Kampala, Uganda. The Uganda Protestant Medical Bureau (UPMB) and the Uganda Catholic Medical Bureau (UCMB) are faith-based umbrella organizations that oversee more than 400 hospitals, health centers, and other clinics. Together with the Uganda Muslim Medical Bureau, they provide nearly half the medical services in Uganda. The Government of Uganda contributes 30 percent of the two bureaus’ budget, with the rest coming from fees, their respective churches, and other donor contributions. As similar institutions with similar missions, UPMB and UCMB often coordinate activities, especially issues affecting their health facilities. Dr. Henry Katamba, the Health Coordinator for UPMB, explains that "when we are building capacity for our member facilities we always involve facilities from the UCMB, especially when it is a regional activity, and they do the same for us."

The medical bureaus have to compete with the Government of Uganda and other organizations for qualified health workers. Limited budgets and working primarily in remote rural areas has made recruitment and retention of staff extremely challenging. In 2005, the Government of Uganda secured sufficient budget to fill many of its existing vacancies, lifted ceiling limits on hiring, and increased salaries. As a result, the attrition rates at UPMB and UCMB facilities skyrocketed. Resulting staff shortages threatened to overwhelm their health facilities, causing increased waiting times and reduced quality of services for clients. Add to this the major diseases of malaria, TB, and HIV/AIDS, the result is a severe health crisis.

In 2006, personnel from both medical bureaus attended a conference in Nairobi where they learned about a program designed to strengthen leadership and management skills—the Virtual Leadership Development Program (VLDP) developed by MSH.

Leadership Development for HR Managers

The VLDP platform and content were adapted by LMS and the Capacity Project to address the critical global challenge of human resources for health.  The VLDP for Human Resource Managers in Health was offered for the first time April – July 2006. Seventy participants (10 teams) from seven countries across Sub-Saharan Africa completed.  The Program was facilitated by staff from LMS, Capacity, and ESAMI (Eastern and Southern Africa Management Institute). One of the VLDP teams enrolled was from UPMB and UCMB. 

The UPMB/UCMB team chose, as their leadership challenge, to reduce the attrition rate at their health facilities from 18 percent when they started the VLDP to 10 percent within a year. In the past, the well-regarded training and development programs offered to staff by the medical bureaus kept turnover in check; however, the higher salaries offered by the government had shifted the balance.

"The [VLDP] helped us refocus ourselves on the issue, to come up with a plan to face our challenges," said Mr. Kagimu of the UCMB. "We thought our challenges were unique to us, but the VLDP modules and being able to chat with others on the website showed that this happens a lot and how we could manage it."

For the UPMB and UCMB, completing the VLDP got the team mobilized to action. "We agreed on a common approach for collecting information to look at attrition," Mr. Kagimu describes the team’s first steps. "Where are people leaving the most? Under what circumstances?" With this information, the team was better able to measure the attrition rate and get at the true root causes of why the turnover was high.

Taking Action and Producing Results

The team developed a joint position paper to present to the government, seeking input from hospital managers and using concepts from the VLDP’s approach to facing challenges. This paper communicated the current situation the organization’s face as well as their contribution to the health system of the country. While the two bureaus continue to lobby the government for increased support to assure effective implementation of the private/public partnership in health service delivery, they are also having joint planning workshops with health facilities to address their human resource challenges.

"It helped us to have a team spirit," Mr. Katamba says about the VLDP. "It brought out the strengths in different team members especially in mobilization, in focusing, in aligning. It broke down the walls within the team and we are working a lot better. It has really changed the attitude within the department and it also changed the way we look at our challenges. It is easier for a subordinate to come and ask for my view on a specific challenge that he is dealing with than it was in the past. "

Mr. Katamba has noticed additional improvements. "The approach members of our team take in carrying out their tasks has changed dramatically. Programs like this, that do not largely interfere with the already existing structure, I think they are very, very relevant. Not only for just this organization, but also for what I am seeing in the other facilities that I am seeing in my day to day work."

The final evaluation completed by all the VLDP participants at the conclusion the program documented that 78% of the participants have brought about changes in their organizations as a direct result of the VLDP, with 98% of participants stating that they would recommend the VLDP to others. UPMB/UCMB team is implementing its strategy to reduce attrition among its health centers. Already, they are cooperating more, enabling them to present a united front in addressing this human resource management challenge.