By Lawel Muhwezi
A controversial government proposal to restructure medical training in Uganda is raising a troubling question in the health sector: who, exactly, will treat patients in public hospitals?
At the centre of the debate is a new policy direction from the Ministry of Health and the Ministry of Education that would fundamentally alter how doctors are trained. From July 2026, medical students may need to complete a one-year internship before graduating, extending the five-year program to six years, and automatically embeds internship into the academic curriculum.
On paper, it is presented as a quality assurance measure. But inside Uganda’s hospitals and lecture rooms, it is being read differently.
In a recent media interview, Dr. Frank Asiimwe, a lecturer and specialist, voiced a concern that has since unsettled many in the profession. He questioned whether it would be safe or even ethical to entrust critically ill patients to individuals who, under the new system, would still be classified as students.
Across Uganda’s public hospitals, interns are not passive learners. They run emergency wards at night, stabilize patients, assist with surgeries, and ensure care in chronically understaffed facilities. Under the proposed changes, they’d technically not be graduates.
For many practitioners, that contradiction is alarming. The Uganda Medical Association has openly rejected the reforms, warning that they blur the line between academic training and professional practice.
Dr. Mirembe Joel, the general secretary of Uganda Medical Association, argues that graduation is an academic certification, while internship is a separate, regulated stage for licensure. Merging the two creates confusion in roles, standards, and accountability. “This conflates two distinct processes,” Dr. Mirembe explained.
Dr. Nalukwago also explained, emphasizing that internship is a professional requirement governed by regulatory bodies, not universities.
The concerns also involve another controversial issue: money. For years, the government has struggled to consistently pay medical interns, despite relying heavily on their labour in public hospitals. Reclassifying them as students could mean withdrawing financial support altogether. This could let the government justify ending allowances, saying interns are “in training,” not working. That fear is not unfounded.
Senior doctors have pointed out that the proposal has been accompanied by discussions around reducing or eliminating intern pay. Dr. Joel Mirembe described the move as deeply concerning, warning that internship is not a luxury but a mandatory, supervised stage critical for patient safety.
To many in the profession, the implications are stark. A medical student who’s completed five years of training, passed exams, and fulfilled all academic requirements would still not graduate. Their degree would effectively be withheld until they complete internship, a period during which they may also not be guaranteed pay. Ironically, hospitals would still rely on them to deliver care.
This contradiction has sparked resistance across the medical fraternity. Associations representing doctors, students, pharmacists, and nurses have all rejected the policy, warning it could lead to exploitation, financial strain on families, and weakened professional standards.
The other concern is that the reform risks placing an additional burden on students and their sponsors. With internship now embedded into the academic programme, families may be required to finance an extra year of training, adding to the already high costs of medical training.
Then there’s the issue of patients. Uganda’s health system already operates under significant pressure, with shortages of doctors across many regions. Interns help bridge this gap, providing essential services in emergency units, maternity wards, and general hospital departments. Any policy that disrupts their role, motivation, or welfare could have immediate consequences for patient care.
This is where voices like Dr. Judith Nalukwago, Head of Professions at the National Unity Platform, who recently petitioned the office of the leader of opposition in parliament, framed it as both a labour rights concern and a public health risk. Her position reflects the sentiment that the country can’t afford to weaken the very workforce sustaining its hospitals.
Government officials, however, maintain that the reform is intended to strengthen training and improve the quality of healthcare workers. The Ministry argues that integrating internship into the academic programme allows for better supervision and assessment before graduation.
But for many doctors on the ground, the debate is not about structure; it is about reality because in Uganda’s hospitals, interns are already doing the work. They are diagnosing, treating, responding to emergencies, and making life and death decisions under pressure. Calling them students does not change that. It only raises a more uncomfortable question about the system itself.
The question that remains is, if those providing frontline care aren’t recognized as qualified graduates, what does that mean for patients? As the policy edges closer to implementation, that question becomes urgent.
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