Health
Interventions to Increase Compliance Levels Around COVID-19 In Refugee Communities
By Joseph Odoi
Uganda’s open-door policy on refugee-hosting has been internationally acclaimed as “the world’s most compassionate”. And while Uganda is among the world’s top three refugee-hosting nations, possibly the first in Africa, refugee communities continue to be disadvantaged on many fronts with poor socioeconomic and health outcomes.
Refugee settings are already besieged with a socially disrupted existence, and the COVID-19 experience could have catastrophic consequences in their context. Yet the extent to which refugee communities are aware of Covid-19, have complied, and are coping with the related preventive measures, remains largely unknown.
Moved mainly by three issues: 1) Uganda’s open-door policy on refugee hosting; 2) COVID-19; and 3) the knowledge gap on COVID-19 impact in refugee communities, Makerere University researchers in partnership with different institutions in academia, policy and practice have commenced on a study contributing to increased compliance with the Ministry of Health’s Covid-19 prevention guidelines under the project entitled “Refugee Lived Experiences, Compliance, and Thinking” (REFLECT) in Covid-19.
According to Dr. Gloria Seruwagi, the Principal Investigator, study findings will contribute to filling gaps in knowledge, policy by designing programmes to increase understanding and compliance levels around COVID-19 and refugee communities:
“Little is known about how refugee communities have complied with the Ministry’s guidelines like social distancing, wearing masks, sanitizing or frequent washing of hands with soap. Yet it is widely known that their living arrangements in crowded spaces with massive WASH (Water, Sanitation and Hygiene) challenges have been a long-standing challenge, even before the Covid-19 pandemic. To address this knowledge gap the Ministry of Health has partnered (as a Co-Investigator) with our study team which also comprises other Co-Investigators from Gulu University, ACORD and Lutheran World Federation which are implementing partners in refugee settlements.” explained Dr. Seruwagi
‘’This mixed methods research has a sample size of ~1,500 participants evenly distributed across three study sites in Central, West Nile and South Western refugee settlements. Similarly, there was fairly even distribution across nationalities with Congolese (30%), Somalis (33%) and South Sudanese (33%). Overall, the majority of participants were aged between 25-34 years (35%), of female gender (68%), of Moslem (30%) or Protestant (36%) religious denomination, uneducated (40%) and earned less than UGX 50,000 weekly (57%). In addition, the overwhelming majority neither smoked (97%) nor drunk alcohol (92%). Except for age and gender, there were variations in demographic and behavioral characteristics across the three study sites’’ she added.
Preliminary Findings
As part of preliminary findings from the study, Dr Seruwagi noted that there are very high levels of awareness about COVID-19 among the majority of the adult population. However, there are variations in this knowledge across refugee settings, with urban refugees being more knowledgeable on average than their rural counterparts. However, in reverse they [urban refugees] also displayed and reported higher risk behaviour in regards to Covid-19 than their rural-based counterparts who showed relatively more compliance. Despite being more knowledgeable than women with regard to symptoms, causes, risk factors, and treatment of COVID-19, men have poor compliance with Covid-19 preventive measures compared to women.
Children ages 5-12 were found to have very low levels of knowledge, explained by the assumption that adults at home will always pass on information and so, no targeted information is being given to children. “Due to school closure, teachers who are key change agents and transmit information were not in contact with the children. We believe this is a missed opportunity greatly contributing to these low knowledge levels among children” Dr. Gloria explained while sharing findings at Makerere University (CTF1 Building). In addition to disenfranchisement around access to Covid-related knowledge, school closure further heightened children’s vulnerability with a marked increase in neglect, exposure to different forms of violence and teenage pregnancy.
On attitudes, Dr. Seruwagi noted that previous adverse experiences like war, torture, rape or hunger have produced a “survivor” mentality with little or no fear among respondents in refugee communities. One refugee said “I have dodged bullets, been tortured and slept hungry for days, what more harm can Covid do to me?”
On adherence to preventive guidelines, Presidential directives and SOPs, handwashing was the most commonly adhered to guideline, again among the adults. Local leaders had come up with innovative mechanisms for ensuring compliance through supervision; and most households had washing points at the peak of COVID-19. ‘’Handwashing was even much higher in Muslim communities, mostly because it is in tandem with their religious and sociocultural practices’’ Dr. Seruwagi explained.
On masks, the researchers noted that there was not so much compliance in wearing masks, reportedly after restrictions were eased. There was a lot of “chin-masking” with those who had just wearing them on chins but without using them to cover up. Some other risky behaviours were observed such as borrowing masks at places where it was mandatory (health facilities, offices) or when they saw authorities and enforcers coming.
On social distancing: the researchers noted that local leaders have tried to enforce this at public meeting spaces; but it’s almost impossible at household level due to large family sizes. Also, sociocultural norms require them to sit together, eat together (including from the same utensils) which makes it almost impractical.
Despite the challenges, the researchers observed that there are also stories of resilience, innovation and improvisation among refugee communities. Local leaders made arrangements to help their people including translating prevention messages into local languages, having strict rules e.g. for social distancing at water collection points and enforcing handwashing facilities at household level. They also internally arranged some relief items. And new businesses (e.g. mask production) were birthed out of COVID-19. Key support systems during Covid-19 were reported to be health facilities, WASH, community leaders including religious leaders and the diaspora.
On the way forward, the research team highlighted the need for innovation and designing age-appropriate messages and interventions for children, incorporating mainstream COVID-19 messaging in all teacher-learner interactions, building on community resilience and leadership, continuous communication and impact messaging with heavy focus on risk reduction.
In his presentation entitled; REFLECT study implications for policy, Mr. Brian Luswata the Principal Legal Officer from Ministry of Health (MOH) reported that MOH is conducting an integrated Covid-19 response to the entire public regardless of nationality. He indicated that available data shows that over 151 refugees countrywide have contacted Covid-19 and 3 deaths have been registered. He further revealed that MoH conducts regular trainings of health workers in refugee settlements and quarantine facilities have been created to counter any spread of the pandemic. He noted the timeliness and importance of this study, saying it will directly feed into policy and guidelines on the prevention of COVID-19 and other similar pandemics.
Representing the Dean, Makerere University School of Public Health, Dr. Elizabeth Ekirapa commended the REFLECT study team led by Dr. Seruwagi noting that the study will shed more light on how to deal with issues like human behaviour during the Covid-19 pandemic.
“When COVID-19 started people were saying nobody is dying and now people have started to die. Human beings keep coming up with explanations in a manner that you wouldn’t expect. So this study will help us learn on how we can deal with ourselves’’ said Dr. Ekirapa who is also Chair of the Department of Health Policy Planning and Management at MakSPH.
She further appreciated the REFLECT study’s multisectoral approach adding that the findings will contribute to changes in the different multisectoral approaches Uganda is using to address COVID-19.
In her remarks, Prof. Josephine Ahikire, the Principal of the College of Humanities and Social Sciences (CHUSS) said that the role of Makerere University is to create knowledge that will be used for societal development and transformation.
She equally thanked Government of Uganda for continuous support to Makerere University through the Research and Innovation Fund (Mak-RIF) which also has a provision for research on COVID-19. She congratulated the researchers for the timely study which underscores the academia role in social work, humanity and public health. She also thanked the partners for supporting the initiative.
Jesse Kamstra, the Country Representative for Lutheran World Federation (LWF) commended Uganda’s effort in the fight against Covid-19.
“I feel safer in Uganda than any other country due to the different adaptations they have taken up to make this disease less spread in the country’’ said Kamstra.
As implementing partners in the study, he mentioned that LWF expects actionable recommendations and evidence-based understanding of social behaviours of refugees during COVID-19. He further noted that the recommendations will be used to adjust future programming together with other implementing partners like Office of the Prime Minister (OPM)’s refugee department.
Ms Ellen Bajenja Kajura the Country Director for ACORD, also one of the study partners, expressed her pride at the partnership with Makerere and the other partners. Even from preliminary findings, she talked about some of the immediate actions her organisation will begin taking forward like designing child-friendly messages on Covid-19 in addition to strengthening ACORD’s programming in child protection and gender-based violence.
At the event, Dr. Misaki Wayengera, Chairman of Scientific Advisory Committee (SAC) on the National Taskforce for COVID-19 revealed that despite challenges brought by Covid-19, total reopening of various sectors will go on.
‘’We started opening up but some sectors remain closed because we are still studying transmission dynamics, however we shall continue opening up because we will have to live with COVID-19’’ he explained.
Professor Noeline Nakasujja the Adhoc Chair (psychosocial) on the COVID-19 Taskforce and also Head of Psychiatry Department of Makerere University College of Health Sciences noted the significant increase in Mental Health issues and psychiatry referrals during COVID-19. She decried the limited infrastructure or community capacity to handle these. She called on all stakeholders to work together in their different capacity to address mental health and psychosocial support especially for more vulnerable populations like those in refugee settings.
During the event, refuge representatives shared their experiences during pandemic response.
On what makes Uganda one of the best refugee host community, Ms. Lilly Anek a Refugee representative from Adjumani had this to say: ‘’Uganda is the best refugee host country because they treat us like brothers and sisters. This is why we intermarry as South Sudanese and Ugandans… people treat us so well’’ Similarly, other refuge representatives like Sandie from Kyaka II at the event were in agreement with her statement as they confirmed receiving handwashing detergents, face masks and training on COVID-19 prevention. Together, they called upon government of Uganda to put in a place an additional taskforce in the refuge communities so that new entrants are quarantined before joining the community.
The event was graced by officials from Office of the Prime Minister (OPM) which manages the national refugee response, UNHCR, representatives from the ministry of health, Makerere University, civil society, the media and other stakeholders. Discussions during this dialogue centered around the growing numbers of challenges during Covid-19, perceptions and nomenclature, infrastructural limits in refugee hosting communities and adaptations to the new normal in this Pandemic era.
Dr Julius Kasozi representing UNHCR assured the study team that UNHCR is more than ready to take forward and implement any actionable recommendations from the REFLECT study. In his closing remarks as government representative, Mr. Byaruhanga of OPM said there was a lot to learn and adapt from the study. He encouraged the study team to engage further with his office to ensure ownership and uptake of the study findings.
More about the REFLECT Study
The research topic is “Knowledge, adherence and the lived experiences of refugees in COVID-19: A comparative assessment of urban and rural refugee settings in Uganda”. The project has been shorted to the acronym REFLECT (Refugee Lived Experiences, Compliance, and Thinking).
The study is cross-sectional mixed and has a multinational focus covering refugees from South Sudan, Somalia, and Eritrea, Democratic Republic of Congo (DRC), Rwanda, and Burundi. Similarly, Study sites are Kisenyi in Kampala, Kyaka II Refugee Settlement in Kyegegwa, South-Western Uganda, and eleven (11) refugee settlements in West Nile.
The REFLECT study is funded by the UK government through Elrha/Research for Health in Humanitarian Crises (R2HC) supported by Wellcome Trust, UKAID and National Institutes for Health Research (NIHR). It is conducted by Makerere University with Dr. Gloria Seruwagi as Principal Investigator. The Co-Investigators are from Gulu University, Agency for Cooperation and Research in Development (ACORD), Lutheran World Federation (LWF), the National Association of Social Workers of Uganda (NASWU) and Ministry of Health. The study team includes Dr Gloria Kimuli Seruwagi, Dr. Denis Muhangi, Dr. Betty Okot, Prof. Stephen Lawoko, Eng. Dunstan Ddamulira, Andrew Masaba and Brian Luswata.
Article originally posted on MakSPH
The Makerere University School of Public Health (MakSPH) has formally transitioned leadership of the Department of Disease Control and Environmental Health, with Dr. David Musoke taking over from Dr. Esther Buregyeya, who served as Head of Department for more than nine years.
The handover marked both an appreciation of Dr. Buregyeya’s tenure and a renewed call for the Department to strengthen its position as a leading centre for Environmental Health, Occupational Health, Disease Control and Prevention.
Dr. Buregyeya, who took over the leadership of the Department in January 2017 and served until May 2026, described her tenure as a period of significant growth in teaching, research, community engagement and staff development. She emphasised that the achievements were a result of shared leadership and the collective efforts of Department members, School leadership and partners.
Among the key milestones during her tenure was the strengthening of the Department’s academic portfolio. The Department completed the review of the Bachelor of Environmental Health Science curriculum and supported the development of the Master’s programme in Environmental and Occupational Health. It also contributed to the development of the PhD by coursework and expanded online learning materials and short-course offerings, including training in Water, Sanitation and Hygiene and Occupational Health and Safety.
The Department also made progress in strengthening its laboratory capacity. With support from the School leadership, equipment was procured for the Environmental Health laboratory, which is currently based at Kasangati. The Department has also benefited from equipment donated through partnerships.
Another significant achievement highlighted during the handover was the development of human capacity. Several staff and research associates have pursued doctoral training, strengthening the Department’s pool of researchers and future academic leaders. Dr. Buregyeya noted that building this capacity was essential to ensuring continuity and preparing the next generation of faculty.
Dean commends leadership and mentorship
The Dean of MakSPH, Prof. Rhoda Wanyenze, commended Dr. Buregyeya for her leadership and credited the Department with developing a strong culture of mentorship and nurturing young professionals.
Prof. Wanyenze noted that although Disease Control is one of the School’s original departments, its membership has remained relatively young, with many emerging professionals being mentored and supported to grow within the School. She particularly applauded the Department for attracting and retaining talented Environmental Health graduates and for creating opportunities for research associates to contribute to the School’s work.
She also welcomed the establishment of the Master’s programme in Environmental Health, describing Environmental Health as an important frontier for public health. She challenged the Department to consider developing a PhD pathway in Environmental Health and to build a coordinated research agenda examining the links between the environment, infectious diseases, non-communicable diseases and broader health systems.
Prof. Wanyenze further called for greater investment in Occupational Health, noting the importance of workplace health, mental health, physical health and occupational safety, particularly as Uganda’s informal sector continues to grow. She also urged the Department to strengthen entomology and related research in vector-borne diseases.
A new chapter under Associate Professor David Musoke
Receiving the responsibility, Associate Professor David Musoke described his appointment as both an honour and a homecoming. He completed his Bachelor’s degree in Environmental Health at Makerere and later worked in the Department of Health Policy, Planning and Management before returning to Disease Control, where he has spent much of his professional career.
Assoc. Prof. Musoke paid tribute to Dr. Buregyeya, whom he described as a mentor and an example of shared leadership. He noted that during her tenure, the Department had grown from having a single undergraduate programme to developing a Master’s programme, contributing to PhD training and expanding its research portfolio into new and emerging areas. He also recognised the growth of early-career researchers, many of whom have progressed through doctoral training and into academic roles.
He pledged to build on these achievements while working closely with Department members, the Dean and other School departments. He also acknowledged the confidence placed in him by colleagues during the selection process and committed to working collectively to advance the Department.
A call to define the Department’s future
While celebrating the Department’s achievements, Prof. Wanyenze challenged the new leadership to develop a clear strategic agenda that distinguishes and strengthens the Department’s areas of expertise.
Prof. Wanyenze urged the Department to take forward the urban health agenda, particularly in light of Uganda’s rapid urbanisation and the emerging challenges associated with waste management, environmental health and the delivery of preventive health services in urban settings.
She further called for deliberate investment in people, infrastructure, research and partnerships. In particular, she encouraged the Department to use the new School infrastructure to develop a laboratory and to strategically support PhD training in areas where expertise is currently limited.
“You don’t have to carry this burden alone. There are people who can support the growth of the department,” Prof. Wanyenze said in encouraging the new leadership to build on the expertise already within the Department.
The handover concluded with the formal transfer of responsibility, followed by a presentation to Dr. Buregyeya in appreciation of her service and a cake-cutting ceremony bringing together the outgoing and incoming Heads of Department and members of the Department.
Health
MakCHS 2026 Orientation begins: Freshers Urged to Prioritise Responsibility, Integrity and Academic Excellence
New students joining Makerere University College of Health Sciences (MakCHS) have been urged to embrace responsibility, discipline, integrity and hard work as they embark on their journey towards becoming healthcare professionals.
The call was made during the opening session of the college’s orientation programme that began on the 4th August and will conclude on 7th August 2026. During the session, College leaders including the Principal and Deans welcomed students admitted to study various programmes at MakCHS. The speakers outlined expectations for academic and professional conduct.
The session was moderated by Professor Mark Kaddu, Deputy Dean-School of Medicine. Welcoming the freshers, he stressed the importance of hard work highlighting that ‘your academic documents will speak for you and excellence will open doors’.
The college leaders congratulated the students on securing admission to Makerere University, noting that many qualified applicants were unable to secure places. They encouraged the new entrants to make the most of the opportunity by committing themselves to excellence from the first day. The students were reminded that programmes offered by the college are rigorous full-time courses that demand commitment, discipline and consistency.
In his remarks, Professor Bruce Kirenga – Principal, MakCHS welcomed the new entrants and provided an overview of the College’s rich history, highlighting its growth and commitment to excellence in health professionals’ education. The Principal reaffirmed the college’s mission of impacting the national health agenda through transformational teaching, research and innovation for societal development. Students were encouraged to embrace the wide range of career pathways and professional opportunities available upon qualification, emphasizing that their training would equip them to make a meaningful contribution to society.
Stressing the importance of mind-set change which has also been introduced as a crosscutting course, the Principal urged the students to cultivate discipline, resilience, professionalism, and a passion for lifelong learning. “The journey you have embarked on is challenging, but it is achievable,” the Principal noted, reminding the students that many graduates before them successfully completed the programme through dedication and hard work. The address concluded with a call for the new students to remain focused, work diligently, and strive for academic excellence as they prepare to become the next generation of healthcare professionals who will transform their communities.
Professor Annettee Nakimuli, Dean – School of Medicine encouraged students to work collaboratively rather than viewing learning as a competition. She urged them to form productive study groups, support one another and take advantage of opportunities for mentorship, research and international exchange programmes available through the college. “We are here to support you throughout your journey,” she told the students, adding that strong academic performance could open doors to international exchanges, postgraduate training and research collaborations with universities around the world.
Professor Nakimuli warned students against academic dishonesty, including examination malpractice, falsification of academic records and illegal programme changes. She cautioned that such misconduct could lead to dismissal from the university, even after several years of study. Students were further advised to be vigilant against fraudsters who promise to alter admission records or transfer students into different academic programmes through unofficial channels.
In his remarks, Dr. Richard Muhindo, Dean-School of Health Sciences highlighted the importance of personal responsibility and wellbeing beyond academics. He encouraged students to manage their time wisely, avoid drug and alcohol abuse, stay away from gambling and maintain healthy lifestyles throughout their studies. Dr. Muhindo emphasized the importance of professionalism, reminding students that healthcare careers are built on compassion, teamwork and service to humanity. He encouraged students from different programmes to learn together, respect one another’s professions and build networks that will benefit them throughout their careers.
In his address to the freshers, Dr. David Nono who represented Dr. Annet Kutesa, Dean – School of Dentistry, encouraged students to embrace the opportunities before them by working hard, maintaining discipline, and striving for academic excellence. He emphasised the importance of achieving a strong academic record, noting that outstanding performance opens doors to competitive opportunities and future specialisation. The Dean also urged students to pursue postgraduate studies, reminding them that the dental profession requires highly qualified specialists. Reflecting on his own academic journey, he shared how dedication and continuous learning enabled him to study and work internationally before returning to serve the University. He concluded by encouraging students to remain focused, respect University rules, support one another, and make the most of their time at the institution as they prepare for successful professional careers.
Representing the Dean of the School of Biomedical Sciences, Professor Elisa Mwaka welcomed the freshers and congratulated them on earning admission to the College, urging them to embrace responsibility and discipline as they begin university life. Introducing the School of Biomedical Sciences to students, he explained that it handles core foundational courses like Physiology, Biochemistry, Pathology, Medical Microbiology, Immunology, Molecular Biology, among others that support their academic journey. Professor Mwaka reminded students that success at university depends on personal responsibility, regular class attendance, effective time management, and organised study habits, emphasizing that attendance of at least 80 percent of lectures and practical sessions is required to qualify for examinations. He also encouraged students facing academic or personal challenges to seek guidance from their lecturers early rather than waiting until examination time, and urged them to be punctual, prepare adequately for classes.
Mental health featured prominently during the orientation. Leaders acknowledged that health sciences programmes can be stressful encouraging students experiencing emotional or psychological challenges to seek support early rather than suffering in silence. They also called on students to avoid stigmatizing colleagues facing mental health difficulties.
Students were also cautioned to safeguard their personal belongings, particularly phones and laptops, as they settle into campus life. Officials warned that new students are often targeted by thieves during the first weeks of the academic year.
The opening session for the 2026 orientation concluded with a message of encouragement, with MakCHS leaders expressing confidence that the students would develop into competent, ethical and compassionate healthcare professionals capable of contributing to Uganda’s health sector and beyond.
The Orientation Programme continues until Friday, 7th August, and all students were strongly encouraged to attend every session to give themselves the best possible start to their academic journey. Important topics to be covered include IT services, registration procedures, university policies, mental health and well-being, and awareness and prevention of sexual harassment. These sessions are designed to equip students with the knowledge and support they need to thrive both academically and personally.
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