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Book on Universal Health Coverage in Uganda Launched: President Uhuru Engaging Mak Researchers on Kenya’s Plans

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She was astonished to have her child admitted in a room with about 5 others, all with respiratory complications requiring urgent interventions like a nebulizer; a device that delivers drugs in the form of mist inhaled into the lungs, and oxygen.

However, Dr. Suzanne Kiwanuka; a Senior Lecturer at the School of Public Health, Makerere University (MakSPH), was shocked when some of the parents opted to go home with their children in such conditions. Thinking she was missing something, an alarmed Dr. Kiwanuka inquired as to why anyone would want to get their child discharged in that state. She was even more shocked by the uniform response; the parents claimed they would rather go and do their best to manage the situation at home because healthcare at this facility was expensive and they could not afford it.

The parents were so desperate to avoid the costly healthcare that a decision, akin to surrendering the lives of their children to fate; something that is extremely difficult for any parent, came quite easily to this particular lot. Clearly, the current cost of healthcare in the country causes parents like these to make hard choices because the country does not have a universal system to cater for citizens’ needs.

Dr. Kiwanuka was relating this painful experience to an audience that had gathered at the launch of a book she had co-authored titled, UNIVERSAL HEALTH COVERAGE IN UGANDA: Looking Back and Forward to Speed Up the Progress, held on 3rd May 2018 at the Kampala Serena Hotel. The aforementioned experience inspired 3 years’ work that Dr. Kiwanuka and a team of nearly 30 people from different sectors, put in to producing this book which was also edited by Assoc. Prof. Freddie Ssengooba; who led the team, Prof. Elizeus Rutebemberwa and Dr. Elizabeth Ekirapa-Kiracho. All the editors are members of staff at MakSPH.

The book does not only concentrate on curative health care but also explores preventive health care options. It is localised to Uganda and thus offers solutions to how issues like financing can be dealt with in the face of tight budgets and competing demands.

Seated: Hon. Sarah Opendi (R) and Mr. Thomas Tiedemann (L) exchange copies of the book as R-L: Dr. Elizabeth Ekirapa-Kiracho, Prof. William Bazeyo, Prof. Charles Ibingira, Dr. Esther Byakika, Assoc. Prof Freddie Sengooba and Prof. Christopher Garimoi Orach witness.

The book writing was coordinated by MakSPH’s SPEED (Supporting Policy Engagement for Evidence-based Decision) Project with the main intention of capturing the status of Universal Health Coverage (UHC) readiness. The captured evidence past including the challenges and successes regarding the health sector over the last 10 to 15 years can be used to support health policy and systems developments for UHC agenda in Uganda and beyond.

The Team Leader speaks out about the genesis of this achievement

Relating the origin of this achievement to an expectant audience, Assoc. Prof. Ssengooba said he came across a call by the European Union to support Schools of Public Health to put up policies for their countries. It was quite late to apply; about 4 weeks to the deadline.

“I told colleagues that this looked like something we could get and I urged them to put in effort,” he added. “We were happy to emerge successful together with partners like the National Planning Authority, Uganda National Health Consumers Organisation and the Institute of Tropical Medicine in Europe.”

About the book which is a policy document, Assoc. Prof. Ssengooba noted that policy analysis is quite complicated because it requires working from where other scientists stopped and walking the delicate bridge of moving the science to the politicians and policy-makers. He added that the book has been a learning process for the whole team as they brainstormed on how they could expand coverage with the limited resources available.

“In Uganda, we’re expected to do miracles because unlike the US where a single person’s health budget is $7,000, here it is $11. So we decided that this new mission requires local thinking about ideas that can be put into practice. The book customizes lessons; not just best practice, but also how to fit into our own context,” he explained.

On behalf of his team, Assoc. Prof. Ssengooba thanked the Ministry of Health for documenting their practice over the last couple of years because this gave them a starting point in their work. He thanked the European Union (EU) for the 3 years generously apportioned to reflect and produce a good policy document. The EU Ambassador to Uganda was represented at the event by the Acting Head of Cooperation, Thomas Tiedemann.

Hon. Sarah Opendi and Mr. Thomas Tiedemann pose with some of the 30 authors of the UHC Book

President Uhuru is consulting with MakSPH over policy recommendations in the book

Assoc. Prof. Ssengooba also made an astounding revelation to the audience when he shared that part of his team had already been to Kenya to give technical support to President Uhuru Kenyatta in his quest to implement Universal Health Coverage for his country. This move stems from his campaign manifesto which highlighted “The Big Four”; an outline of four areas that he would focus on during his presidency, UHC being one of them.

“As you can see, this work is already being asked for, which is a way of saying that there is need for UHC research in the region. In seeking to implement his manifesto about UHC, President Kenyatta contacted the World Health Organisation and WHO directed him to us saying there are some people who are already doing this. We have been to Kenya at President Uhuru’s invitation and met an assembled pane of experts but we are still going back,” Assoc. Prof. Ssengooba said.

Speaking on behalf of the MakSPH Dean, Prof. Garimoi Orach expressed pride at the work done by Assoc. Prof. Ssengooba and his team as fellow members of staff.

“We pledge that we shall continue to support the Ministry of Health and we are grateful to the EU for this grant and to all institutions that supported this work,” Prof Orach said, before adding “We are also excited that the book is receiving attention in neighbouring countries. We are very proud indeed because this demonstrates that Makerere University is the institution to do business with.”

Uganda stands out among the countries that applied for EU funding

In his remarks, Mr. Thomas Tiedemann commended the team that put together this book and revealed that Uganda stands out among all the countries with Schools of Public Health that applied for funding to develop UHC policies. He congratulated MakSPH upon this achievement and thanked the SPEED project for the great work done in coordinating the writing. The UHC agenda is not only tailored to Uganda but to other developing countries aiming at attaining universal health coverage as well.

“It pains to hear of things like unavailability of high quality cancer treatment. The book launched today is calling upon government to invest more both in curative and preventive healthcare. With this book, we are hoping that a lot of lessons will be drawn for Uganda with the aim of generating evidence-based policy,” Mr. Tiedemann said.

Ministry of Health should utilize Makerere University

In his speech, the Acting Deputy Vice Chancellor (Finance and Administration), Prof. William Bazeyo who represented the Vice Chancellor, Prof. Barnabas Nawangwe called upon the Ministry of Health to take advantage of the specialised human resource at the University in situations of policy implementation or disease outbreaks.

Makerere has always done research as its mandate and we have shared several policy documents from these findings with the Ministry of Health. We have done work with the malaria policy, the health insurance policy, HIV, circumcision and some work around sector training. Where you find it difficult to implement, talk to us and we shall walk with you,” Prof Bazeyo said.

“We may not have the resources but we shall look to our partners to work with you to achieve any agenda,” he added, in address to the Minister of State for Primary Health Care, Hon Sarah Opendi, who represented the Minister of Health, Hon. Ruth Aceng.

Prof. Bazeyo also thanked the EU for supporting the institution to address the country’s development needs. He thanked Assoc. Prof. Ssengooba who was in the 1st cohort of students taught at MakSPH for being exemplary and shared that the College of Health Sciences (CHS) to which MakSPH belongs, contributes 80% to Makerere University’s research.

“90% of this research is funded by donors. At the moment, the university is ranked number 2 in Africa in research despite the challenges but we want to visit you Honourable Minister because we know that if you support our budget, we shall become number one,” Prof. Bazeyo appealed.

The Principal CHS, Prof. Charles Ibingira also informed the Minister that the college has the capacity to train human resource for the health sector for the whole country and the diaspora.

“You need to think about utilising the college because we provide accountability,” he added, explaining that the university is the leading research institution in the country and can be used to solve many key issues in the health sector. He also talked about plans by CHS to spearhead a think tank that will contribute to the management of health issues in the country and region at large.

Prof. Ibingira equally expressed his exhilaration about the book and he thanked Assoc. Prof.  Ssengooba and his team for delivering.

The cover page of the book UNIVERSAL HEALTH COVERAGE IN UGANDA: Looking Back and Forward to Speed Up the Progress authored by Staff at MakSPH, Makerere University, Kampala Uganda

“I am very excited on this occasion where we are delivering on our promises and I am grateful to everyone who has made sure that the work is well-packaged. I humbly beg though that the information in the book will lead us to achieving UHC. This book strengthens the relevance of Makerere University and alerts us to the changing needs of health workers. It is an analysis of the different health policies in Uganda and a valuable asset to all partners engaged in seeing to UHC,” Prof Ibingira pointed out.

Government to commit 1% towards research

Speaking as Chief Guest at the launch, Hon. Opendi informed the audience that Government was committing to give 1% of the national budget towards research in the country, a move that comes at the right time when the health sector is re-positioning itself. She added that this commitment does not come easy since the country is resource-constrained alongside competing demands.

Hon. Opendi however added that the government was making progress with the implementation of the National Health Insurance Scheme. She acknowledged the proposal by Prof. Ibingira to set up a think tank and expressed her Ministry’s willingness to seeking guidance from it. She commended the book authors for focusing on other factors around health including prevention and human resource.

Authors speak about the book

One of the lead authors, Prof. Rutebemberwa also noted that whereas Uganda’s history over the years has been dotted with attempts to improve UHC, the advocates were usually not sure about what exactly should be covered.

Dr. Kiwanuka on the other hand noted that there is need to move away from the thinking that a good health sector only refers to functional hospitals.

“Everyone needs to be healthy enough not to go to hospital in the first place and that is what Universal Health Coverage is about,” she pointed out.

According to Assoc. Prof. Ssengooba, the target audiences for this book are the policymakers, health funders, civil societies who engage and teach people about health, and the media. He also noted that the population is spending a lot of their money on health, which calls for the government to invest more in prevention than cure.

He said the book also explores alternative ways in which all other sectors can support the achievement of UHC. For example when enforcement of traffic rules is tightened; as was the case along Masaka Road leading to reduced accidents, the burden to treat patients from accidents will reduce.

Speaking on the implementation of the policy, co-author Dr. Ekirapa-Kiracho shared that the team would continue to come up with policy briefs that will be issued to different stakeholders.

The book perfectly captures the adage that what we do today has been influenced by what was done yesterday. It examines previous attempts at addressing UHC and integrates them into the current health situation while taking into account the financial and political situation in the country to see how best the policy can be implemented going forward.

Article by Agnes Namaganda, Communications Office, MakSPH

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Short Course Announcement: Fundamentals of Teaching and Learning

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The Lead Facilitator, Dr. Roy William Mayega (Left) takes participants through Instructional Design (ID) Training held from 29th January to 2nd February 2018. RAN Innovation Lab, ResilientAfrica Network (RAN), School of Public Health Annex, College of Health Sciences (CHS), Plot 28, House 30, Upper Kololo Terrace, Kampala Uganda, East Africa.

Many faculty members in Higher Education Institutions do not get pre-service training in teaching and learning before they start teaching. This means that they have to learn the ‘hard way’ on the job, and this often affects the quality of delivery. The Office of the Dean, Makerere University School of Public Health (MakSPH), in collaboration with the Department of Epidemiology and Biostatistics, MakSPH, ResilientAfrica Network (RAN) and Institute of Open Distance and eLearning – Makerere University hereby announce the 2024 edition of the course titled: Fundamentals of Teaching and Learning. The course will run from Monday 29th July to Friday 2nd August 2024, only in the morning hours (08.00am – 11.30 am). The course will be delivered in dual mode: Both online (through the zoom platform) and face-to-face (at the RAN Lower Lab, MakSPH Annex in Kololo). The course is open to both junior and senior faculty members, research fellows, honorary lecturers and academic program administrators from Makerere University and other Universities wishing to enhance their teaching skills, with a view to improving teaching and learning.

Applying

Interested applicants are requested to send a short expression of interest that includes their designation, by email, to: Mr. Ivan Mutyaba, Administrator, Department of Epidemiology and Biostatistics, using the following email address: imutyaba@musph.ac.ug. Admission will be on a first-come-first-served basis. Applicants should be ready to take off 5 mornings of intense work during the week indicated. Come and discover the frontiers of teaching and learning.

The Course Team

Course Lead: Dr. Roy William Mayega (MBChB, MPH, PhD), Senior Lecturer, Instructional Materials Designer/Editor, MPH DE Program, MakSPH; Lead the co-creation of instructional materials for the inaugural MPH DE Program

Course Facilitators

  1. Dr. Roy Gonzaga Mubuuke (PhD), Breast Radiology Specialist/Medical Education Consultant/Member HEPI Project Team
  2. Dr. Rovincer Najjuma (PhD), Senior Lecturer/Curriculum Specialist, College of Education and External Studies, Makerere University
  3. Dr. Suzanne Kiwanuka (PhD), Senior Lecturer/Chair Department of Health Policy, Planning & Management, MakSPH, College of Health Sciences, Makerere University
  4. Dr. Barbara Kirunda (PhD), Lecturer, Department of Epidemiology & Biostatistics, MakSPH, MakCHS, Field Coordinator, MPHDE Program
  5. Mr. Jude Oboth, IT Specialist, MakSPH; 12 years of professional experience managing large organizational computer networks
  6. Prof. Pauline Byakika (PhD), Professor of Medicine, Chair Department of Internal Medicine, MakSoM, MakCHS, Head, Mentorship Program MakCHS
  7. Dr. John Bosco Isunju (PhD), Lecturer, Department of Disease Control and Environmental Health, MakSPH, MakCHS; Head, COVID Task force on alternative assessment, MakSPH

Support Team

  • Ivan Mutyaba, Administrator, Department of Epidemiology and Biostatistics – Admin Support
  • Harriet Adong, Communications Specialist, ResilientAfrica Network and MakRIF – Course Communications lead
  • Wilson Abigaba, IT Specialist RAN and MakRIF – Course IT Support
  • Debbie Namirembe, Senior Administrator, RAN – Admin Support

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Mary Stuart Hall Rehabilitation Commences as VC Hands over Site to NEC

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The Vice Chancellor, Prof. Barnabas Nawangwe (Centre) hands over a file to NEC Managing Director and CEO, Lieutenant General James Mugira (Left) as Ag. DVCFA, Prof. Henry Alinaitwe (Right) witnesses on 31st May 2024. Site Handover for the proposed rehabilitation of Mary Stuart Hall, Mary Stuart Road, Makerere University, Kampala Uganda, East Africa.

The proposed rehabilitation of Mary Stuart Hall commenced on Friday 31st May 2024 with the Vice Chancellor, Prof. Barnabas Nawangwe handing over the site to the contractor National Enterprise Corporation (NEC) represented by Managing Director and CEO, Lieutenant General James Mugira. The first and largest female Hall of residence, Mary Stuart was completed in 1953 and named after wife to Bishop Simon Cyril Edgar Stuart, the Third Bishop of the Diocese of Uganda from 1932-1952. Mary Stuart worked hard for the betterment of women education during her time in Uganda.

Mary Stuart becomes the second student residence to undergo rehabilitation following the handover of Lumumba Hall to NEC on 27th June 2023. Both projects are fully funded by the Government of Uganda. And whereas Lumumba’s works cost UGX9billion, Mary Stuart’s will cost UGX10.5billion, and cover roof repairs, plumbing and electrical systems and installations overhaul, as well as external aesthetic works.

In his remarks, the Vice Chancellor thanked the President, H.E. Yoweri Kaguta Museveni and Government of Uganda for ensuring that funds for the long-awaited rehabilitation of student halls of residence are availed. In the same breath, he thanked the First Lady and Minister of Education and Sports Hon. Janet Museveni for not only inspecting the state of the halls on 19th January 2021 but also ensuring that funding for the halls rehabilitation project is prioritized.

Prof. Nawangwe commended NEC on being a professional contractor, noting that all matters arising out of previous projects had been handled within original budgets and time-frames.

Prof. Barnabas Nawangwe (Left) and Lt. Gen. James Mugira (2nd Right) receive a guided tour of the Mary Stuart Hall site from Mrs. Winifred Kabumbuli (Right), Eng. Okuk Geoffrey Bright Owera (2nd Left) and other officials. Site Handover for the proposed rehabilitation of Mary Stuart Hall, Mary Stuart Road, Makerere University, Kampala Uganda, East Africa.
Prof. Barnabas Nawangwe (Left) and Lt. Gen. James Mugira (2nd Right) receive a guided tour of the Mary Stuart Hall site from Mrs. Winifred Kabumbuli (Right), Eng. Okuk Geoffrey Bright Owera (2nd Left) and other officials.

“Now that we are in a girls’ hall, every detail matters. We must make this hall look like one that is going to house the future mothers and leaders of this nation so that when they leave, they feel that they have attended a leading university in the world” the Vice Chancellor advised NEC.

Prof. Nawangwe equally urged the Project Consultants led by Dr. Kenneth Ssemwogere, Senior Lecturer, Department of Architecture and Physical Planning, College of Engineering, Design, Art and Technology (CEDAT) to work with the contractor on ensuring that the project works and aesthetics give the hall a fresh new look.

On behalf of NEC, Lt. Gen. James Mugira thanked the Vice Chancellor and leadership of Makerere University for the trust and confidence shown in the Corporation’s capabilities, adding that he was happy as an alumnus of the School of Law to be back to contribute the development of his Alma mater. “This is the third project we are undertaking as the National Enterprise Corporation; we started with the perimeter wall, and we are now at Lumumba Hall where works are at 80-85% completion.”

Lt. Gen. Mugira therefore reassured the Management that NEC would do quality work and try as much as possible to complete the project in time, at a relatively lower cost than other contractors. “With NEC, we bring on board military discipline and we don’t have red tape or bureaucracies; once a decision has been taken, it has been taken” he clarified.

“I want to thank the Vice Chancellor for believing in and promoting local content, because NEC is a local company. With NEC engaging in such a project, we are first of all giving jobs to our young people, we are skilling them, we are saving foreign exchange that would otherwise be repatriated and as a country, we are building capacity” Lt. Gen. Mugira summed up.

Prof. Barnabas Nawangwe (3rd Left) and Lt. Gen. James Mugira (4th Left) pose for a group photo with Left to Right: Ms. Ritah Namisango, Eng. Brian Buhanda, Mr. Yusuf Kiranda, Ms. Mary Gloria Nakajubi, Prof. Henry Alinaitwe, Eng. Okuk Geoffrey Bright Owera, Mrs. Winifred Kabumbuli, Mr. Rodney Rugyema and Ms. Norah Nalubowa. Site Handover for the proposed rehabilitation of Mary Stuart Hall, Mary Stuart Road, Makerere University, Kampala Uganda, East Africa.
Prof. Barnabas Nawangwe (3rd Left) and Lt. Gen. James Mugira (4th Left) pose for a group photo with Left to Right: Ms. Ritah Namisango, Eng. Brian Buhanda, Mr. Yusuf Kiranda, Ms. Mary Gloria Nakajubi, Prof. Henry Alinaitwe, Eng. Okuk Geoffrey Bright Owera, Mrs. Winifred Kabumbuli, Mr. Rodney Rugyema and Ms. Norah Nalubowa.

The Acting Deputy Vice Chancellor (Finance and Administration), Prof. Henry Alinaitwe expressed happiness that the second phase of rehabilitation of halls of residence was finally taking off under the NEC, a contractor that had done quality work on other projects such as the new Kiira Motors Corporation (KMC) plant in Jinja.

He noted that the project will provide good grounds for hands-on industrial training for students of quantity surveying, architecture, civil engineering, and other disciplines. Prof. Alinaitwe further observed that the project accords staff the opportunity to not only improve their professional profiles but also practice as consultants within the university premises, “and so we thank the Vice Chancellor for availing us these opportunities.”

The University Secretary and former Guild President, Mr. Yusuf Kiranda shared that the University Leadership looks forward to the rehabilitation works being expedited. “The current student leaders have challenged us that they would like to be around for the commissioning of the finished product and so I hope that we can finish these works and give them an opportunity to account to their electorate.

Prior to the handover ceremony, the parties were taken on a guided tour of the site by the Director, Estates and Works Department, Eng. Okuk Geoffrey Bright Owera, Dean of Students, Mrs. Winifred Kabumbuli, Warden Mary Stuart Hall, Ms. Norah Nalubowa and a host of other officials accompanied by the Chairlady Mary Stuart Hall, Ms. Mary Gloria Nakajubi.

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Prof. Hisali, Prof. Yawe handover office to Prof. Bbaale, Prof. Wokadala

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In a vibrant ceremony brimming with nostalgia and optimism, College of Business and Management Sciences-Makerere University (CoBAMS) celebrated the transition of leadership from the accomplished hands of Prof. Eria Hisali and Prof. Bruno L. Yawe to the promising stewardship of Prof. Edward Bbaale and Prof. James Wokadala on Friday 31st May 2024.

The event, attended by esteemed members of the university community, including representatives from the Vice Chancellor’s office and members of the Central Management Team, was a testament to the collaborative spirit and dedication that have come to define CoBAMS. The outgoing Principal, Prof. Eria Hisali, and Deputy Principal, Prof. Bruno Yawe, were lauded for their eight years of service, during which they significantly advanced the college’s academic and infrastructural capabilities.

A Legacy of Excellence

Prof. Hisali’s farewell address highlighted the numerous achievements under his leadership. He proudly noted the establishment of strategic partnerships and collaborations that have greatly benefited the college. “Our MoU with Stellenbosch University provided full PhD scholarships for four Academic Staff Members, while our partnership with Wageningen University in the Netherlands supported PhD training for two Staff Members. Additionally, the Republic of Korea’s embassy in Uganda granted three PhD scholarships,” he remarked.

Assoc Prof. Bruno Yawe (Left) handing over to incoming Deputy Principal Dr. James Wokadala.

These collaborations extended to notable institutions such as ACCA, Prudential Uganda, Addis Ababa University, The University of Rwanda, Universidade Eduardo Mondlane, and the University of Dar es Salaam, reflecting CoBAMS’ commitment to internationalization and academic excellence. Prof. Hisali also mentioned the development of a Quality Assurance Framework and significant infrastructural proposals, including a new block pending government funding.

The outgoing Principal shared impressive statistics: a fivefold increase in publications from 30 in 2017 to 150 in 2023, expansion of wireless internet coverage to over 90% of the college, and a significant rise in PhD holders among the academic staff to 60%.

Prof. Yawe appreciated all the academic, administrative and support staff that supported his leadership throughout the 8 years of service.

Looking Ahead

Prof. Edward Bbaale, the incoming Principal, expressed his vision to elevate CoBAMS as a global leader in innovative teaching, research, and policy engagement. With over two decades at CoBAMS, including eight years as Dean of the School of Economics, he emphasized his commitment to continuing the progress made by his predecessors. He pledged to prioritize graduate training, faculty research, and the commercialization of innovations, alongside strategic financial initiatives such as the College Endowment Fund.

Prof. Eria Hisali receiving a token of appreciation from memebers of the Administrative Staff at MakCoBAMS.

Prof. James Wokadala, the new Deputy Principal, acknowledged the substantial achievements of the outgoing leaders and outlined his plans to build on their legacy. He aims to foster a supportive and engaging environment by establishing a gym for staff and creating a Savings and Credit Cooperative Organization (SACCO).

Heartfelt Farewells and New Beginnings

The ceremony featured heartfelt speeches from various stakeholders, celebrating the contributions of Prof. Hisali and Prof. Yawe. Dr. Susan Namirembe Kavuma, representing the academic staff, praised the outgoing leaders for their unwavering support and urged the new administration to continue fostering a conducive environment for teaching and learning. Ms. Caroline Nanono Jjingo, on behalf of the administrative staff, echoed these sentiments, appreciating the open and inspirational leadership style of Prof. Hisali and Prof. Yawe. “Throughout their tenure, they have resonated the words of Henry Ross Perot, who said that “Lead and inspire people. Don’t try to manage and manipulate people. Inventories can be managed but people must be led.”  She said.

Outgoing Principal Eria Hisali and outgoing Deputy Principal Bruno Yawe cut cake.

The Deputy University Secretary, Mr. Simon Kizito, provided sage advice to the incoming leaders, emphasizing the importance of openness to feedback, leading by example, and maintaining accountability. He reminded them that failure is an inevitable part of leadership and encouraged them to learn from it while prioritizing self-care.

On their part, the support staff appreciated the outgoing leadership for their open door policy and willingness to support all staff especially those experiencing life challenges. Quoting Ecclesiastes 3:1, Mr Joseph Ikarokot said there was a season for everything and staff were privileged to have worked with the duo.

A Promising Future

As the new leadership team embarks on their journey, they carry forward a legacy of excellence and a vision for a brighter future. With their extensive experience and commitment to innovation and collaboration, Prof. Bbaale and Prof. Wokadala are well-positioned to steer CoBAMS toward greater achievements and global recognition.

The ceremony concluded with a celebratory cake-cutting, gifts from the administrative staff, and a reaffirmation of the college’s enduring spirit of unity and progress. The new era at CoBAMS promises continued growth and success, building on the solid foundation laid by Prof. Hisali and Prof. Yawe.

Some of the staff memebers who were present at the handover ceremony.

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