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
Health
Makerere University Explores Strategic Partnership with Tsinghua University in Safety Science, Disaster Resilience and Public Health
Makerere University has taken a significant step toward strengthening global research collaboration following a high-level meeting between Vice Chancellor Prof. Barnabas Nawangwe and a delegation from Tsinghua University’s Hefei Institute for Public Safety Research, one of China’s leading centres of excellence in disaster prevention, public safety, and emergency management. The engagement marked a renewed commitment to advancing scientific cooperation between the two institutions, particularly in addressing complex environmental and public health challenges that continue to shape national and global development.
A Partnership Anchored in Shared Challenges and Global Priorities
In his remarks, Prof. Nawangwe emphasized that the concept of comprehensive public safety, spanning natural disasters, epidemics, infrastructure failures, and social risks, is increasingly relevant to all colleges and disciplines at Makerere. Uganda’s experience with epidemics such as Ebola, cholera, and COVID-19; frequent landslides in mountainous regions; flooding events; and rising traffic-related incidents place the University in a unique position to contribute applied research, community-based insights, and local knowledge to a global scientific dialogue.
He noted that the Tsinghua presentation revealed new areas of alignment, particularly in epidemic modelling, early-warning systems, and integrated emergency management, areas where Makerere’s public health scientists, medical researchers, and social scientists have extensive expertise.
“This collaboration offers meaningful opportunities for nearly every college at Makerere,” he noted. “Public safety touches the environment, public health, engineering, social sciences, ICT, humanities, and urban planning. The challenges we face as a country make this partnership both timely and essential.” Prof. Barnabas Nawangwe noted.
Tsinghua University: A Global Leader in Comprehensive Public Safety.
The delegation from Tsinghua University outlined China’s national investment in Public safety over the past two decades, an effort driven by the recognition that life and security are the foundation of sustainable development. Tsinghua’s Hefei Institute for Public Safety Research has developed nationally recognised research platforms and large-scale simulation facilities dedicated to Natural disaster modelling (earthquakes, landslides, floods, typhoons, Infrastructure and urban systems safety, Public health emergencies and epidemic preparedness, Early-warning, monitoring, and emergency communication, Traffic and transportation safety, Post-disaster reconstruction and resilience planning.
Their systems currently support over 100 provincial and municipal emergency management centres in China, underscoring their global leadership in practical, scalable solutions for disaster risk management. The delegation reaffirmed that Uganda’s lived experience with multiple hazards presents opportunities for meaningful knowledge exchange. They expressed particular interest in learning from Makerere’s work on epidemic response, community health systems, and the social dimensions of disaster management.
Emerging Areas of Partnership
The meeting identified several promising pathways for long-term collaboration:
1. Joint Research in Disaster Risk Reduction and Climate-Related Hazards
Both institutions expressed readiness to co-develop research projects on landslides, floods, urban resilience, and multi-hazard modelling, drawing on Tsinghua’s advanced simulation technologies and Makerere’s environmental expertise and geographic field realities.
2. Public Health Emergency Preparedness and Epidemic Response
Makerere’s renowned public health schools and research centres will collaborate with Tsinghua on epidemic prediction, early-warning systems, and integrated preparedness frameworks, leveraging Uganda’s decades of experience managing high-risk disease outbreaks.
3. Infrastructure and Urban Safety, Including Traffic Systems
With Uganda experiencing rapid urbanisation and high rates of motorcycle-related road incidents, Tsinghua shared insights from China’s own transformation, including infrastructure redesign, transport modelling, and public transit innovations. Collaborative work in this area would support city planning and road safety interventions in Kampala and other urban centres.
4. Academic Exchange and Capacity Building
Both sides expressed interest in student exchanges, staff mobility, co-supervision of postgraduate research, and specialised training programmes hosted at Tsinghua’s world-class safety research facilities.
5. Development of a Joint Public Safety Laboratory at Makerere
The institutions are exploring the establishment of a collaborative safety research platform in Uganda. This initiative could serve as a regional hub for innovation in emergency management, environmental safety, and technology-driven risk assessment.
Towards a Long-Term, Impactful Collaboration
The meeting concluded with a shared commitment to develop a structured partnership framework in the coming months, supported by both universities and aligned with Uganda–China cooperation priorities. Both teams acknowledged that the partnership must yield tangible results that enhance community resilience, bolster national preparedness systems, and foster scientific capacity for future generations.
Prof. Nawangwe commended Tsinghua University for its willingness to co-invest in research and capacity building, noting that such collaborations position Makerere not only as a leading research institution in Africa but as an active contributor to global scientific progress.
“This partnership has the potential to transform our understanding of the science of public safety to deliver solutions that safeguard lives.” Prof. Barnabas Nawangwe noted.
“It aligns perfectly with Makerere’s mission to be a research-led, innovation-driven university responding to the world’s most urgent challenges.” He added.
As part of this strategic partnership engagement, Makerere University will, on Wednesday, 17th December, co-host the Makerere University–Tsinghua University Symposium on Public Safety and Natural Disaster Management. The symposium will run from 8:00 AM to 2:00 PM in the University Main Hall, Main Building.
This symposium represents a deepening of collaboration not only between Makerere University and Tsinghua University, but also a broader strategic partnership between Uganda and the People’s Republic of China.
During the event, H.E. Zhang Lizhong, Ambassador of the People’s Republic of China to Uganda, together with the State Minister for Higher Education, Government of Uganda, will officially launch the China–Uganda Belt and Road Joint Laboratory on Natural Disaster Monitoring and Early Warning. The Laboratory will be hosted at Makerere University, positioning the University to play a central role in strengthening Uganda’s and the region’s capacity for natural disaster preparedness, public safety, and emergency management research.
Caroline Kainomugisha is the Communications Officer, Advancement Office, Makerere University.
Makerere University on 11th November 2025 marked a significant milestone as the Health User Committee (Mak-HUC)—established by the Vice Chancellor in 2022 as part of his strategic mandate to strengthen and oversee the University’s health service delivery—formally handed over its three-year report. The event highlighted the committee’s achievements in guiding, monitoring, and improving Makerere University Health Services, presenting a record of progress that has reshaped confidence, strengthened systems, and expanded care for staff and students.
A Call for Integrated and Sustainable Health Services
The Vice Chancellor Prof. Barnabas Nawangwe emphasized the need for a more integrated, efficient, and sustainable approach to delivering health services for Makerere University staff and students. He noted that while the University does not receive supplies from the National Medical Stores system, its community remains entitled to quality care, urging renewed consideration of how essential services—such as drug access, surgical limits, and special medical cases—can be better supported. He highlighted the importance of practical costing models, especially for extending care to staff dependents, and called for flexibility in managing exceptional cases like complex surgeries or referrals abroad.
The Vice Chancellor also underscored the urgent need to modernize the University Hospital, proposing that Makerere begin incrementally establishing a teaching hospital using existing facilities and leveraging expertise of highly qualified consultants the College of Health Sciences (CHS). He reiterated that government budget ceilings remain a major constraint, but encouraged the committee to develop a concept that could be presented to Council and later supported through strategic engagement with the Ministry of Finance, Planning and Economic Development. Throughout his remarks, he applauded the Mak-HUC for its work and reaffirmed that even with the creation of a professional hospital board, the committee must remain central in representing service users.
Aligning Health Services with Sustainable Insurance Models
Prof. Bruce Kirenga the Principal College of Health Sciences responded by clarifying the committee’s efforts to align Makerere’s health services with real insurance models, including cost projections for covering additional family members and encouraging voluntary staff contributions where necessary. He acknowledged the complexity of expanding service coverage—especially in cases of chronic illness or high-cost procedures—but emphasized the committee’s commitment to cautious, sustainable planning. He confirmed that the College is working closely with the Hospital to improve services, attract specialists, and integrate students into the health system, a model that naturally draws academic staff into clinical roles without imposing unrealistic obligations.
Prof. Kirenga also noted the College’s ongoing assessments of facility needs, including dialysis, ICU expansion, and equipment placement, stressing that the ultimate goal is a unified, well-structured health network across the University. He welcomed the Vice Chancellor’s support for transforming existing facilities into a teaching hospital and pledged to refine proposals that reflect both current realities and long-term institutional needs.
Committee Chair Reflects on Three-Year Achievements
Dr. Allen Kabagyenyi, Chair of Mak-HUC, reflected on the three-year journey with gratitude and pride, noting that the committee not only fulfilled its terms of reference but exceeded expectations. She highlighted major gains made under the Vice Chancellor’s support, including transforming the University Hospital into a self-accounting unit—an intervention that unlocked smoother financial management and accelerated service delivery. Dr. Kabagyenyi commended the strong collaboration with the Hospital administration, Human Resources Directorate, and other units, which ensured staffing stability even during institutional transitions.
She pointed to the expansion of referral partnerships—now totaling 29 health facilities nationwide—as a crucial achievement that guarantees continuity of care for staff and students wherever they are. She also emphasized the committee’s work in guiding policies for specialized treatment and cross-border care, strengthening fraud-prevention systems, and advancing digital transformation through an integrated health information system and the new Makerere University Health Services (MakHS) website. Dr. Kabagyenyi noted that these improvements have directly benefited staff and enhanced the overall quality of care, supported by close collaboration with the College of Health Sciences and access to some of the country’s best consultants. She concluded by underscoring the ongoing need for a comprehensive University Health Policy and expressed deep appreciation to the Vice Chancellor and University Management for their unwavering openness and support—attributes she credited for the committee’s success.
Highlights of Service Growth and Infrastructure Upgrades
The Chief, Makerere University Health Services, Prof. Josaphat Byamugisha, highlighted the significant progress achieved under the Health User Committee’s oversight, noting especially the steady rise in service utilization and renewed confidence among staff and students. He emphasized that trust in the University Hospital has grown organically—built not through advertising, but through improved patient experience, stronger systems, and word of mouth.
Prof. Byamugisha pointed to major achievements such as expanded Out-Patient Department (OPD) attendance, better student access to care, enhanced infrastructure including modernized theatres capable of complex procedures, and upgraded laboratories supported through framework agreements that ensure continuous equipment renewal. He noted that specialized clinics, increased inpatient capacity, and expanded referral networks have strengthened the Hospital’s reach and responsiveness. The Hospital is also taking on more research work and clinical training, partnering with units such as optometry, internal medicine, and the Clinical Trials Unit, with new collaborations—like the MasterCard Foundation—driving further growth.
He reaffirmed that the long-term vision of establishing a fully-fledged Makerere University Teaching Hospital is taking shape through coordinated efforts with the College of Health Sciences. Prof. Byamugisha credited the Vice Chancellor’s support for enabling these strides and expressed deep appreciation to all stakeholders contributing to the continued improvement of health services for the entire University community.
DICTS Unveils Modular Information System & Health Services Website
The Directorate for ICT Support (DICTS) presented the newly developed Makerere University Integrated Health Management Information System (MakIHMIS), designed around a modular system that streamlines all hospital processes. The platform integrates eight functional modules, including registration, triage, clinician workflows, inventory and medicines management, pharmacy dispensing, laboratory information management, user management, and linkages to both the Academic and Human Resource Management Information Systems ACMIS and e-HRMS respetively. Most of these modules are already active, enabling smooth patient registration, accurate record-keeping, real-time inventory tracking, and seamless access to student and staff data without duplication. Only two modules—land and insurance—remain under development before the system becomes fully end-to-end. The MakHS website on the other hand features information about hospital services, events, research activities, and staff profiles, offering both the university community and the public a centralized and efficient digital gateway to the hospital’s operations.
The term of the outgoing committee has officially concluded, and preparations are now underway for the incoming committee to assume its duties and continue advancing the work ahead.
Health
Proceedings of the National Annual Communicable and Non-Communicable Diseases and 19th Joint Scientific Health Conference 2025
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