Health
Dr. Kakumba Officially Opens HPE Conference 2021
The Deputy Vice Chancellor (Academic Affairs)-DVCAA, Dr. Umar Kakumba on Thursday 27th May, 2021 officially opened the two-day Health Profession’s Education Conference based on the theme; “Transforming Health Professions Education (HPE) in the 21st Century: From Theory to Practice”. The Conference was organised by the Eastern Africa Health Professions Educators’ Association (EAHPEA), and the Health Professions Education Partnership Initiative (HEPI) Project co-hosted by the College of Health Sciences (CHS), Makerere University.
The project; Health Professions Education and training for Strengthening the Health System and Services in Uganda(HEPI-SHSSU), is an innovative Education Research NIH-funded program implemented by a partnership between CHS, Busitema University School of Health Sciences, Kabale University School of Medicine, Clarke International University, Mulago School of Nursing and Midwifery, The African center for Global health and social transformation (ACHEST), Yale University and John Hopkins University (JHU). Prof. Sarah Kiguli from the School of Medicine, CHS is the project’s Principal Investigator and the Conference’s Chairperson Organising Committee.
The goal of the HEPI program, which started in August 2018 is to improve service delivery of the Ugandan health system through strengthened interdisciplinary health professional education and research training to produce graduates with competencies to address the priority health needs of the population.
Dr. Kakumba in his remarks noted that health is a critical success factor towards sustaining and promoting high levels of human development and it is therefore important that all stakeholders are involved in strengthening education and training systems for Health Professionals.
In this regard, he said that EAHPEA and the HEPI Project both provide opportunities and platforms for stakeholders to collaborate, plan and implement strategies that will improve the competence of educators and ultimately, the quality of graduates and health of communities.
“At institutional level, Makerere is especially aware of the dire need to recruit adequate numbers of well qualified staff, who should be developed in knowledge, and other competencies. Indeed a number of actions continue to be undertaken in the units with most critical need” he shared.
The DVCAA made specific mention of CHS’ proposed; pre-entry exam to improve the process of admitting medical students, and establishment of the Health Professions Education Centre to support faculty development at the college and other Institutions, as interventions that will contribute to the University’s efforts to implement student-centred learning.
“I equally bid to support the establishment of the Health Professions Education Centre” he vouched.
Dr. Kakumba therefore urged the College to strengthen its partnership with Government, particularly the Ministries of Health and Education as well as development partners and the community to ensure that meaningful transformation in Health Professions Education is achieved.
“I extend special thanks to all the Keynote Speakers, Partner Institutions represented, and the National Institutes of Health that has funded the conference through the Makerere University HEPI Project” he concluded.
The Principal CHS, Prof. Damalie Nakanjako thanked Dr. Kakumba for being supportive of the college’s innovations, particularly the proposal to establish the Health Professions Education Centre. She added that CHS had since followed it through to the next level. “The proposal is already under review by the Senate sub-Committee.”
Prof. Nakajanko shared that CHS was proud to have led the transformation of traditional curricular into the student-centred curricular. This curricular is grounded in problem-based learning and community-based education and services. The college has also embraced inter-disciplinary education.
“All these innovations would not have been possible without the efforts of; Prof. Nelson Sewankambo, Prof. Sarah Kiguli and Prof. Elsie Kiguli Malwadde” remarked Prof. Kiguli to applause from the audience.
She added that the Professors have since gone beyond CHS to support and work with all other Health Education Programmes in the country. “It is because of you that our Medical Education continues to be the leader in the region and we thank you very much.”
The Principal said her college was able to carry on teaching despite restrictions to institutions aimed at preventing the spread of COVID-19 thanks largely to the pedagogical support provided by the HEPI program. She therefore called for the need to reclassify computers and e-Learning equipment as teaching materials at procurement stage, so as to facilitate increased roll-out of online education.
Prof. Nelson Sewankambo is a Professor of Internal Medicine in the School of Medicine, CHS. Having served as Associate Dean and Dean of the School of Medicine and thereafter Principal CHS, he has been at the helm of various academic and administrative innovations and dedicated his efforts to improving medical education both in Uganda and internationally. Recently awarded Professor Emeritus of Makerere University, he was therefore the perfect candidate to deliver the opening ceremony’s keynote address on “Transformative Health Professions Education: Owning and Changing Our Future”.
“As we think about transformation of education, we need to link education and health systems. We cannot or should not work with one system and not the other. We as health profession educators should contribute to building the health systems as well” said Prof. Sewankambo as he tackled the need for holistic transformative education.
Reflecting on the three types of learning of health professions education; Transmissional, Transactional and Transformational, Prof. Sewankambo said that the latter; Transformative learning involves experiencing a deep, structural shift in the basic premises of thought, feelings and actions.
“Many of you know that young people join health professions training institutions with a lot of vigour and interest to do wonderful things and by the time they leave these institutions they have given up; they are not thinking the way they did when they were coming in” he shared solemnly.
This point then drove him to ask “So, how can we lay the foundation for transformational learning?” and as his audience pondered he answered, “We need to analyse the main opportunities and challenges which are facing the health workforce… and then we need to recognise and accept the need for change.”
Prof. Sewankambo acknowledged that we are in most cases our own barriers because we do not recognise the need for change. “We have therefore, before we talk about transformative education, to transform our own minds, then we can plunge into transformative education.”
Other factors identified by Prof. Sewankambo in laying the foundation for transformative education included; Strategic vision and change management, Balancing the top-down and bottom-up approach and above all, Transformative leadership and a learning system/institution.
He further warned that a failure to re-lay the foundations would most likely result in Uganda and the region risking a “continued deterioration of service provision, worsening health outcomes and a system poorly equipped to respond to future health challenges.”
Prof. Sewankambo in conclusion tasked the delegates who were drawn from various institutions within Uganda and the region to come up with a call to action. This, he opined, would serve as the turning point for ensuring transformative health professions education in the period following the conference.
Health
Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet
By Joseph Odoi
A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.
This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.
Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”
‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.
Innovation details
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
“While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.
HOW THE SAFEBANGLE TECHNOLOGY WORKS
The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.
All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.
Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.
A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)
| Key Findings | Lessons learned |
| Prevalence of GBV. – Overall prevalence: 34.1% of women and girls reported experiencing GBV. – Among adolescents (15-19 years): Over 50% reported experiencing GBV. | – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors. – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises. – Economic independence proved crucial, enabling women to leave abusive environments. – Involving men and boys as allies in GBV prevention efforts is essential. |
| Age-related trends | – GBV prevalence tends to decrease with increasing age. |
| Physical and health consequences. | – Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access. – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS. |
| Social and economic impact. . | – GBV contributed to family breakups, strained marriages due to financial stress. – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation. – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations. – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment. |
| Psychological effects | – Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse. |
| Long-term effects | – Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues. |
Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.
Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.
One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).
Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.
Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.
Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.
Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.
Lessons learned
The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.
Recommendations
To address GBV against women and girls, the researchers recommend the following moving forward;
- There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
- Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
- Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
- Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
- Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
- Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
- Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
- Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
- Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
- Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
- A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
- Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.
MORE ABOUT THE STUDY
The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof. Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.
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