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

More in This Issue

View full issue →
11
Gendered Financial Governance: Salary Handover as Compensatory Strategy in Household Economics and the Politics of Planning
Dr. Arinaitwe Julius1 , Ahumuza Audrey2
gendered financial governance salary handover household economics compensatory strategy
12
Interconnected Voids: Internet Accessibility and Digital Credit as Compensatory Systems in Uganda's Digital Economy
Asiimwe Isaac Kazaara1 , Musimenta Nancy2
Internet accessibility digital credit financial inclusion digital economy
13
Learner Perceptions and Appreciation of Artificial Intelligence Education Delivery in Ugandan Higher Education: A Mixed-Methods Exploration
Dr. Arinaitwe Julius1 , Musimenta Nancy2
Artificial Intelligence Education Learner Perceptions Higher Education Uganda
14
Present-Moment Living as Psychological Liberation: A Theoretical Analysis of Guilt, Anxiety, and Temporal Focus in Human Experience
Ahumuza Audrey1 , Musimenta Nancy2
Present-moment living psychological liberation guilt anxiety
15
Strategic Pathways to Publication: A Framework for African Scholars Navigating Peer-Reviewed Journal Submission
Dr. Arinaitwe Julius1 , Ahumuza Audrey2
African scholars peer-reviewed journals academic publishing publication barriers