General
Govt called upon to Fund Research in NCDs: Diabetes can be Prevented and Effectively Managed
“Non-communicable diseases (NCDs) are a rapidly growing health burden in Uganda, and many other low and middle income countries. I call upon the Government of Uganda to fund research in NCDs. Most people with NCDs do not know that they are suffering from NCDs such as diabetes, high blood pressure, cancer, or heart diseases. For diabetes, about half of the people with diabetes in Uganda do not know that they have it,” said Prof. Rhoda Wanyenze, Dean of Makerere University School of Public Health.
According to the World Health Organisation (WHO) report of 2016, deaths from NCDs were on the rise, with developing countries hit hardest. NCDs are the leading cause of death globally. In 2016, they caused 71% of all deaths (40.5 million) up from 60% in 2000.
Opening the SMART2D Research Dissemination Workshop to various stakeholders held on 21st March 2019, Prof. Wanyenze applauded researchers from Makerere University School of Public Health for teaming up with other partners to undertake a multi-country four year research project aimed at identifying strategies to better prevent and manage Type-2-Diabetes, one of the NCDs.
She commended the research team headed by the Uganda co-Principal Investigator, Prof. David Guwatudde for not only describing problems, but also providing prevention and management strategies for Type-2-Diabetes.
The co-Principal Investigator of SMART2D, Prof. David Guwatudde emphasized that the primary aim of the four year research was to strengthen capacity for both prevention and management of Type-2-Diabetes.
“Health systems in most parts of the world were struggling to diagnose and manage Type-2-Diabetes especially in low and middle income countries. More than 50% of people with diabetes in Uganda are undiagnosed. They are not aware that they have diabetes. Further in Uganda, only about 30% of people with diabetes have ever had their blood tested for high blood sugar,” he said.
Funded by the European Union (EU) and Government of Sweden through the Swedish International Development Cooperation Agency (Sida), the SMART2D research presents a people-centered approach through Self-Management and Reciprocal Learning for the Prevention and Management of Type-2-Diabetes.
Prof. Guwatudde revealed that Type-2-Diabetes is more of a lifestyle disease, which can be prevented if we modify our lifestyle and behaviour. The nutrition aspect is one of the factors leading people to get diabetes.
According to Dr. Juliet Kiguli, co-Investigator on the SMART2D, some of the factors putting one at the risk of getting diabetes included: consumption of unhealthy foods (eating sweet things, too much oil, alcohol); physical inactivity (not exercising); Worrying; and ignoring the advice from medical personnel.
With Dr. Elizabeth Ekirapa sharing statistics that diabetes wields a tremendous economic burden on society (to patients and the economy at large); and further revelation from Dr. Roy William Mayega that most of the patients the research team interviewed, could not afford the drugs and equipment to monitor their blood sugar, yet often there are stock-outs of these at Government health centers. He emphasized that SMART2D advocates for strategies aimed at prevention and effective management of diabetes. “Prevention is better than cure. Since diabetes can be prevented and the prevalence of pre-diabetes is high, preventive efforts should be stepped up so as to save lives as well as resources that are going to be spent on treatment.”
For those living with diabetes, Prof. David Guwatudde emphasized that if they follow the advice of the medical personnel and take the prescribed medicines; they can live a normal life. “It is not true that when they diagnose you with diabetes you die soon. If you take the prescribed medicines and follow the advice from medical personnel, you will live with diabetes and still live a normal life.”
The SMART2D research team consists of the following researchers: Prof. David Guwatudde, Dr. Juliet Kiguli, Dr. Roy William Mayega, Dr. Barbara Kirunda Tabusibwa, Dr. Elizabeth Ekirapa Kiracho, Dr. Francis Xavier Kasujja, Dr. Anthony Muyingo, Mrs. Max Walusimbi, Ms. Gloria Naggayi, Mr. Edward Ikoona, and Mr. Kusolo Ronald.
Some of the challenges in the prevention and management of NCDs include: Inadequate prevention strategies; a large proportion of people with NCDs are undiagnosed; lack of funds to buy the recommended medicines; and poor retention into care.
To address the four challenges, the SMART2D research team came up with a set of Facility and Community interventions.
Minimal improvements in organization of facility-based care significantly improved the percentage of patients with diabetes that are retained into care by over 30%. It also improved control of the disease in the patients by over 10%, and prevented the development of diabetes among people at high risk by over 50%.
In line with WHO report published in 2002 titled Innovative Care for Chronic Conditions: Building Blocks for Action which noted that a community has a crucial role to play in chronic care, Dr. Francis Xavier Kasujja reiterated that peer groups were instrumental in the ongoing support to diabetes patients in Iganga and Mayuge communities.
Delivering a personal testimony, one of the patients with diabetes said that they significantly benefited from the engagement and trainings received during the SMART2D project.
However, with the end of the project, most of the patients were worried because they cannot afford the cost of treatment for management of diabetes.
Presenting the implications of their findings on policy, Dr. Roy William Mayega highlighted the following recommendations:
• Health Centres from level III+ should be supported to establish diabetes care and prevention services and accredited in a phased way
• Roll-out of a minimum package of equipment, and essential drugs from Health Centre III and above, supported by a regular supply, inclusive of hypertension medicines
• Need to roll out lean clinical guidelines and a care algorithm to all facilities
• Scaled training (pre- and -in-service), supervision and clinical mentorship of nurses and clinical staff on care and prevention
• Strengthen the information system for chronic care including appointments, clinical records and follow-up
• A simple health education and coaching approach and manuals should be rolled out to facilities targeting patients and people at high risk
• A task shifting approach should be scaled up where stable patients are managed by nurses
• Need to strengthen self-care so that patients can manage themselves
Representing the Ministry of Health, Dr. Gerald Mutungi the Senior Medical Officer in Charge on Non-Communicable Diseases shared with workshop participants some of the strategies being undertaken: The Ministry of Health has a technical working group on NCDs; ongoing research aimed at studying the effectiveness of the integration of HIV/AIDS and NCDs into the chronic care clinic; and Government entering into a strategic partnership with Novartis, an NCD drugs manufacturer, to ensure that drugs for NCDs are available at all Government health facilities.
Some of the key stakeholders who attended the SMART2D Research Dissemination workshop include: Dr. Gity Behravan,1st Secretary and Senior Research Advisor, Swedish Embassy- Kampala, Dr. Fred Makumbi-Deputy Dean of Mak School of Public Health, Dr. Esther Buregyeya, Dr. Noah Kiwanuka and officials from the World Health Organisation, Ministry of Health, NCD platforms, diabetic associations, lung and heart institutions, district health workers, patients from Iganga and Mayuge, Makerere University Directorate of Research and Graduate Training, and among others.
Written by: Ritah Namisango, Mak Public Relations Office
The Gender Mainstreaming Directorate (GMD), Makerere University on 14th September 2021 presented findings from phase one of the study on Enhancing Women’s Participation and Visibility in Leadership and Decision-Making Organs of Public Universities in Uganda through Action Research. The study team led by the Director GMD and Principal Investigator (PI), Dr. Euzobia Mugisha Baine also consists of Assoc. Prof. Consolata Kabonesa, Dr. Anna Ninsiima, Ms. Frances Nyachwo, Ms. Susan Mbabazi and Mr. Eric Tumwesigye.
The team is also made of coordinators from participating Universities such as Busitema University-Ms. Elizabeth Birabwa, Kabale University-Sr. Dr. Eva Tumusiime, Mbarara University of Science and Technology (MUST)-Dr. Specioza Twinamasiko, Muni University-Ms. Amandru Stella Wawa, and Gulu Univeristy-Sr. Rosalba Aciro.
Funded by the Government of Uganda through the Makerere University Research and Innovations Fund (Mak-RIF), the study was inspired by the fact that women are persistently few in numbers as staff, more so in leadership and decision-making organs of Ugandan Public Universities. “This is despite all the various efforts at national and international levels; the numbers are not growing as fast as needed to meet development goals of the country” explained Dr. Euzobia.
Based on this background, the study team therefore sought to conduct a situational analysis of the gender terrain of the six public universities to obtain baseline information encompassing the composition of governance and leadership organs and senior staff by sex, as well as a needs assessment and profiles of potential mentors and mentees.
Furthermore, the team sought to explore the capacity to conduct gender-responsive research as well as the role of male staff engagement in gender equity interventions within the universities as the drivers of development.
Dr. Mugisha-Baine shared that results of the baseline would then be used to design participatory training manuals or guides on gender and leadership. The manuals would cover; Institutionalized mentorship, How to conduct gender-responsive research, gender and equity budgeting, among others.
“Within these manuals, we shall have a male staff engagement strategy in gender equity interventions in universities” she explained.
The development of the aforementioned materials would then be followed by their adoption and use to build capacity for women not only in leadership of participating and other public university but also beyond. “We shall periodically evaluate whether the capacity we have built has influenced women’s participation in leadership and decision-making organs of the university” supplemented the PI.
The capacity building trainings for women, it is envisaged, will lay the foundation for the formation of a functional Uganda University Women’s Think Tank, starting with the six participating universities. Dr. Mugisha Baine added that through this Think Tank, a monitoring and tracking system for gender representation in recruitment, promotion, retention/turnover and leadership of public universities shall be established and maintained.
At the conclusion of phase one, the study team had drafted participatory training manuals in gender and leadership with content on; gender specific critical analysis of the leadership spectrum of public universities, positioning of individual women within the institutional framework and strategies for their advancement, gender equity advocacy in the university setting, institutional mentorship, building capacity in conducting gender-responsive research, among others.
“This content will be validated by the participating universities before the actual research training is conducted” added the PI.
On behalf of the research team, Dr. Mugisha Baine thanked the Government of Uganda for providing the resources that facilitated phase one of the study and prayed that the Mak-RIF Grants Management Committee (GMC) would support the next phase of capacity building.
Speaking on behalf of the Mak-RIF GMC Chairperson, Prof. William Bazeyo, Dr. Helen Nambalirwa Nkabala thanked and congratulated the team led by the Director GMD upon the milestones registered in the critical research.
“We are very proud of that work that is being done by all researchers in Mak-RIF and we would like to most sincerely thank Management for all the support throughout this process” she remarked.
Dr. Nkabala encouraged the research team to continue disseminating and using the findings for the furtherance of gender mainstreaming, particularly through the aspect of male staff engagement in gender equity interventions.
Prior to delivering the keynote address of the day, the Executive Director National Council for Higher Education (NCHE) Prof. Mary Okwakol thanked the Vice Chancellor, Prof. Barnabas Nawangwe for inviting her to the important forum, noting that women’s participation in decision making and governance is a priority area of the Uganda Gender Policy 2007.
She commended Makerere University for being at the forefront of gender mainstreaming in Uganda, noting that this prominence was one of the reasons why the Gender in Education Policy 2007 provides for replicating the institution’s strategy in all other Higher Education Institutions.
Prof. Okwakol whose keynote address was punctuated incisive personal examples reaffirmed the statistics that women are generally not visible in leadership of Universities. That notwithstanding, in instances where they rise to leadership and decision-making positions, they are regularly subject to roles traditionally deemed as women’s inconsiderate of their managerial seniority and experience.
She nevertheless rallied the women to play their respective roles in enhancing participation and visibility at a personal level. The following were some of the strategies she proposed; work hard to acquire academic credentials so as to compete favourably with men, acquire necessary administrative training and experience, network among women, join professional networks as well as do research and publish.
On joining professional networks, she shared her personal experience as a young zoologist who joined UNESCO’s Tropical Biology and Fertility Programme. “Within a short time I was appointed Coordinator for Africa and after two years, I was elected as a Member of the International Board of Management. After serving for two years, I became Vice Chairperson of that Board and finally I became Chairperson of that International Board.”
At the institutional level, Prof. Okwakol appealed to the Chairperson Council and Vice Chancellor to proactively recruit women who meet the requirements for leadership positions even if it means actively seeking out the reluctant ones. In this regard, she shared that it would be useful for the university to develop a database of women and their qualifications to ease this process.
She shared that NCHE has in recognition of female underrepresentation at every level in Higher Education approved the establishment of a Gender and Equity Unit with the aim of promoting inclusive gender participation in the sub-sector.
“This unit has been placed under the Directorate of Quality Assurance and Accreditation which implies that as we look out for and regulate quality, gender will be a very important aspect of that regulation” she reassured.
Prof. Okwakol concluded by urging participants to read the; Third National Development Plan (NDPIII), Uganda Vision 2040, and Sustainable Development Goals (SDGs) noting that there is no way all three can be achieved while women are left behind because they each make a case for inclusion of the female gender.
“What we are addressing here are historical injustices” said Prof. Barnabas Nawangwe as he commenced his remarks, “And in the case of Makerere University, it is well known that the institution started as a male-only institution and we all know the original motto was ‘Let us be men’” he added.
Citing examples from history such as; Marie Curie – one of the smartest physicists, Hatshepsut, Nefertiti and Cleopatra – prominent Pharaohs of Egypt, George Eliot, Rosa Luxemburg and Hypatia – all great philosophers as well as Chancellor Angela Merkel – first female Chancellor of Germany, the Vice Chancellor said there is no plausible argument that there are things women cannot do as well as their male counterparts.
He said it was against this knowledge and in a bid to correct historical injustices that Makerere University pioneered initiatives such as putting in place affirmative action for girls, establishing a Gender Mainstreaming Directorate as well as a School of Women and Gender Studies. The Vice Chancellor nevertheless stressed the need to go beyond pioneering to protecting these gains through legislation. “Historically we have seen that discrimination can only be addressed by laws and policies.”
Prof. Nawangwe thanked the Government for providing funds to support Mak-RIF as well as the Funds GMC and Secretariat for ensuring that these funds are put to good use. He equally thanked the Chairperson of Council, Mrs. Lorna Magara for her not only her support but also sparing time to attend a good number of the research dissemination events.
Delivering the concluding remarks, Mrs. Magara acknowledged that the study was timely and relevant the contemporary University, as one of the critical drivers of the national and international development agenda. She therefore reechoed the Vice Chancellor’s thanks to the Government of Uganda for generously supporting the University’s research through Mak-RIF.
Turning to the keynote speaker she said, “I thank Prof. Okwakol for ardently discussing the critical issues affecting the female gender, the strategies to overcome the challenges, including sharing her inspiring personal experiences.”
Mrs. Magara equally thanked Prof. Okwakol for her very instructional analysis, providing mentorship guidance with the resultant impact of enhancing the female gender in decision-making positions. In the same breath she congratulated the PI and her team upon successfully concluding phase one of the project.
“Phase one has generated insights in understanding the status of women in leadership in public universities, the legal and policy framework and its implications on women’s visibility, the institutional mentoring systems and the gaps therein” she observed.
The Chairperson of Council acknowledged that the challenge of underrepresentation of women in leadership roles cannot be resolved at an individual level. She therefore advocated for broad based strategies that can address deep-seated structural and cultural biases facing women. “These include developing mentorship networks, enacting laws and policies that address the imbalances and providing training programmes to address the leadership gaps.”
She therefore pledged the University Council’s unwavering support to the Gender Mainstreaming Programme by ensuring an enabling policy environment that facilitates gender-responsive teaching, learning, research innovation and community service.
The research dissemination was moderated by the Principal Public Relations Officer (PRO), Ms. Ritah Namisango and the Director Communications, Learning and Knowledge Management, ResilientAfrica Network (RAN) and PRO Mak-RIF, Ms. Harriet Adong.
