Table 3 A timeline of critical events and government policy on dual practice
Year | Event | Dual practice policy | Consequences |
|---|---|---|---|
Pre- | Nr. of African health professionals growing | Weak formal govt. restrictions: dual practice allowed after govt. hours | None |
1962 | Ugandan independence | ||
Post-1962 | Govt. suspicions about private sector growing | Strong formal govt. restrictions: dual practice not allowed | No immediate effects |
… | |||
Transition to military rule and civil war | |||
1972 | Asian doctors expulsed | After 1970’s events, restrictions to dual practice contributed to resignations from government services and provider migration – therefore reducing the number of govt. providers | |
… | Ugandan doctors take over private practices | ||
1974 | Government shuts down private practices | ||
… | Provider protest advocacy to allow dual practice | ||
Late 1970’s | Broadly, international sanctions on military government led to economic collapse and decline in government salaries relative to cost of living | Weak formal govt. restrictions: dual practice allowed after govt. hours | Dual practice is a coping mechanism for providers remaining in Uganda |
Government changes policy on dual practice as incentive for govt. providers | |||
1980’s | Govt. suspicions about dual practice and private sector strengthen | Weak, formal govt. restrictions: dual practice not allowed | |
1990’s | |||
2000’s | Rapid private sector growth, especially after system recovered from civil war, creates increasing nr. of dual practice opportunities | No formal govt. restrictions | |
… | |||
Informal govt. restrictions on dual practice, with weak influence | |||
2005–2007 | MOH tests ban on dual practice in few hospitals | Providers threaten to resign | |
2009–2010 | Office of President establishes Medicines and Health Service Delivery Monitoring Unit | Dual practice important coping mechanism | |
Increasing nr. of policy discussions around dual practice, absenteeism, ghost workers | Providers threaten to resign in response to discussions of ban | ||
Increasing concerns about the contribution of dual practice to decreases in quality and access to care in both public and private sectors |