By Henry Mutebe
There has been alot of hullabaloo about Cuban Doctors coming to Uganda. Ugandan doctors are concerned about the fact that instead of facilitating them and incentivising the profession to attract medical professionals into public service, the government has chosen to take unsustainable and counter productive short cuts by deciding to import Cuban Doctors to address the shortages in the health care system.
In my view, what the government should be doing is to learn how the Cubans positioned themselves to be able to export such high numbers of medical professionals. In this piece, I will paint for you a picture of what Cuba looks like compared to Uganda and what lessons we can take from Cuba.
Cuba is an island with a population of about 11 million people. Cuba has for over 50 years been under international embargo aimed at strangling its economy and bringing it to its knees. However, Cuba has displayed incredible resilience even amidst these conditions. As a way of positioning themselves as key players in global affairs, Cuba, under the leadership Fidel Castro made a strategic decision to develop their medical sector and be a global power leading the frontline in aninating action around health care.
First, they made it clear that health care and treatment is a right of all Cubans and thereby embedded it in all their developmemt plans. They committed alot of funding for training of medical proffesionals and conducting research.
In 1959, Cuba is said to have had about 6000 Doctors. This number is less than what Uganda currently has in public service. Over 50 years later, Uganda has less doctors than Cuba had in 1959.
Fidel Castro felt that using medical diplomacy; exporting medical proffesionals around the world, he would be able to circumvent the effects of the embargo placed around his neck by the West/US. Indeed, to some extent, his plan worked.
In the last 50 years, Cuba has exported over 300,000 medical proffesionals to over 157 countries around the world. Currently, Cuba has over 70,000 medical proffesionals for their 11 million people. This means that there is one doctor for every 157 people. In Uganda there is one doctor for every 24,000 people. God forbid, but if catastrophe struck and a huge number of Ugandans got sick requiring the services of a qualified medical doctor for each case, there is a probability that you would have to wait for 23,999 people before it would be your turn to see a doctor.
Even if all doctors in public service were all present, attending to patients, working 24 hours a day (which is impossible), seeing a patient every 2 minutes, it would take you approximately 33 days before you would eventually see that doctor. That doctor would actually be dead because no human being can work for 24 hours, for 33 days non-stop.Thank God we never fall sick at the same time…but that is what it would mean.
The recommended ratio by WHO is one doctor for every 1000 people. Cubans have one doctor for every 157 people, We have one doctor for every about 24000 people. So Cubans are well above many countries…including countries in the global north (which some call developed countries…as if they have reached the end of development and are now static).
Cubans are so ahead that only two states float above their capacity. Qatar and Monaco are the only players above Cuba. Qatar is ahead, partly because it has a very small population.In absolute numbers, Cuba is ahead.
How did this happen? The leaders of Cuba made a strategic decision to position themselves as the leading suppliers of medical proffesionals in the world, and they are earning big from it. Let me give you the picture in ‘Ugandan terms’ so that you appreciate it better.
Currently, Cuba has 70,000 doctors. Those are the medical proffesionals resident in Cuba. But Cuba has over 50,000 doctors or medical workers spread accross the world. The average income of those doctors working abroad is about US $1000 after taxes. (about 3.7 million Ugx shillings) per person, every month. In 2014 alone, Cuban Doctors working abroad sent in over US $8 billion ( about Uganda shillings 29.6 trillion). Let’s make sense of what this means.
Uganda’s GDP or the money we have in this economy is about US $26 billion (about Ugh.96.2 trillion shillings). So Cuban Doctors working abroad collectively send back to their country money equivalent to 30% of the total amount of money Uganda owns.
Lets get it even more clear. Out of the 96.2 trillion Uganda shillings that we have as Uganda, Uganda Revenue Authority collects less than 14 trillion which our government uses to run the country. To undertand how huge this money is, think of it this way. If those Cuban Doctors working abroad were Ugandans, the money they send back to their country would be enough for the Ugandan government to run for two years without taxing any of you or any of the goods and services you consume. Thats how huge the money is. It is double what our tax body collects every year. So what they send back to their country is enough for our government to run for two years without collecting any money from any Ugandan.
The doctors are so many in Cuba that some work as shop keepers, taxi drivers, hotel attendants, tourists guides among other jobs. The average pay for a doctor in Cuba is about 190,000 Ugh a month. So most of them choose to leave Cuba and work elsewhere. They are on high demand elsewhere.
The Cuban government is reaping so big from them that it even has special arrangements with some governments. For example, Venezuela entered into an agreement with Cuba to be supplied with 3,500 Doctors. It in return, pays them using Oil. So Cuba’s Oil needs are addressed because of this vital resource called Doctors.
Cuban Doctors are given good training and there are many international students at Latin American school of Medical sciences in Havana. The state commitment to funding research has helped Cuban medical scientists to engage in cutting edge research that led to the to the discovery of the first and only vaccine against Meningitis B. Cuban scientists also pioneered a lung cancer vaccine that has been tried in the US. Cuba was the first country to eliminate transmission of HIV/Syphilis from mother to Child.
Their health care system is robust although there are reports of a two tier system where the poor get limited supplies and bad services while the tourists, politicians and other VIPs get elite treatment in the same system. That not withstanding, they continue to lead the frontline and produce doctors for the world. To tell the health of a nation, you can look at the life expectancy of its people. Cubans life expectancy is over 75 years. In Uganda, we are still fighting to make it to 60 years.
With over 50,000 doctors accross the world, providing services to other countries and earning an average of 3.7 million each-every month, even if each doctor sends back about Ugx. 2 million, their country would be making over UGx.100 billion every month. This is more than the annual budget of many of our ministries.
The lesson we should take from Cuba is that leaders must identify an area, in which they invest heavily and selflessly to position their country as leaders in that field. Cuban Doctors are so needed that in 2013-2014, despite the embargo, the US had to go against its earlier position, and created the Cuban medical proffesionals parole through they absorbed about 3000 Doctors into the US health care system. This injection was the equiavelent of taking twice the number of all Ugandans doctors in our healh public service. The lessons cuba offers is that leaders must be able to do things they may never see in their life time. The castros are now gone…Cuban doctors live on.
I do not want to discount what our leaders are doing, but I think, we need to do more to create a Uganda which has some sort of soft power in something, like Cuban Doctors have given Cuba soft power. We need to invest in something (I don’t know what it is), that will position Uganda as a global leader in that XYZ sector.
The President of Uganda has for the last 32 years been surrounded by people who feel they should be rewarded because they fought. He has given jobs and opportunities to many people. Many have done a good job and others have simply stolen or looted. This country, even with its little revenue has capacity to invest for the future. We can do better than we are doing.
Those who fought have been rewarded. I think its time for the president to focus on development of Uganda as a whole. Today, businessmen and women run our government. They can not get a good deal for the government. They instead give themselves the tenders and contracts through third parties. They exploit and take the very maximum from government coffers. Every tender is always far and above the market prices of things. Nobody or few, seem to be concerned about the rest of the people who ought to be benefiting from those services. The decision makers inflate things just to take everything they can from the poor who pay that money from their hard incomes. Government money is treated as nobody’s money. Few, if any, cares whether the public loses or not. Many are there to feed themselves only.
I think, as we bring Cubans, let’s not just employ them to treat our people. Like the Arabs in the Emirates and Qatar did, turning dry lands into magnificent places, that are not business and tourist magnents, let’s bring them to teach our own and develop our capacity instead of them offering direct frontline services. More than importing, we need to find out how Cuba managed to develop that capacity to export. This requires serious leadership, selflessness and a leader who is thinking about the future Uganda.
Since President Museveni is still our president, my appeal to him is that for once, his whips his team to concentrate on thinking and executing work instead of looking for which land to buy, which tender to deal in, which government project to loot from. I believe the president has tried to reward the people who fought. We need to move on. So many people loot, make serious blunders, and cost out country so much, but because they say they fought, the president plays soft with them and I think some day, if he doesn’t get hard on his team, they will cost him alot.
The time has come for him to think about the rest of Ugandans. Those who loot government resources, ministers who are doing nothing apart from buying plots of land and deals should be left and serious people, with fresh minds, zeal, commitment and the right orientation be brought on board to steer Uganda to the next level. As long as long we have simply transactional and not transformational leaders, we are bound to roll back the gains made.
The Cuban Doctors are welcome but they would better serve as lecturers and teachers than as frontline carders. Dubai, Qatar, Singapore, Malaysia, Japan, China all did one thing: They imported people who taught them what to do and the rest is history. Ugandan doctors should be well facilitated, the rest should be able to work itself out. Cuba exports doctors because it found a niche and exploited it. What is out niche, what shall we send out in future? How shall we earn as a country? I don’t have the answers.
Instead of paying Cuban Doctors, why wouldnt you increase the local doctors pay and other incentives so that you retain that money in the economy? We are already having balance of payment problems, who does this? Why decide to give away money when you can negotiate with doctors and retain the money within the economy?
Our leaders, please…you have to be deliberate and say, as an example, we want to have the best medical schools in Africa. You fund it fully and leave that as your legacy. As a minister or leader…You have to have that one or two projects you say ‘ON THIS, I AM NOT TALING A SINGLE COIN…I am doing this for my country …for posterity…I am doing this for this country that has given me the opportunity to lead them.’…and you do something historical that perhaps no other in the near future will beat. Please we need to negotiate and think about the future of this country together.