet calculation: transport, rent, and what will be left for food after the day ends.
He adjusts his white coat, checks his notes, and steps into a system that depends heavily on people like him: young doctors in transition, carrying responsibilities that often feel fully formed, even when their pay does not match the weight of the work.
For Kilama and many interns across Uganda’s public hospitals, the final year of medical training is not just about learning. It is about surviving.
Now, that survival is being questioned.
A government proposal to phase out allowances for medical interns by July 2026 has placed the most vulnerable group in Uganda’s medical pipeline at the centre of a national debate, one that blends health policy, public spending, and the lived reality of becoming a doctor.
Living on the edge
Intern doctors occupy a difficult space in Uganda’s health system. They are graduates of medical school, still under supervision, yet already embedded in the daily work of hospitals. They diagnose, assist in surgeries, manage wards, and respond to emergencies, often in understaffed facilities and under sustained pressure.
Yet for many, the financial reality remains fragile.
‘People think because you are a doctor you are fine,’ Kilama says during a brief break between rounds. ‘But internship is when you are actually struggling the most.’
Most interns rely on a monthly government allowance of about Shs1m to cover rent near hospitals, transport, meals during long shifts, and basic living costs. Without it, some say the transition from university to full professional practice becomes even more difficult.
It is this support that now hangs in the balance.
A policy shift redefining training
The proposed changes fall under broader reforms in health professional training guided by the National Education and Training for Health Policy introduced this year.
Under the new framework, the internship year is being repositioned as part of academic training rather than a paid government placement. Officials argue that interns remain trainees and that the system must reflect that distinction more clearly.
The Ministry of Health says the reforms are intended to streamline training, strengthen supervision, and create a more structured transition from classroom learning to clinical practice.
But on the ground, the shift is felt less as restructuring and more as withdrawal.
‘We are already working in hospitals that are overwhelmed,’ says another intern at a regional referral hospital, who asked not to be named. ‘If you remove the allowance, you are asking people to serve patients while worrying about how to eat.’
Question of sustainability
Government officials say the decision is driven by fiscal pressure and the rising number of medical graduates entering internship programmes each year.
Minister of Health Dr Chris Baryomunsi has argued that while interns play a critical role in the health system, the cost of sustaining allowances has become increasingly difficult to manage.
He says the reforms are part of a broader effort to align health training with available resources as government balances competing national priorities, including infrastructure, security, and service delivery.
Dr Jane Ruth Aceng has similarly stated that the internship year will now be fully integrated into university training structures, reframing it as an academic phase rather than paid employment.
Anxiety in hospital corridors
In hospitals, policy language translates into uncertainty. Interns describe growing anxiety about what comes next; whether they will afford accommodation near facilities, take on debt, or reconsider their career paths altogether.
The clinical workload remains unchanged. Patients continue to arrive in large numbers. Emergencies come without warning. Supervising doctors still expect interns to perform.
What shifts is what happens after the shift ends, when exhaustion meets financial reality.
A debate years in the making
The question of intern allowances is not new.
In 2024, President Yoweri Kaguta Museveni raised concerns about the sustainability of the system while addressing medical interns at the Kyankwanzi National Leadership Institute. He noted that the growing number of interns, now in the thousands, was placing increasing pressure on public finances.
While acknowledging the importance of supporting young medical professionals, he pointed to competing national priorities, suggesting that government would struggle to maintain the arrangement indefinitely.
Those remarks are now widely viewed as an early signal of the direction policy would take.
What is at stake
Critics argue that removing allowances risks weakening morale in an already strained health system. They say interns are not only trainees but essential contributors to public healthcare delivery, often filling critical staffing gaps. Some have also questioned government spending priorities, pointing to administrative allocations and arguing that a rebalancing of resources could better support frontline health workers.
Government, however, maintains that comparisons between budget lines do not capture the complexity of national financing decisions, which must account for long-term sustainability.
Back to Kilama
As the afternoon wears on, Kilama returns to the ward. There is little time to dwell on policy debates. A patient needs attention. A procedure must be supervised. Another file is opened.
The rhythm of the hospital continues, regardless of uncertainty beyond its walls.
For his colleague, Lydia Birungi, the concern is more immediate. She travels about four kilometres daily to reach her training hospital and says transport costs already stretch her budget. The allowance, she says, has been essential in keeping her training manageable.
Hospital administrator Dr Joseph Obicci, based in Pader District, says interns remain central to service delivery in public facilities. He describes them as a critical layer of support in overcrowded hospitals, often stepping in during emergencies and easing pressure on senior staff.
For Uganda’s future doctors, the question is no longer theoretical. It is immediate and practical: how to train for a profession built on care while navigating the cost of sustaining oneself within it.
As the system moves toward reform, what remains unresolved is not whether interns learn medicine, but at what personal price they will continue to do so, and what that means for the future of the country’s health workforce.
Key facts
Who becomes an intern: Final-year medical graduates after completing university training
Purpose: One-year supervised clinical practice before full registration as a medical doctor
Placement sites: Public referral hospitals and accredited health facilities across Uganda
Core departments rotated: Medicine, surgery, paediatrics, and obstetrics and gynaecology
Supervision: Conducted under senior medical officers and consultants
Current monthly allowance: Approximately Shs1 million (under existing system)
Status under reform: Allowances set to be phased out under new policy framework by July 2026
Policy goal: Integration of internship into academic training and restructuring of health professional education
Key concern raised: Financial sustainability versus welfare of young medical professionals
Debate status: Ongoing between government, medical associations, and trainees.