Chapter 2 - Human Resources

Introduction

The recruitment of staff and its retention have always represented a serious challenge to the management of the Hospital. The harshness of living conditions in Karamoja, its many years of insecurity, its remoteness: all this concurs in rendering work in Matany less than attractive. Neverthless, the Hospital has managed to have enough Medical Officers. During 1998 an average of 5 Medical Officers were present in the station, three Ugandan and two expatriate CUAMM volunteers : a paediatrician and the MS who has a a post-graduate degree in Surgery.

During the year more Administrative staff had to be employed to cope with the increasing complexity of the administrative work, though the lack of local skilled administrative staff is still a problem. One expatriate VSO volunteer was appointed Office Supervisor and another Accountant was employed. The administrative reform launched last year continued also throughout this year under the guidance of a Ugandan Certified Public Accountant hired as consultant. A Laboratory Technician, a VSO volunteer is now the Incharge of Laboratory in an effort to improve quality laboratory services

The Administrator who has served the Hospital for more than ten years, was appointed Executive Secretary of the UCMB and a new Administrator, also a Comboni Brother, took his place in August 1998.

The opening of the training school for nurses in 1984 has managed to secure the needed qualified nursing staff. A big problem is still represented by all categories of allied medical professionals (for whom the opportunities of employment in large cities are many and very attractive) and by capable indigenous technical cadres. The technical department still has to rely on the supervision of two expatriate staff.

An additional problem is posed by the lack of qualified cadres from among the ranks of Karimojong indigenous. Despite the generous investment of the Hospital management in the training of young Karimojong the results are still poor. The low academic standards of schooling offered in Karamoja makes it more difficult for people there trained to have access to professional training.

In addition to this, the lack of well established career development schemes and promotional outlets, makes the employment in Matany a temporary arrangement for most people who achieve a professional qualification.

Present situation (end of 1998)

In December 1997 the Hospital Administration was forced to introduce additional incentives for its Staff in order to avoid discontent and loss of precious cadres. Though following the Government Salaray scale, Matany was registering the lowest levels of pay in the District. At present, thanks to government intervention in the form of Delegated Funds, the Hospital Management has been able to maintain salary levels of 95% compared to those paid by the private sector or by the very attractive employment in NGOs operating in the frame of projects.

At the end of 1998 Government posted Officers were three (one Medical Officer and the Principal Tutor); the third posted Officer (the former Medical Superintendent) returned in August from his study leave for a Master of Public Health under a scholarship secured by the Hospital. The expatriate staff comprise two Medical Officers (one MMB volunteer finished her contract in September 1998), the Administrator, the Senior Nursing Officer, the Office Supervisor, the Laboratory Technician Incharge, two Technical Supervisors, the Domestic Officer, the Assistant Tutor, one Store Keeper. Two are Comboni Missionary Brothers and four are Comboni Missionary Sisters.

The total number of employees is 210, 143 (68%) of whom are Karimojong. The distribution by department appears in table 2.1. The number of qualified staff (employees holding a diploma, certificate or degree) is 64 (30%).

Trends

With the exception of nursing, administrative, PHC and teaching staff, the number of employees decreased in 1995 (graphic A, table 2.1) and increased again in 1996 and 1997. In 1998 there is a marked increase in the overall number of employees, especially Nursing Staff, in order to face the increase demand for health care services which has registered this year a record level. The number of Karimojong Staff (142) is the highest level noted in the last 10 years.The institutional policy of favouring the employment of indigenous personnel is well established as it can be seen in these last two years. The Technical Department maintained its Staff level and continues to be a necessary department. On one hand this department is essential for the proper running of the Hospital ; on the other side the department provides services to the public and to projects, generating additional income. Its growing importance in the hospital economy justifies its size.

In the period covered by the report the hospital has continued promoting the up-grading of staff: more details are given in Table 2.3.

The salaries paid to the employees are slightly lower than in Government Hospitals but the housing provided seems to be better. All employees are covered by NSSF insurance. With exception of some of the Technical department staff, all employees are paid on a salary basis. The salary is composed by a basic salary (Government scale) to which some incentives have been added (Hospital incentive plus government incentive). This constitutes the basis of calculation for insurance purpose. Other payments (overtime, calls, stand-by allowance and specific tasks related allowances) are instead considered for the purpose of calculation of PAYE. The average salaries paid at the end of the year for the stated categories of staff are in Table 2.3

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	end '93	End '94	end '95	end ‘96	end ‘97	End´98
MEDICAL STAFF	5	5	4	5	4	6
ALLIED MEDICAL PROFESSIONS	9	7	7 (5)	8 (4)	13 (6)	14 (4)
NURSING STAFF	35	40	44 (19)	46 (16)	42 (19)	57 (22)
ADMINISTRATIVE STAFF	4	4	5 (3)	8 (1)	8 (1)	11 (4)
PHC STAFF	25	24	25 (25)	23 (23)	29 (28)	27 (25)
TECHNICAL STAFF	54	52	32 (23)	35 (21)	43 (28)	42 (38)
SUPPORT STAFF	34	32	29 (22)	30 (25)	42 (36)	39 (38)
SCHOOL STAFF	10	10	12 (9)	12 (9)	11 (7)	12 (9)
KHRDCH STAFF					2 (2)	2 (2)
TOTAL	176	174	158	167	194	210
(.) = Karimojong Personnel	128	129	106	99	127	142
Table 2.1 : Establishment at Matany Hospital – 1993-98

Average Salaries	End ‘98	Ush
ALL. MEDICAL PROFESSIONS*		200,000
UEN/MW		130,000
URN/MW		180,000
Aide Nurse		80,000
ADMINISTRATIVE STAFF		170,000
PHC STAFF		52,000
TECHNICAL STAFF		120,000
SUPPORT STAFF		65,000
SCHOOL STAFF		200,000
KHRDCH STAFF		120,000
Table 2.2: Average salary per category of employee; end of 1998 * Qualified cadres

Table 2.3 : Training of Staff : (* Karimojong)

Type of Training	Institution
Laboratory Technician 2 *	Nsambya Hospital Laboratory Tech. T. S.
Store Management 1 *	Institute of Professional Studies – Mbale
Registration in Midwifery 3 (1*)	Rubaga Midwifery T.S./Nsambya Hospital
Laboratory Assistant 1*	School for Lab. Assist – Kitovu Hospital
Clinical Officer 1*	Mbale Clinical Officers School
Enrolled Midwifery 4*	St. Mary´s Midwifery T. S. – Kalongo
Diploma in Hospital Management 1*	Uganda Martyrs´University
Diploma In Hotel and Institutional Catering 1*	Rubaga Catholic Social Training Centre
Nurse Anaesthetist 1*	Lacor Hospital School of Anaesthesia
Registration in Nursing 1	Rubaga Nursing T. S.
Accountant	Multitech Institute - Kampala

Conclusion

The management of human resources with the management of finances are clearly the main management problem of the Hospital. The lack of qualified Karimojong personnel will require a more substantial investment in their training. The training will have to be focused in 1999 on the development of administrative cadres as priority. Investments are being made in providing training for Domestic Officers in view of the function that the KHRDCH will exercise in the District. Other training to be pursued are: Health Information/Record management, Secretary, Accountant, Radiologist, Physiotherapist, Public Health Officer and another Medical Officer to replace the MMB volunteer who finished the contract. This conclusion also indicates the points of action for 1999.

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