MJAAR

The Double Burden: Human and Material Resource Scarcity in Uganda's Nursing and Midwifery Workforce

Dr. Arinaitwe Julius, Asiimwe Isaac Kazaara


Abstract

Background: Uganda faces a compounding health workforce crisis characterised by a dual scarcity of both human capital and material resources within its nursing and midwifery sector. The country's nurse-to-population ratio remains critically below the World Health Organization recommended threshold of 10 per 10,000, with disparities most acute in rural and peri-urban health facilities across the Northern, Eastern, and South-Western regions. Objective: This study sought to assess the magnitude of human and material resource scarcity among nursing and midwifery professionals in Uganda, identify multilevel determinants driving workforce attrition, and examine how equipment deficits compound service delivery failures at the frontline of care. Methods: A sequential explanatory mixed-methods crosssectional design was employed involving 847 nurses and midwives recruited from 94 health facilities across five regions of Uganda. Quantitative data were collected using structured questionnaires and facility-level registers, and were analysed using univariate descriptive statistics, bivariate chi-square and t-tests, and three-level random intercept multilevel logistic regression modelling. Qualitative data were gathered through 32 in-depth interviews and 8 focus group discussions and analysed thematically using Braun and Clarke's framework. Results: The national nurse-topopulation ratio was found to be 3.8 per 10,000, well below the WHO standard. Northern Uganda recorded the most critical staffing gap at 1.9 per 10,000, while vacancy rates at Health Centre III reached 72.6%. Over 63% of Health Centres III and IV reported more than half of essential equipment as non-functional. The annual attrition rate for nurses escalated from 12.4% in 2018 to 21.3% in 2023. Multilevel modelling identified inadequate equipment (AOR: 3.42; 95% CI: 2.18-5.37), salary dissatisfaction (AOR: 2.89; 95% CI: 1.97-4.24), high burnout (AOR: 4.21; 95% CI: 2.78-6.38), and rural location (AOR: 2.15; 95% CI: 1.44-3.21) as independently significant predictors of intent to leave. Qualitative findings echoed themes of moral distress, professional devaluation, and systemic neglect. Conclusion: The dual burden of inadequate staffing and depleted material resources creates a self-reinforcing cycle of poor health outcomes and continued workforce exodus. Urgent, equity-focused policy action is required to reverse these trends.

Keywords

Nursing workforce midwifery resource scarcity health workforce attrition Uganda multilevel analysis mixed-methods
Metropolitan Journal of Academic and Applied Research

Cite This Article

Dr. Arinaitwe Julius & Asiimwe Isaac Kazaara (2026). The Double Burden: Human and Material Resource Scarcity in Uganda's Nursing and Midwifery Workforce. Metropolitan Journal of Academic and Applied Research, 5(4). https://journals.miu.ac.ug/pages/article.php?article_id=377

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