By Bakshi Asuman
In his pathological work, Rudolf Virchow’s often used political metaphors, for example when he described the living organism as a “free state of individuals with equal rights, although not with equal talents, which is kept together by the fact that the individuals depend on each other”
Historically the origins and contemporary resonances of Rudolf Virchow’s famous statement “Medicine is a social science, and politics nothing but medicine at a larger scale”. Virchow was convinced that social inequality was a root cause of ill-health and that medicine, therefore, had to be a social science. Because of their intimate knowledge of the problems of society, doctors, according to Virchow, also were better statesmen. Although Virchow’s analogies between biology and sociology are out of date, some of his core ideas still resonate in public health. Aggregate population health may well be different from the sum (or average) of the health statuses of all individual members: populations sometimes operate as malfunctioning systems, and positive feedback loops will let population health diverge from the aggregate of individual health statuses.
History teaches us that the outcome of a single election can have profound, generation-defining consequences and that these consequences can depend on the slimmest of margins. This is implied in different general election cycles of different countries for example President Yoweri Kaguta Museveni during the 2016 -2021 general elections in his manifesto is to ensure that all Ugandans have access to high quality and affordable health care so as to contribute to social-economic development through delivery of promotive, preventive, curative, palliative and rehabilitative health services.
The 2021-2026 NRM Manifesto still emphasizes increase in access to quality health care through infrastructure development including for example renovate or construct theatres and wards in 37 HCIVs without functional theatres, construct at least 500 staff houses for health workers at HCIIIs and HCIVs, construct and equip five regional equipment maintenance workshops, increase access to specialised healthcare services by construction, rehabilitation and equipping of hospitals and super specialised/centres of excellence in line with the National Health Policy, upgrading the physical and technological infrastructure at the Uganda Heart Institute, construction of regional cancer centres in Arua, Gulu, Jinja and Mbarara, construction of the Orthopaedic and Traumatology Institute at Mulago, upgrading of Gulu, Mbale and Mbarara regional referral hospitals to national referral status in a phased manner, equipping of six regional referral hospitals of Gulu, Mbale, Hoima, Bombo, Kawolo and Moroto with CT scans and equipping Mbale, Gulu and Mbarara with MRIs.
With focus on the infrastructure development of the health sector, the manifesto comes short with one of the critical aspects of quality health care, skilled labor force. The government has a myriad of health workforce problems to fix in order to achieve adequate service coverage with well-constituted work teams at all levels of health care. Merely framing the problem of the workforce in Uganda as absenteeism is unlikely to generate the correct solution to pervasive workforce shortage and inadequate skill mix, poor motivation, and labour market dynamics. The drivers of the workforce shortage. The constraints on the wage bill and restrictive macro-economic rationales need to be relaxed to effectively solve the workforce challenges in production, deployment and retention.
For quality healthcare to be achieved, training policies and institutions need to be enhanced to sustainably generate adequate, appropriately skilled, fit-for-purpose and well distributed health workers. The governance of multiple agencies that espouse conflicting and adverse objectives with regard to the workforce developments need to be realigned with the overall aim of improving Uganda’s health system performance and resilience. The major lever for the alleviation of workforce shortage is wage bill increase, which would stimulate production and guarantee attractive remuneration for health professionals entering employment, coupled with improved provisions for workforce performance to improve and sustain service coverage.
With this it also places the role of government top priority in planning including financing and implementation of different health interventions like infrastructure development including construction and rehabilitation of health facilities at all levels, recruiting, and supporting welfare of the health personnel.
Politics, economics, and public policy are important determinants of population health. Countries with social democratic regimes, higher public spending, and lower-income inequalities have populations with better health. There are substantial gaps in the synthesized evidence on the relationship between political economy and health and there is a need for higher quality reviews and empirical studies in this area. However, there is sufficient evidence in this review, if applied through policy and practice, to have marked beneficial health impacts.
About the author:
Bakshi Asuman writer is an SRHR and Public Health Practitioner