In my MSc. class at Edinburgh, we’ve been discussing how external influences shape our ability to work effectively—not only as individuals, but also in teams, and ultimately in how safe and high-quality care is delivered. I found myself reflecting on this topic deeply, both from my perspective as an optometrist in Uganda and from the wider lens of healthcare systems.

Financial Stress and Pay Structures

One of the most pressing external influences in Uganda is financial stress. Unlike the UK’s Agenda for Change system, which provides structured pay bands for healthcare staff (with the exception of doctors, dentists and some senior managers), Uganda has no comparable, well-established pay standards for several health cadres. Even though a public service structure exists on paper, optometrists—despite being trained at Makerere University for four years to international standards—are not yet officially absorbed into the public service. Salaries, in practice, are determined by private employers, resulting in wide disparities.

This is not just an optometry problem. Across the sector, healthcare workers are generally underpaid, a reality shaped by economic constraints and governance challenges. The impact extends beyond personal wellbeing—it affects staff retention, morale, and the sustainability of services (1,2).

Workload, Stress, and Monotony

The high workload and often monotonous nature of certain clinical roles also weigh heavily. In optometry, routine refractions can feel repetitive, yet the stakes remain high because sight problems are so prevalent. In a resource-limited setting, the emotional strain of not being able to provide the full range of care—due to equipment shortages, unclear referral pathways—adds another layer of stress.

Knowledge and Development Opportunities

Another external influence is the limited access to structured professional development. Training opportunities exist, but they are not equitably distributed. Peer-support groups and informal mentoring help bridge this gap, but without systemic backing, these often remain fragmented. In the UK, senior midwives, known as Professional Midwifery Advocates (PMAs) mentor less experienced colleagues to build their capacity to provide high quality care. In Uganda, much as certain mentorship relationships exist at various levels, there are no such formally appointed individuals. Much less of such mentorship is to be found in other healthcare cadres.

Recognition and Pride

Despite these challenges, Ugandan health workers are widely respected at home and abroad for their skill, resilience, and innovation. National platforms like the Heroes in Health Awards celebrate this excellence (3), while global recognition—such as Prof. Francis Omaswa’s Hideyo Noguchi Africa Prize—shows that the quality of training and practice in Uganda is world-class (4).

What Can Be Done?

For me, the big takeaway is that external influences can’t be ignored if we are serious about patient safety and quality of care. Financial stress, poor support structures, and inconsistent career pathways all erode the capacity of healthcare workers to give their best. But change is possible. Structured pay systems, leadership development, civility training, and embedded peer-support frameworks are all strategies with proven impact.

As a Ugandan optometrist, I see the potential clearly: a health system where clinicians are not only well-trained but also well-supported, respected, and empowered. That is the kind of environment where patient safety and human factors truly align.

Resources

1. Shumba CS, Kielmann K, Witter S. Health workers’ perceptions of private-not-for-profit health facilities’ organizational culture and its influence on retention in Uganda. BMC Health Serv Res. 2017;17(1):809. doi:10.1186/s12913-017-2763-5.

2. Twineamatsiko A, Mugenyi N, Kuteesa YN, Ejalu DL. Factors associated with retention of health workers in remote public health centers in Northern Uganda: a cross-sectional study. Hum Resour Health. 2023;21(1):83. doi:10.1186/s12960-023-00870-0.

3. World Health Organization Regional Office for Africa. WHO Uganda recognized for excellence at 2024 Heroes in Health Awards [Internet]. Brazzaville: WHO; 2024 [cited 2025 Sept 26]. Available from: https://www.afro.who.int/countries/uganda/news/who-uganda-recognized-excellence-2024-heroes-health-awards

4. New Vision. Prof Omaswa wins global health award [Internet]. Kampala: Vision Group; 2019 [cited 2025 Sept 26]. Available from: https://www.newvision.co.ug/news/1499270/prof-omaswa-wins-global-health-award