Civil servants barred from owning schools, health facilities

It has been a practice that senior education and medical officers employed by the Government-run private facilities alongside their duly paid responsibilities.

Many of the education officials run schools while doctors run health facilities such as clinics, pharmacies and hospitals to which they accord more time, thereby neglecting their duties.

Medics have also been accused of referring patients to their private facilities for services at a fee, yet such services are supposed to be offered at government facilities at no cost.

Theft

In addition, some civil servants are accused of stealing government stores such as medicines and equipment, for use at their private facilities.

Several principals and headteachers of government schools, as well as commissioners under the education sector, operate nurseries, and primary and secondary schools, alongside managing schools under the government.

Just like doctors, these have also been accused of neglecting government schools from where they draw salaries, and focus on their own.

This is contained in the National Development Plan (NDP) IV, which is one of the key reforms the Government wants to adopt to fully implement the human capital development programme and realise the intended goals in the next five years.

The NDP IV strategic direction was approved by Cabinet in March 2024, and its implementation will start effective next financial year (2025/2026). However, the ban does not affect political leaders.

As a result, effective July 1, this year, all civil servants working in the education and health sectors will not be allowed to run private facilities in their line sectors.

Several senior civil servants in both the education and health sectors own private schools and health facilities respectively. However, it remains unclear whether the Government will require civil servants already owning private facilities to resign from their current jobs.

However, sources in Government indicate that Cabinet will have a final say on what the course of action for such civil servants will be.

“One of the available options is to resign from civil service and operate their private facilities or stay on the job and sell their facilities,” the source said.

The NDP IV was based on the challenges highlighted in the NDP III mid-term review assessment, the Uganda Vision 2040 and the Government’s strategy to grow the economy 10-fold in the next 15 years.

There were also inputs by experts, programme working groups, locally, regionally and globally.

According to NDP IV, “the key implementation reforms required to fully implement this programme and realise expected goals in the next five years are: address conflict of interest in the provision of education and health services by banning all employees in these sectors from operating private schools and health facilities”.

The development comes at a time when President Yoweri Museveni has directed the public service ministry to review the civil service standing orders to address the issue of moonlighting after several civil servants were found to be neglecting their duties for private gigs.

Why now?

A source in government, who is familiar with the policy, explained that the ban on teachers and health workers from running private facilities is intended to ensure equitable utilisation of the available resources.

“Conflict of interest is common in those two sectors (health and education), but worse in health. Those senior health workers are never at their stations. When they give you an appointment, you meet them at their private facilities,” the source said.

Adding that: “Some of these medical officers refer patients to their private facilities to buy medicines and yet the same medicine is in government facilities they serve. It is unfair.”

The source added that the challenge is so big that some officials set up facilities, but put them under pseudo-names and proxies. The source noted that it is important to improve public services but ensure that such gaps are covered.

“If we improve the government schools or health facilities, the population will not suffer a huge cost of the private service. This explains why we want the conflict of interest eliminated,” the source added.

Challenges

Although the Government has made strides in improving services, the NDP IV highlights the high cost of the provision of and access to health and education services

is still a pain.

Under NDP IV, the Government noted that there is still an increasing cost of providing education and health services due to the persistent increase in the cost of inputs, increase in the population, technical and allocative inefficiencies, and private sector dominance amidst weak policies and regulation.

As a result, there has been a disproportionate increase in the contribution by parents to education in Uganda, nearly 47% contribution by households towards funding education.

Relatedly, data indicates that the cost of health service provision also remains high notwithstanding that over 75% of Uganda’s current disease burden is preventable.

Despite a reduction in out-of-pocket expenditure for the total health expenditure to 29% in the financial year 2020/21 from 41% in 2018/19, out-of-pocket expenditure still remains a major barrier towards accessing health services with a health insurance coverage of less than 3% countrywide.

As of last year, there were about 8,900 doctors in the country, resulting in a doctor-to-patient ratio of about 1: 20,000. However, the World Health Organisation recommends a doctor-to-patient ratio of 1:1,000.

In the education sector, whereas the Government employs about 160,000 teachers at both primary and secondary schools, there is a shortage of 78,000 teachers at primary level and 20,000 at secondary level.

The United Nations Educational, Scientific and Cultural Organisation (UNESCO) recommends one teacher to serve 25 learners on average at the secondary school level and one for every 40 pupils at the primary level. However, the teacher-student ratio in Uganda is estimated at 1:43 in secondary schools and 1:50 in primary schools.

Experts weigh in

Prof. Francis Omaswa, a celebrated medical researcher and senior consultant cardiovascular surgeon, is of the view that asking senior doctors to choose between staying or resigning will see many of them quitting. Omaswa, a retired former director of health services, said many of the senior medics will choose to leave and run their private facilities. Omaswa said private practice among doctors has been around since colonial days.

“The only difference between then and now is that the colonial leadership introduced private wings in government facilities where doctors would admit patients in the private wing, but not to open private facilities,” Omaswa said.

He added: “This was good and kept many doctors around these facilities. The Government needs to revive and strengthen those private wings in government facilities.”

The other alternative, he said, is for medical doctors and other public servants to do private practice after working hours, which would solve the problem of conflict of interest.

“When I was still working with the Government, I would do private practice as well, but after 5:00pm after I have fully delivered on my duties. This kind of discipline is important,” he said.

Onesmus Mugyenyi, a policy analyst and deputy executive director of Advocates Coalition for Development and Environment (ACODE), said the ban on civil servants from running health facilities and schools is a good idea. However, he noted: “It will be hard to implement.” According to Mugyenyi, the Government should address why civil servants are running private facilities.

“The Government should improve facilities and also pay these people better. Although they enhanced their salaries, are they commensurate with the cost of living? If these things are not answered, they will continue to operate these facilities,” he said.