Private health care providers are an important component of pluralistic national health systems. In Uganda, the public-private partnership for health (PPPH) has led to the government assisting the private health sector in various ways, in recognition of and support to their work. Apart from financial assistance, the government deploys civil servants to work in private-not-for-profit (PNFP) health facilities. Such government-seconded health workers are recruited, deployed and paid by the government but they work under the management of the PNFP health units. In the rural and remote district of Kibaale in mid-western Uganda, government-seconded health workers form 48% of the key professional staff in PNFP health services. However, government secondment raises a number of important managerial and human resource challenges. PNFP health care managers have some workers over whom they do not have full authority and control. The seconded workers have to serve two authorities and satisfy them equally. This cross-sectional descriptive study aimed at identifying the problems arising from this kind of relationship in a district where PNFP health units are heavily dependent on government-seconded personnel, and how such problems may be addressed.
It was found that there is unequal treatment of seconded and non-seconded staff, with the former receiving better pay, and having more professional management than the latter. However, they felt there was too much workload in PNFP units compared to government and were not comfortable with the PNFP prohibition of private practice. In addition, they felt that they were not trusted by the PNFP managers and that they had limited or no opportunities for career development and further studies. PNFP managers felt they had no control over seconded staff and felt that they have no possibility to participate in the selection of staff to be seconded to their units. As a result, seconded staff were perceived to have no commitment to work in PNFP units, and to be prone to absenteeism, illegal private practice, demand for big financial allowances, abrupt attrition and pilferage of health care supplies.
This paper proposes quick enactment of the PPPH policy to define the relationship between the public and the private sectors. It also proposes that the government gives unconditional funding to the PNFP facilities on a contractual basis, and only demands for accountability on agreed outputs. This would facilitate the PNFP managers to recruit their own staff and endeavour to attain the agreed outputs.
