Written by Dr. Sarah Bireete

Uganda’s public health system is facing a deepening moral, legal, and policy crisis following the government’s refusal to pay medical interns. At the center of this dispute are young doctors who, after years of intense and costly training, are expected to shoulder the backbone of hospital care, without pay. The decision has far-reaching consequences for healthcare delivery, medical education, and the future of the profession in Uganda

Medical interns in Uganda are not observers or trainees in a casual sense. They are frontline healthcare providers. In many public hospitals, interns cover critical staffing gaps, run wards, attend to emergencies, clerk patients, prescribe under supervision, and provide round-the-clock care.

In practice, interns do most of the regular medical work that keeps hospitals functional, especially in regional referral hospitals where shortages of senior doctors are chronic. Demotivating interns through non-payment directly undermines patient care, increases preventable deaths, and overburdens the few fully employed doctors who remain. Refusing to pay interns while continuing to rely on their labor amounts to institutionalized exploitation.

Before internship, a Ugandan medical doctor spends at least five years at university, followed by internship as a mandatory requirement for full registration. Medical education is among the most demanding and expensive courses in the country. By the time students reach internship, many come from families already financially exhausted. Internship pay is therefore not a luxury, it is basic subsistence, covering rent, food, transport, among others.

Denying interns pay after such prolonged investment effectively turns medical training into a pathway of debt, distress, and despair. The situation poses a sharp dilemma, especially for government-sponsored medical students.

On one hand, the state argues fiscal constraints and frames internship as “training.” On the other hand, it compels graduates to serve, posts them to hospitals, assigns shifts, and disciplines them as workers. This contradiction raises fundamental questions. If internship is compulsory national service, why is it unpaid? Why should interns offer an unpaid service in government hospitals? What’s government’s commitment to universal healthcare?

Uganda’s approach stands in stark contrast to practices across much of Africa. In Kenya, Medical interns are salaried government employees, with formal contracts and monthly pay. In South Africa, Interns receive structured remuneration and are fully integrated into the public service payroll. In Rwanda, Internship is funded as part of national health workforce planning, with clear state responsibility. In Ghana, House officers (interns) are paid and recognized as essential health workers.

In these countries, governments acknowledge a basic truth: you cannot sustain a health system on unpaid labor.
Uganda’s refusal to pay interns risks isolating the country, accelerating brain drain, and making medicine unattractive to talented students, especially those from poor backgrounds.

The unpaid internship policy has consequences beyond medical interns themselves. Patients suffer from demoralized staff and service disruptions
Rural and public hospitals face collapse as interns withdraw labor. Medical students reconsider their career choices or plan to leave the country. Public trust in health governance erodes.

Uganda cannot claim commitment to universal healthcare while refusing to pay the very doctors who keep hospitals running. Internship is not charity work; it is essential labor performed after years of specialized training. Government decision undermines its health system, exploits young professionals, and jeopardizes the future of medical education in Uganda.

Paying medical interns is not merely a budgetary decision; it is a test of justice, foresight, and national priorities.