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
A Voice for Excellence, Equity and African Sovereignty
When Dr. Michael Makanga walked onto the stage at the 8th Galien Forum Africa in Dakar on 31 October 2025 to receive the Special Career Achievement Galien Prize, presented by President Bassirou Diomaye Faye under the theme Health sovereignty: an imperative for Africa, the moment carried weight beyond any medal or citation. “It is a celebration of a lifelong commitment,” he said, “but also a reminder of a responsibility I have never been willing to compromise: to inspire others to raise their voices for excellence, science, and equity.”
For more than two decades, Dr. Makanga has been a quiet architect of Africa’s health sovereignty. His work has unfolded far from cameras: in laboratories constrained by resources, in policy rooms where African priorities demanded a stronger voice, and in mentoring sessions with young scientists seeking reassurance that their ideas mattered.
Born and trained in Uganda, Dr. Makanga earned a Bachelor of Medicine and Surgery from Makerere University before pursuing a master’s degree and PhD at the Liverpool School of Tropical Medicine. His career spans nearly 30 years, encompassing tropical medicine, clinical trials in Africa and Europe, and senior international management roles. Since joining EDCTP in 2004, he has guided its growth as a unique Africa–Europe partnership, strengthening African capacity for high-quality, ethical clinical research while accelerating solutions for poverty-related diseases. Today, he leads the Global Health EDCTP3 Joint Undertaking under the EU’s Horizon Europe programme.
President Faye captured the essence of Dr. Makanga’s achievement: “Scientific excellence is not negotiable; it is earned. It underpins our credibility and our sovereignty.” For Dr. Makanga, the statement is a call to action. “I hope this recognition reminds us that Africa’s scientists and innovators can lead global health research with excellence and purpose. We owe it to the next generation to build the systems and confidence that make this possible,” he said.
Dr. Makanga’s peers describe him as a “builder”: someone who strengthens research systems, mentors emerging scientists, and fosters equitable partnerships long before “local ownership” became a policy buzzword. In his own words, the award honors his “career’s contribution to advancing Africa’s health sovereignty” while reinforcing his commitment to ensure younger scientists do not have to fight for legitimacy as previous generations did.
The 2025 Prix Galien Africa celebrated Dr. Makanga alongside innovators reshaping African science. La Ruche Health, a Côte d’Ivoire-based digital health platform, won for connecting users to certified providers through an AI-powered system. Senegalese computer scientist Adji Bousso Dieng received a special prize for applying artificial intelligence to the natural sciences, including spotting emerging viral variants using her “Vendi Score” tool. The awards were organised with the support of the Presidency of Senegal, the Gates Foundation, the West African Health Organization, and the Rockefeller Foundation, with a jury co-chaired by Dr. John Nkengasong and Professor Souleymane Mboup.
Yet the award’s true weight lies not in ceremony, but in its symbolism. Dr. Makanga’s career exemplifies how African scientists can lead, shape policy, and influence global health priorities when empowered and supported.
Makerere University colleagues attest to this impact. Dr. Victoria Nankabirwa, a clinical researcher and epidemiologist, reflects: “EDCTP support allowed me to build multidisciplinary teams, enhance laboratory and trial infrastructure, and generate evidence relevant for policy and practice. It strengthened my scientific independence and expanded the long-term sustainability of my research, particularly on childhood vaccines.”
She adds, “Dr. Makanga’s vision and commitment have strengthened institutions, built capacity, and fostered equitable partnerships, enabling African investigators to lead complex studies that address the continent’s priorities. His recognition shows what is possible when scientists are empowered, trusted, and supported.”
Dr. Alex Kayongo, an immunologist at Makerere University, describes EDCTP support as “catalytic,” enabling advanced training and a platform to study microbiome–immune interactions in HIV-associated COPD. His work is shaping mechanistic insights and strengthening Uganda’s capacity for complex respiratory immunology research. “Global health funding is increasingly competitive, making EDCTP’s role even more vital,” he says. “Africa needs sustainable support for complex, lab-intensive research. Continued investment in infrastructure, leadership, and fair partnerships is essential if African institutions are to drive innovation and secure true scientific sovereignty.”
Dr. David Musoke, an associate professor of disease control, credits his EDCTP fellowship with deepening his malaria research and advancing his career. His studies combined housing improvements, environmental management, and behavioural measures to complement traditional malaria prevention, shaping practical, community-informed interventions. “Dr. Makanga’s contribution to African science has been tremendous, and his continued stewardship gives us confidence that evidence generated on the continent will increasingly shape policy and practice,” he observes.
Dr. Makanga’s impact is visible not only in individual careers but across institutions and nations. Through EDCTP, he has championed African-led trials, strengthened laboratory capacity, and fostered cross-country collaboration. Colleagues emphasize that his leadership has created a generation of African scientists who are confident, collaborative, and globally competitive.
“My experience with EDCTP-funded programmes has shown the transformative impact of African-led research,” Dr. Nankabirwa reflects. “Dr. Makanga’s vision and commitment have strengthened institutions, built capacity, and fostered equitable partnerships, enabling African investigators to lead complex studies that address the continent’s priorities. His recognition shows what is possible when scientists are empowered, trusted, and supported, inspiring the next generation of research leaders.”
Dr. Makanga’s recognition is a tribute to perseverance, vision, and mentorship: a scientist who kept going when resources were scarce, a leader who refused partnerships that treated Africans as subjects, and a mentor who reminded young researchers that they belong at the centre of global science.
As he stood among Africa’s leading innovators in Dakar, the message was unmistakable: Africa can lead, Africa must lead, and it will lead, through science, excellence, and equity.
Makerere University is proud to celebrate Dr. Michael Makanga, one of its distinguished alumni, on receiving the Special Career Achievement Prize of the Prix Galien Africa 2025. This honor recognises his exceptional leadership in medical research and his role in advancing African-led science. Through his work, Dr. Makanga continues to strengthen institutions, mentor emerging researchers, and amplify Africa’s voice on the global health stage.
Kalangala, an idyllic archipelago often romanticised for its sunsets, today witnessed a historic leap in healthcare. Makerere University Vice Chancellor, Prof. Barnabas Nawangwe, launched the Infectious Diseases Institute (IDI) Kalangala Clinical Research Centre—the island’s first modern research facility.
“This is more than a building; it’s a lifeline,” said Prof. Nawangwe. “IDI is not only Uganda’s leading health partner, managing over 20% of HIV cases, but research is first on its agenda. If people are not healthy, they can’t work—it’s useless to invest in anything else.”
Kalangala ranks third in HIV prevalence nationwide at 13.1%, with fishing communities hardest hit. Until now, residents endured perilous boat rides to the mainland for advanced care. “Accessing healthcare has always meant a journey across waves—long, costly, and sometimes dangerous,” said District Chairperson Jajab Ssemakula. “You have not only invested in Kalangala; you have brought Makerere University to Kalangala.”
Supported by the Gates Foundation, the centre is part of a multinational HIV prevention study conducted across 31 sites in Kenya, South Africa, and Uganda. Its first mission: testing whether a monthly pill can protect adolescent girls and young women from HIV—a breakthrough that could transform vulnerable communities.
“This centre means access without barriers,” said Dr. Andrew Kambugu, IDI Executive Director. “Kalangala residents no longer need to travel long distances for clinical trials or advanced care.”
Prof. Samuel Luboga, IDI Board Chairperson, reassured residents of IDI’s long-term commitment:
“We are not a fleeting partner. This sentinel research centre aligns with our vision of freeing Africa from the burden of infectious diseases. The assurance I give Kalangala is—we are here to stay.”
Henry Ssebunya, Deputy Resident District Commissioner, praised IDI’s innovation and consistency:
“IDI has treated and cared for people living with HIV, deployed medical drones to deliver life-saving medicines, and now built a research centre. This is a new chapter for Kalangala.”
From a sleeping sickness camp in 1906 to a cutting-edge research hub in 2025, Kalangala’s story is one of resilience, innovation, and hope.
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