And Midwifery Cadre

AN INSIGHT INTO THE DELAYED IMPLEMENTATION OF THE SCHEMES OF SERVICE FOR THE NURSING AND MIDWIFERY CADRE

By: Ms. Catherine Odeke, National Coordinator, Nursing Now Campaign Uganda (Photo courtesy of Agha Akan)

The Government of Uganda recognizes that Human Resources for Health (HRH)are a key input in the provision of high-quality health services. The sector is labor-intensive and therefore the availability of adequate and skilled human resources is central to the achievement of the health sector objectives. Nurses and midwives constitute seventy-three percent (73%) of the skilled health workforce and as such lack of a clear Scheme of Service. This gap can greatly compromise delivery of quality health services and the achievement of Universal Health Coverage (UHC).

The health sector reforms, including the decentralization of health services, the proliferation of training institutions across the country preparing Nurses and Midwives at certificate, diploma, bachelors and postgraduate degree levels, regrading of jobs and other policy shifts have all necessitated the need for a cost effective, competent and skilled Nursing and Midwifery workforce, capable of delivering preventive, promotive, rehabilitative and therapeutic health care services at all levels of health care.

In view of these reforms the Scheme of Service (SOS) for the nursing and midwifery cadre was revised to provide for a clearly defined career progression, professional advancement, streamlined job descriptions and specifications to attract and retain an adequate supply of nursing and midwifery professionals who are appropriately educated and skilled to meet the health needs of all Ugandans wherever they are deployed.

This exercise has addressed the issues that the Health Service Commission (HSC) had earlier raised through their chairperson to a meeting held at the Ministry of Health headquarters (level 111 board room on 24th June 2014), to discuss the implementation of the nursing and midwifery SOS; a meeting which was chaired by the then Hon. Minister of health Dr. Rukahana Rugunda.

The process of revising the Nursing and Midwifery SOS was highly consultative through workshops and meetings with Senior officials of Ministry of Health and representatives of several key stakeholders including Line Ministries, Professional Councils, Health Training Institutions, Development Partners, as well as Nursing and Midwifery practitioners and Educators at different levels of the healthcare system.

The Ministry of Public Service approved the new revised SOS for nursing and midwifery cadre in November 2017 and passed out a circular for its implementation on 27th December 2017. Submissions on all serving officers

for redesignation to District Health Service Commissions (DHSCs) and HSC should have been done by 30th March 2018 whereby on receipt of these submissions, the DHSCs and HSC should have undertaken the exercise to redesignate all officers accordingly. But to date, only a few districts have implemented the SOS. Majority of the DHSCs have not implemented or picked only the title of Assistants and redesignated their officers as such, irrespective of whether they have required degrees or not. The same applies to the HSC.

What are the bottlenecks to the implementation of the SOS?

• Personal responsibility: Majority of Nurses and Midwives, irrespective of having received the SOS and

Circular, have not internalized the document and are relying on their Human Resource Officers to guide them instead of them owning the document and leading its implementation. • HSC is combining the issue of staffing and restructuring with redesignation and they say officers cannot be redesignated without restructuring being completed. • The restructuring is being done in phases; it is only the headquarters where it has been completed, and it has just been started at the Regional Referral Hospitals. • Redesignating Nurses and Midwives will open up slots for recruitment and promotions as vacant positions will clearly be identified, others will retire, and new officers will be recruited and promoted when the structure is completed. • Officers are to be redesignated to the given Public Service titles of their salary scales - so they are already in Public Service earning their monthly salary given by Public Service or Local Government and even after redesignation, they will continue earning their same salary so it does not require one to be interviewed because it is not a promotion but only ones’ documents for the title will be validated. • Some Nurses and Midwives think redesignation is a demotion such as if s/he is a Senior Nursing Officer with a degree in the old Scheme of Service on salary scale U4 then she is to be redesignated to a Nursing

Officer, to her/him this is a demotion and prefers to remain with the Senior title so to her/him better the

Senior Assistant Nursing Officer title which should be for the one without a degree. • The delay in implementing the SOS is disadvantageous to nurses and midwives since other cadres were able to implement this swiftly. • A unified approach by nurses and midwives is urgently needed: Although not perfect, the SOS is a tool that helps streamline some differences such as being an Officer on a salary scale of a diploma holder; or a Senior

Nursing Officer in title only but at a salary scale of a Nursing Officer. Currently, Public Service recognizes one as an “Officer” when one has secured the relevant degree for the profession, they are in. • Persons without the relevant degree education are to be re-designated with the title of “Assistant”.

Individuals holding the title of Assistant are considered “Person-to Holder” until they retire or go back to school to pursue a degree.

What needs to be done to have the SOS fully implemented?

• All Nurses and Midwives need to understand and interpret this document very well to defend it rightfully and advocate for its implementation.

• Nurses and Midwives involved with the Health Service Commission both at the district and Health Service

Commission HQ need to internalize the SOS correctly, interpret it and guide their committees on proper implementation of it. • The In- charges should submit the names of their officers to their Human Resource Officers to be submitted to the DHSCs and HSC for redesignation with immediate effect. Commissioner Health Services – Nursing and Midwifery should call for immediate meeting of Nurse and Midwives leaders to discuss on the immediate implementation of the SOS.

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For more details on the Schemes of Service, please visit the link below:

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