At least 15 high-tech beds inside the Intensive Care Unit (ICU) of Mulago National Referral Hospital are lying idle due to a chronic staffing shortage. Despite boasting a 27-bed capacity equipped with world-class technology valued at approximately UGX 200 billion, the hospital is forced to operate at less than half capacity.
Currently, only 12 patients can be admitted at any given time because there simply aren’t enough medical professionals to keep them alive.
The staffing gap is staggering. The unit currently employs only 30 nurses out of the 128 required and approved by the government. The physician shortage is even more acute, with only one intensivist and two lower-grade medical officers assigned to manage the unit, the most delicate stage of healthcare administration.
Martha Alupo, the Nurse in Charge of the ICU at Mulago Specialized Hospital, says the most haunting sound is the silence coming from the 15 empty beds.
“We have state-of-the-art equipment that has been here since 2013/2014, even before the major renovations,” Alupo says. “But it is lying idle. Our cry is human resources.” Mulago offers perhaps the most affordable lifeline in Uganda. The hospital charges approximately UGX 200,000 per day for general inpatients and UGX 300,000 for private referrals, a fraction of the millions charged by private facilities.
This affordability creates relentless demand, with referrals pouring in from across the country. Yet, the unit is frequently forced to turn the critically ill away. “When we are full, we advise the family to take the patient to another ICU. When space opens, we call them back. But there is always a struggle for space,” Alupo explains.
While the World Health Organization (WHO) standard for critical care is a 1:1 nurse-to-patient ratio, Mulago’s reality is a dangerous contrast. A single nurse often finds themselves managing three ventilated patients simultaneously (1:3 ratio).
“The quality of care reduces,” Alupo admits. “One patient can be on six different drugs to support the heart, kidneys, and lungs. Each is infused through a pump. When that alarm goes off, you must be there. If you are busy diluting a drug for one patient while another crashes, it becomes a challenge to resuscitate them.”
The shortage isn’t just a numbers game; it is physically breaking the staff. Nurses perform “holistic” care, handling everything from clinical monitoring to the heavy lifting involved in bathing and repositioning unconscious patients.
The strain has been “decimated” in the workforce. Alupo says that in the last three months alone, at least three nurses underwent spinal surgery due to the rigors of the job and had to be transferred to “lighter” units. Furthermore, advanced machinery designed for specialized lung support remains wrapped in plastic because no one on-site has the specific training required to operate it.
Winifred Mbabazi, Assistant Commissioner of Nursing and Head of Nursing at Mulago, explains that the crisis is compounded by Mulago essentially operating as two institutions: the National Referral Hospital and the Super-Specialized Hospital.
“The structure we are using now is for the National Referral, but we have the Organ Transplant Unit, the Paediatric ICU, and specialized neuro-theatres,” Mbabazi says. “We have 14 beds in the Paediatric ICU, but can only functionalize five. Why? Staffing.” Currently, Mulago has 624 nurses out of the required nearly 1,000 nurses.
The 2025 Auditor General’s Report, released in early 2026, confirms this dire situation. The report describes a “near-collapse” of critical care capacity, noting that while infrastructure is “state-of-the-art,” it is effectively non-functional because staffing gaps in these units exceed 90%. The report notes that there is a 91% shortfall in specialized nurses required for the ICU, and out of 20 approved positions nationwide for Senior Consultant Intensivists (the majority of which are for Mulago), only one is currently filled.
Mulago has only 1,327 staff positions filled out of 2,344 approved structures for all cadres, constituting approximately 43% staffing gap. Hospital management says the Human Resource office has completed wage analyses and held multiple meetings with Parliament and the Ministry of Finance, but with little success. Last year, the hospital recruited 35 new nurses, but Mbabazi describes this as a “drop in the ocean” for a hospital spanning 69 different units.
