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Govt. Asked to Scale up Successes in Buikwe, Mukono CVDs Interventions to the Rest of the Country

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Africa continues to record the highest prevalence of hypertension globally. Studies show that Uganda’s hypertension prevalence stands at 26.4% and public health experts are worried that rising prevalence of noncommunicable diseases (NCDs) should be curbed lest it contributes to the disease burden.

In Africa, just like other low- and middle-income countries, the burden of disease is transitioning from infectious diseases to NCDs and the World Health Organisation predicts that they are likely to become a major health system challenge in Africa as they are predicted to become the leading cause of death in the region by 2030.

Studies estimate Uganda’s NCDs prevalence at 33 in every 100 people die of cardiovascular diseases (CVDs). The prevalence of hypertension for instance among adults stands at 26.4% with the highest prevalence in central Uganda (28.5%) which hosts Mukono and Buikwe districts.

In Mukono and Buikwe districts, among persons aged 15 years and above, the age standardized prevalence of hypertension is 27.2%.

Makerere University School of Public Health has for close to three (03) years now been impacting the communities in Mukono and Buikwe districts through its project; Cardiovascular Disease prevention program -Scaling -up Packages for Interventions for Cardiovascular diseases prevention in selected sites in Europe and sub-Saharan Africa (SPICES) Uganda.

The SPICES project focuses on prevention of diseases of the heart and blood vessels. The project has conducted a comprehensive study  at both health facility level and community level where a number of community workers and health workers from randomly selected villages and health facilities in Mukono and Buikwe have been trained in cardiovascular disease prevention and control.  

So far, a total of 366 health workers and 80 community health workers (CHWs/VHTs) received training. In addition, the project provided the health centers with equipment to support screening and management of cardiovascular diseases. The project team has, with support of health facilities been involved in screening CVD risk, care and management as well as health promotion and profiling at community level.

As a result of this intervention, there are higher volumes of hypertension and diabetes patients being received as a result of sensitization by the community health workers. There are also reports of changes in behavior in lifestyles especially diet and physical activity as well as improved patient health seeking behaviors for chronic services.

For instance, while presenting results at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district, Dr. Geofrey Musinguzi, the Principal Investigator of the SPICES Project expressed that the project has had significant impact in terms of knowledge changes, and in terms of profiles.

SPICES project Principal Investigator Dr. Geofrey Musinguzi in an interview with journalists immediately after the dissemination in Mukono on Wednesday.
SPICES project Principal Investigator Dr. Geofrey Musinguzi in an interview with journalists immediately after the dissemination in Mukono on Wednesday. 

“Much as the prevalence of smoking didn’t seem to change, there was a change in frequency of smoking. For example, those who were smoking daily, we saw a reduction from 2018/19 to 2021,” says Dr. Musinguzi.

He adds that there was a significant difference in passive smoking. “Passive smoking is as dangerous as active smoking. At the baseline, people were smoking and exposing their love ones to tobacco but when they were trained from the health facilities and from the community on the dangers of smoking and passive smoking. So, we have seen an attitude of people in families where people are smoking, of if they can’t avoid smoking, doing it away from their families.”

Arising out of the successes of the project so far, Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) has asked government and the Ministry of Health in particular to support noncommunicable diseases care in the districts of Mukono and Buikwe.

Prof. Wanyenze who is also co-principal investigator of the project SPICES project intervention in Mukono and Buikwe could be used as a yardstick to pick lessons for the Ministry of Health to extend the services to other parts of the country.

Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) and SPICES project Co-Principal Investigator
Dr. Rhoda Wanyenze, Professor and Dean of Makerere University School of Public Health (MakSPH) and SPICES project Co-Principal Investigator.

“We can use this as a learning hub so that we can also get the other regions that do not have the standard for NCD care at the level that we have in these districts. Let us maintain it because it is an opportunity for us to show that it is doable, that we can do something about NCDs and that others can learn something from these districts and facilities and we can do better across the country,” Professor Wanyenze said.

Tereza Ssenjova, a resident of Busabala Mukono said; “I used to be diagnosed with fever, yet I did not have it. Not until recently through SPICES screening that I was told I have high blood pressure and diabetes.”

Prof. Wanyenze urged for the Ministry of Health to rally Ugandans, the leadership at all levels to aggressively advocate for a safer population by preventing and reducing cardiovascular diseases.

“Please do speak about NCDs like the way we speak about COVID-19 lately and the way we have been speaking about other diseases. Encourage people to screen. If there is an opportunity, why not have a machine around you in your place so that you can encourage people to screen periodically. Think of how you can creatively encourage the communities to screen, so that we can discover these diseases early and be able to do something,” says Prof. Wanyenze.

Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health admits that cardiovascular diseases are on a rise but hastens to add that they can be prevented.

“What we have found out is that the communities, once educated, sensitized can come for screening, but also can follow some of the guidelines given to prevent cardiovascular diseases. This has been shown and we have the data now,” Dr. Mutungi says.

Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health
Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health

Dr. Mutungi welcomes the results and noted that government will scale-up the interventions.

“We are in evidence-based policy and decision making. This is going to influence our policy. We had already started sensitizing VHTs but we were not sure that actually they can play a big role in prevention of cardiovascular diseases. Now this study is showing that yes, they can. We thought they could only support in distributing bed nets, simple things but they have shown us that they can do a lot in prevention and control of diseases,” he said.

Dr. Musinguzi said the project has had a multi-component intervention including health promotion, screening, training among others.

“We think that this intervention can reach many people. I gave an example of the talking T-Shirt. It has the modifiable risk factors. ‘don’t smoke’, ‘do more exercise’, ‘reduce/avoid alcohol,’ ‘maintain a healthy weight’, ‘go for checkup’ ‘control stress’, ‘eat healthy diet’ among others. In fact, we got reports from VHTs that the messages were received by the population. So, we think all ways of delivering messages must be explored to be able to enhance awareness about CVDs and other NCDs,” Dr. Musinguzi contends.

Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district
Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district.

hailed the SPICES project team for the “wonderful research” and requested the project to include Buvuma and Kayunga districts on the study scope.

“I thank you so much for training the VHTs and our health workers around Mukono and Buikwe districts. This is very good,” said Hajat Nabitaka.

She underscores the need for continued sensitization of the population with a view of changing mindsets to be able to fully realise the benefits.

“Some people think these are diseases of the rich people. Not knowing that even a child in primary school can get diabetes. Not knowing that even an ordinary person in community can get pressure due to the various stress factors. Let us utilize the VHTs to solve many problems including social societal problems such as stress,” Hajat Nabitaka.

Dr. Rawlance Ndejjo, the SPICES Project coordinator said the project has been able to enroll 23 health facilities where it has greatly impacted lives.

He adds that the dissemination is; “a great opportunity to share what we have been doing in field with the rest of the world.”

Dr. Rawlance Ndejjo, the SPICES Project coordinator
Dr. Rawlance Ndejjo, the SPICES Project coordinator

Some health facilities have have adopted strategies to acquire hypertension and diabetes drugs, and all enrolled facilities are now able to identify and manage Type 1 diabetes, unlike in the past.

SPICES project is currently implemented in Uganda, South Africa, France, Belgium and the United Kingdom. It is an implementation science project funded by the European Commission through the Horizon2020 research and innovation.

Mukono and Buikwe district Health workers and community health workers (CHWs/VHTs) in a group photo with SPICES project Principal Investigator Dr. Geofrey Musinguzi and Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health.
Mukono and Buikwe district Health workers and community health workers (CHWs/VHTs) in a group photo with SPICES project Principal Investigator Dr. Geofrey Musinguzi and Dr. Gerald Mutungi, the Assistant Commissioner, Non-Communicable Diseases Department, Ministry of Health at a Dissemination workshop on December 8th 2021 at Colline Hotel, Mukono.

Article originally published on MakSPH website.

Davidson Ndyabahika

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How Jimmy Osuret Turned Childhood Trauma into Evidence for Safer School Crossings

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Pedestrians on high alert as they cross the road in Kampala City. Photo by Katumba Badru

On a weekday morning in Kampala, the city snarls without any signs of awakening. Cars grind bumper to bumper along crumbling asphalt, their horns locked in a long, impatient argument. Rusting taxis and private vehicles shudder under the rising sun. Boda bodas slice through impossibly narrow gaps, mount pavements, edge past crossings, and assert dominance wherever there is room to move. The road belongs to whoever is bold enough to seize it.

And on the margins of this contest, there are children.

At 6 a.m., long before office doors open, primary school pupils begin their walk. Backpacks bounce against narrow shoulders as they navigate broken sidewalks and dusty road edges. When they reach a main road, their rhythm changes. Some stop and scan, small hands grip the straps. Others hesitate, then dart, misjudging speed, trusting that a driver will slow down.

But traffic rarely slows.

In Kampala, pedestrians do not command the road; they negotiate with it. Every crossing is a calculation. Every pause carries risk. Children learn early that movement requires courage. They watch for gaps, read the body language of drivers, and step forward in faith.

A mix of pedestrians and motorists on a busy Kampala Road in Kampala. Photo by Katumba Badru
A mix of pedestrians and motorists on a busy Kampala Road in Kampala. Photo by Katumba Badru

It is in that fragile second, between hesitation and impact, that the question begins to form.

For Jimmy Osuret, this is not an abstract problem of urban mobility but a daily reality, etched into memory long before it became research.

In 1996, as a Primary Four pupil at Shimoni Demonstration School, then located along the busy Nile Avenue corridor in Uganda’s capital, Kampala, he watched a classmate attempt to cross the road on an ordinary school day. A truck did not slow down. The child did not make it to the other side.

“It stayed with me,” Osuret recalls. “At the time, I didn’t have the language for it. But that moment shaped how I came to understand injuries—not as accidents, but as something patterned, preventable, and deeply unfair.”

Nearly three decades later, the school has moved, and the road has changed, but Kampala’s traffic has only grown more unforgiving. Children still gather at pavements across the city, backpacks bouncing, eyes fixed on gaps in traffic that may or may not come. And Osuret would return to these streets, not as a schoolboy navigating danger, but as a public health scientist determined to change what danger looks like for Uganda’s children.

From Personal Loss to Public Health Purpose

Osuret’s journey into injury research unfolded through lived experience, service, and grief, each layer sharpening his understanding of why pedestrian safety matters.

After completing his Bachelor’s degree in Environmental Health at Makerere University, he volunteered with the Uganda Red Cross Society in Bushenyi District between 2009 and 2011. There, he was exposed to emergency response, first aid, and trauma care. Road crashes were no longer statistics but bleeding bodies, panicked families, and systems struggling to respond in time.

“That experience changed how I saw injuries,” he reflects. “They weren’t isolated events. They were predictable outcomes of unsafe systems.”

His MSc in Public Health at Oxford Brookes University deepened that lens. Focusing his dissertation on alcohol-related road traffic injuries, Osuret built strong skills in epidemiology and behavioural research, tools he would later bring back home.

But it was personal loss that cemented his resolve. A cousin was killed in a hit-and-run crash. Another reminder that vulnerability on Uganda’s roads often carries the highest cost.

Together, these experiences shaped the research question that would define his PhD: Why are Kampala’s roads so unsafe for children, and what actually works to protect them?

Children ride boda bodas to school in Kampala without helmets. A 2023 MakSPH–Bloomberg road safety report found helmet use was low among riders (39%) and almost non-existent among passengers (2%). Photo by Katumba Badru.
Children ride boda bodas to school in Kampala without helmets. A 2023 MakSPH–Bloomberg road safety report found helmet use was low among riders (39%) and almost non-existent among passengers (2%). Photo by Katumba Badru.

Kampala’s Roads, Through a Child’s Eyes

Every day, millions of Ugandans walk to school, to work, to markets, to taxi stages. At some point in the day, everyone becomes a pedestrian. For children, walking is not a choice; it is the only option. Yet Kampala’s roads tell children they do not belong.

Rapid urbanisation and motorisation have transformed the city, but road design continues to privilege vehicles over people. Sidewalks are missing or obstructed. Safe crossings are rare. Speed control is weak. Children are forced to negotiate fast-moving traffic despite their limited ability to judge speed and distance.

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.
Students step into traffic at Mulago Roundabout in 2024, where a moment’s hesitation can mean everything. Photo by MakSPH Communications Office

Osuret’s research confirms what many parents already fear. Pedestrians account for more than a third of road casualties in Uganda, with children bearing a disproportionate share of that burden. Unsafe crossing behaviours, running, failing to stop at the pavement, and weaving between vehicles are not acts of carelessness. They are survival strategies in hostile environments.

“Children are expected to behave safely in systems that are fundamentally unsafe,” he explains. “That is not reasonable, and it is not ethical.”

Watching the Road Tell Its Story

Rather than relying on self-reports or simulations, Osuret turned to the road itself. Using discreetly mounted video cameras at school crossings across Kampala, his team observed thousands of real interactions between children, vehicles, and the built environment. The footage captured moments of hesitation, confusion, urgency, and occasionally, near misses that left the researchers gasping for air.

The researcher, Dr. Jimmy Osuret (in an orange reflector jacket), together with his team, mounts video cameras during his PhD study. Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.
The researcher, Dr. Jimmy Osuret (in an orange reflector jacket), together with his team, mounts video cameras during his PhD study.

His findings were sobering. One in five children failed to wait at the pavement. More than a quarter crossed outside marked crosswalks. Many ran. Some crossed between vehicles, often when drivers failed to yield.

“These behaviours are not random,” Osuret notes. “They respond directly to what drivers do and what the road allows.”

Crucially, the data revealed something else: where trained school traffic wardens were present, children behaved differently, and drivers did too.

The Power of a Raised Hand

Osuret’s PhD went beyond observation. It tested a solution.

In a cluster-randomized trial across 34 public primary schools, his team introduced a school traffic warden behavioural promotion programme, a low-cost intervention placing trained adult wardens at school crossings during peak hours. The wardens wore reflective gear, used stop paddles, made eye contact with drivers, and guided children through safe crossing routines: stop, look, wait, walk.

Newly trained School Traffic Wardens stand ready to protect children at busy crossings under Jimmy Osuret’s PhD intervention. Photo by Davidson Ndyabahika. Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.
Newly trained School Traffic Wardens stand ready to protect children at busy crossings under Jimmy Osuret’s PhD intervention. Photo by Davidson Ndyabahika.

Strikingly, drivers were more than seven times more likely to yield to child pedestrians where a traffic warden was present. Children were 70% more likely to cross safely, stopping at the pavement, walking instead of running, and avoiding dangerous gaps between vehicles.

“What surprised me most,” Osuret recalls, “was how quickly children adapted. When the system supported them, safer behaviour became the norm.”

The intervention faced some resistance. Some drivers ignored wardens. Others were openly hostile. These moments revealed a deeper truth that behaviour change cannot rely on goodwill alone. It requires enforcement, legitimacy, and policy backing.

Behaviour Is Not the Problem—Systems Are

A central insight of Osuret’s work is that road safety debates often focus on the wrong actor.

“Children are told to be careful,” he says. “But children are not the ones designing roads, setting speed limits, or enforcing laws.”

His research shows that driver behaviour, especially yielding and speed, has a direct protective effect on children. Higher driver-yielding rates are consistently associated with fewer pedestrian collisions. Behaviour change among drivers is therefore not optional but foundational.

This perspective aligns with the Safe Systems Approach, which recognises human error as inevitable and places responsibility on systems to prevent fatal outcomes. In Kampala, where infrastructure and enforcement gaps are stark, behavioural interventions like traffic wardens offer an immediate, scalable bridge, especially in school zones.

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.

Scholarship Grounded in Community

Osuret’s academic home at Makerere University School of Public Health shaped how his research evolved. Mentorship from senior injury researchers at Makerere University grounded his work in rigorous methods and local relevance.

“I worked closely with Dr. Olive Kobusingye at the Trauma, Injury, and Disability Unit and became involved in research on pedestrian road safety through international collaborations. Makerere taught me to ask questions that matter here,” he says. “Not just what is publishable, but what is usable.”

That grounding helped him navigate the most challenging phase of his PhD, especially balancing full-time academic work, research, and personal responsibilities. Like many African scholars, he conducted much of his doctoral research while teaching, mentoring, and engaging communities.

“It made me deeply aware of the structural barriers young researchers face,” he reflects. “And it strengthened my commitment to mentorship.”

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.

From Evidence to Action

On January 10, 2025, Osuret publicly defended his PhD in a hybrid session at the Makerere University School of Public Health Auditorium. The defense was both a scholarly milestone and a personal reckoning, a moment when decades of memory, loss, and inquiry converged.

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.

But for Osuret, the PhD was never an endpoint.

Today, he serves on the National Road Safety Committee, contributing evidence to Uganda’s National Road Safety Action Plan. He mentors students, collaborates with policymakers, and continues to argue, persistently, that injuries deserve the same public health urgency as infectious diseases.

“The gap is not knowledge,” he says. “We know what works. The gap is translating evidence into action.”

If policymakers took just one lesson from his research, “design roads around children, not vehicles,” he says. Osuret believes that speed management, safe crossings, and visible enforcement around schools are essential obligations, not luxuries.

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.

Walking Toward Safer Futures

As the country prepares for the 76th Makerere University Graduation Ceremony this February 2026, where Osuret and 184 others will receive their PhDs, we are reminded of what scholarship can do when it remains rooted in lived reality.

Every day, children still gather on the road pavements outside schools like Shimoni. Traffic still hums, and risk has not disappeared. But in some places, a raised hand, a reflective vest, and a trained presence have shifted the balance, if only slightly, toward safety.

When asked what responsibility he now carries, Osuret does not hesitate.

“To ensure that evidence informs decisions,” he says. “Because at some point in the day, we are all pedestrians. And no one should have to gamble with their life just to cross the road.”

Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony, Dr. Jimmy Osuret,Public Health Specialist and Research Associate, Department of Disease Control and Environmental Health, Kampala Uganda, East Africa.

—A publication of the Makerere University School of Public Health Communications Office, Graduation Profiles Series, 76th Graduation Ceremony

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Davidson Ndyabahika

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Holding the System Together During COVID-19: Steven Kabwama’s Research on Care Continuity

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An emergency response team extracts a suspected case from the community during the pandemic.

In March 2020, Uganda slowed to a near standstill. Roads emptied. Clinics fell quiet. Fear moved faster than information. Many perceived COVID-19 as a virus to avoid. Others saw it as a barrier that stood between a mother and antenatal care, a child and routine immunization, and a patient and life-saving HIV medication. What followed was not only a public health emergency but also a test of whether health systems could keep doing the ordinary work of care while responding to the extraordinary.

In early December 2025, a question first asked with urgency during a global crisis resurfaced in a quieter, more reflective moment. On December 2, a single bound copy of Steven Kabwama’s doctoral thesis was fastened to a wooden board dubbed ‘The Wall of Fame‘ at Karolinska Institutet. The ritual, known as spikning, is modest in appearance but weighty in meaning: a thesis is made public, opened to scrutiny, and years of private intellectual labour are released into the world. For Kabwama, it marked the moment when research forged in the pressure of a global emergency became part of the public record, no longer his alone but open to collective examination.

Kabwama nails his thesis on the wall at KI.
Kabwama nails his thesis on the wall at KI.

The tradition stretches back centuries, often traced to Martin Luther’s public posting of his theses in the 15th century. But in Stockholm, on a winter afternoon, history gave way to something more immediate. Kabwama stood briefly by the wooden board with a hammer and fixed his work in place. The moment was less about ceremony than readiness. The research was complete. The questions were now open.

Kabwama’s Principal Supervisor, Professor Tobias Alfvén of the Department of Global Public Health, Karolinska Institutet, congratulates him on the milestone.
Kabwama’s Principal Supervisor, Professor Tobias Alfvén of the Department of Global Public Health, Karolinska Institutet, congratulates him on the milestone.

Three days later, on Friday, December 5, 2025, Kabwama publicly defended the thesis in a hybrid ceremony at Wretlindsalen in Solna, joined, both in person and online, by colleagues from Uganda, Sweden, and beyond. By then, the work, which examines how health systems sustain essential services during crises, had already begun to circulate, quietly shaping conversations about preparedness, continuity, and care.

Some of the members of the audience during Kabwama’s PhD Defense at Wretlindsalen in Solna.
Some of the members of the audience during Kabwama’s PhD Defense at Wretlindsalen in Solna.

What that bound document contained, however, had been forged years earlier, inside outbreaks, lockdowns, data sets, and long nights spent asking how health systems hold together when everything else is falling apart.

Steven Ndugwa Kabwama remembers the beginning not as a single crisis, but as a series of decisions, some made urgently, others too late. As an epidemiologist by training, Kabwama, who had spent years responding to outbreaks through Uganda’s Field Epidemiology Fellowship Program, clearly understood that outbreaks had patterns; they arrived, demanded attention, and eventually receded.

COVID-19 was different.

“It became clear very early on,” he recalls, “that the urgency of the response was going to affect everything else: malaria, immunization, maternal health, HIV. And yet, very little had been written about how systems are supposed to hold both at the same time.”

That realization would shape the next chapter of his life and, eventually, his PhD.

From Outbreak Response to System Questions

Kabwama’s academic journey did not begin in epidemiology. In 2006, he enrolled for a Bachelor’s degree in Food Science and Technology at Makerere University, a programme traditionally geared toward food processing, quality assurance, and industrial production. It is a discipline that prepares graduates for careers in manufacturing plants, laboratories, and supply chains, work that often unfolds far from clinics, outbreaks, and emergency response rooms.

Yet even then, his interests leaned beyond production lines and quality controls. He was drawn to how systems affect people’s health long before illness appears and how nutrition, safety, access, and policy intersect. That early grounding in systems thinking would later resurface in unexpected ways.

He went on to earn a Master of Science in Public Health from the University of Southern Denmark in 2013, supported by a Danish State Scholarship. It was there that population-level analysis sharpened his interest in data, surveillance, and health equity. But it was the Advanced Field Epidemiology Fellowship, jointly run by Makerere University School of Public Health (MakSPH), Uganda’s Ministry of Health, and the U.S. Centers for Disease Control and Prevention, that placed him directly inside emergencies, where evidence, decisions, and lives converge.

As a Fellow, his work stood out. He later received the Outstanding Fellow Award from the Uganda Public Health Fellowship Program (Field Epidemiology Track, Cohort 2015), recognition of his contributions to outbreak response, national non-communicable disease analyses, and policy work, including Uganda’s Alcohol Control Policy. “You respond, you stabilize, you move on,” he says. “But I kept asking myself—what happens to everything else while we’re responding?”

Malac awards exceptional fellow Steven Ndugwa Kabwama on February 2, 2017, at Kampala Serena Hotel; l-r: FETP Resident Advisor Bao Ping Zhu, Steven Wiersma, WHO Representative Mazila, and his host mentor Sheila Ndyanabangyi.
Malac awards exceptional fellow Steven Ndugwa Kabwama on February 2, 2017, at Kampala Serena Hotel; l-r: FETP Resident Advisor Bao Ping Zhu, Steven Wiersma, WHO Representative Mazila, and his host mentor Sheila Ndyanabangyi.

The arrival of COVID-19 made it impossible to delay these questions.

A Crisis Within the Crisis

As countries rushed to contain the virus, restrictions came swiftly: lockdowns, curfews, and travel bans. From a disease-control perspective, the logic was familiar and defensible. In outbreak management, 21 days is a standard epidemiological window, often used to break chains of transmission in infectious diseases. But during COVID-19 in Uganda, the phrase “thereforeanother 21 days of lockdown” took on a different meaning altogether: The repeated phrase in presidential addresses stretched from a technical containment tool into a lived reality that reshaped access to care, livelihoods, and movement. From a health-system perspective, the consequences were profound.

Kabwama joined a multi-country research effort spanning Uganda, Nigeria, the Democratic Republic of Congo, Senegal, and Ghana, examining how countries attempted to maintain essential health services while responding to COVID-19. This work was spearheaded by Dr. Rhoda Wanyenze, a Professor of Disease Control, Researcher, Public Health Expert, and Dean of the School of Public Health at Makerere University. She was then a member of the COVID-19 Scientific Advisory Committee to the Ministry of Health.

Kabwama volunteered to lead the objective of documenting these experiences, an area he quickly realized was underexplored.

“Criticism is always easier in hindsight,” he reflects. “But generally, the considerations about how restrictions would affect access to essential health services were made after the fact.”

His doctoral research, later defended at Karolinska Institutet, set out to answer a deceptively simple question: How can health systems minimize disruptions to essential services during public health emergencies while emerging stronger afterward?

Front-line workers on COVID-19 getting a debrief in Kampala.
Front-line workers on COVID-19 getting a debrief in Kampala.

What the Data Revealed

Kabwama examined how health service use changed before and during the pandemic by using a mix of interrupted time-series analysis, document reviews, key informant interviews, and focus group discussions.

The findings were sobering.

Facility deliveries and outpatient visits dropped sharply during lockdown periods. Routine childhood immunizations declined, and DPT3 doses fell by more than 4 percent, with similar reductions across polio vaccines. Movement restrictions, fear of infection, and overwhelmed facilities combined to keep patients away.

But the story did not end there.

Where systems were adapted by integrating services, leveraging community health workers, removing user fees, modifying logistics, and establishing coordination mechanisms for continuity of care, the declines softened. In some cases, the adaptations strengthened systems beyond their pre-pandemic state.

“These were not perfect solutions,” Kabwama notes. “But they showed us what flexibility, leadership, and trust can do under pressure.”

Kabwama presents his findings during his PhD thesis Defense.
Kabwama presents his findings during his PhD thesis Defense.

The Human Cost—and the Human Shield

Behind every data point were health workers navigating impossible conditions. Many worked without adequate protective gear. Others faced delayed allowances, long hours, and constant risk.

Kabwama asserts that health workers risk their lives in their work. “If we expect services to continue, then protecting their physical and mental well-being is not optional.”

His research consistently returned to one conclusion: that service continuity depends on people. Policies can guide. Infrastructure can support. But without motivated, protected health workers and trusted community intermediaries, systems falter.

Uganda’s community health workers, he observed, became a backbone of resilience. They traced contacts, delivered information, encouraged women to attend antenatal care, and helped sustain immunization demand when facilities felt distant or dangerous.

“In our context,” he says, “they were critical. That’s a lesson worth holding onto.”

Learning Across Borders

Conducting his PhD through a collaborative programme between Karolinska Institutet and Makerere University School of Public Health exposed Kabwama to how different systems responded under pressure.

At Karolinska’s Department of Global Public Health, students from around the world shared experiences shaped by culture, trust, and governance. One story stayed with him: Sri Lanka’s military, highly trusted by the public, played a key role in vaccine rollout.

“It taught me that resilience looks different everywhere,” he says. “What matters is understanding what each system already has and how trust operates within it.”

His supervision team, spanning Sweden and Uganda, including Prof. Tobias Alfvén, Prof. Rhoda K. Wanyenze, Dr. John Ssenkusu, Prof. Helena Lindgren, and Dr. Neda Razaz, reflected that same cross-system thinking.

Wanyenze describes Kabwama as “focused, committed, and remarkably productive.” She notes that he led two major workstreams across the five participating countries, helping generate critical evidence on health systems resilience and trust during infectious disease emergencies. “He made an enormous contribution to the research,” she says, “and he continues to do excellent work in this area.”

The Quiet Challenge of Doing Research in a Pandemic

Methodologically, the pandemic forced adaptation. Interviews moved to phones and Zoom. Access was negotiated carefully. Yet Kabwama sees the technology not as a limitation but as a strength.

“We captured experiences while they were still fresh,” he explains. “Before details were forgotten, before narratives were smoothed over.”

That immediacy gave his work an unusual clarity, documenting decisions as they unfolded, not as they were later remembered.

But beyond COVID-19, Kabwama’s thesis does not treat it as an anomaly. Rather, it presents COVID-19 as a stress test, exposing pre-existing weaknesses and potential strengths.

His central argument is that the ability to maintain essential health services during emergencies depends on baseline capacity.

“Now is the time,” he says, “to invest in health workers, in infrastructure, in guidelines for service continuity. This should be done now, not when the next crisis arises.

That conviction extends to learning itself. After-Action Reviews are conducted, lessons are noted, but too often, they fade.

“We need to be deliberate about learning,” he insists. “About documenting what worked and making sure those gains are not lost once the emergency ends.”

Work That Continues

Today, Kabwama is a Research Associate at Makerere University School of Public Health, a Monitoring, Evaluation and Learning Specialist with the Uganda Public Health Fellowship Program, and a member of WHO initiatives on trust and pandemic preparedness. He leads mortality surveillance in Uganda’s island districts, supports national NCD analyses, and continues to advise on emergency preparedness across Africa.

Kabwama admires his portrait on the Wall of Fame, which showcases a collection of portraits of doctoral students, a practice held since the 1950s.
Kabwama admires his portrait on the Wall of Fame, which showcases a collection of portraits of doctoral students, a practice held since the 1950s.

He remains, by his description, an optimist.

“There are people who think we are worse off now than before COVID-19,” he says. “In some ways, that’s true. But there are also many ways in which we are better prepared.”

Vaccines, data systems, community engagement, and global awareness have all shifted. The challenge is ensuring that momentum does not fade.

Dr. Steven Ndugwa Kabwama joins fellows in the MakSPH PhD forum who concluded their doctoral journeys in 2025. And the work of his research and scholarship does not promise certainty but offers something more useful: evidence that systems can bend without breaking—if they are prepared to learn, invest, and protect the people who hold them together.

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Davidson Ndyabahika

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Dr. Samalie Namukose and the Quiet Work of Making Nutrition Count

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Dr. Samalie Namukose.

Between Tuesday, February 24 and Friday, February 27, 2026, Freedom Square at Makerere University will fill with a familiar choreography of anticipation. The air will fill with the rustle of academic gowns, the nervous laughter of graduands, and the careful positioning of proud families searching for familiar faces in a sea of crimson, green, and black. It is a moment of ceremony, yes, but also of reckoning.

Up close, the doctoral gowns feel heavier than they look. The deep crimson fabric, warm and deliberate, settles on the shoulders. Green panels edged in gold are gently pressed against the chest. Wide sleeves gently brush against clasped hands, soft bonnets rest low on foreheads, and tassels remain motionless. Beneath the regalia are steady breaths, quickened heartbeats, and bodies carrying the quiet fatigue of years spent balancing work, study, and life. These are garments worn not only for display but also for endurance, stitched to nights without sleep, to questions carried long before they were answered.

At this four-day Makerere University’s 76th Graduation Ceremony, 185 doctoral degrees will be conferred. Each PhD will represent years of unanswered questions, interrupted sleep, financial strain, and relentless intellectual persistence. Among them will be Dr. Samalie Namukose, a woman whose academic journey was never separate from the health system she serves, only threaded through it.

For more than two decades, Samalie Namukose has worked inside Uganda’s Ministry of Health, rising steadily from Nutritionist to Assistant Commissioner for Health Services/Nutrition. She has helped write policy, coordinate national programs, supervise districts, respond to emergencies, and advocate for mothers and infants whose voices rarely travel beyond clinic walls. Her PhD did not pull her away from that world but plunged her deeper into it.

Dr. Namukose (R) with health workers in one of the facilities.
Dr. Namukose (R) with health workers in one of the facilities.

The Question That Would Not Let Go

Dr. Namukose’s doctoral journey began not in a library, but in a pattern she kept seeing and could no longer ignore.

Uganda’s nutrition policies are robust. They speak clearly about the importance of maternal and infant nutrition, especially in the first 1,000 days of life. Yet in health facilities across the country, nutrition services often appeared fragmented, present in principle, and inconsistent in practice. Mothers attending antenatal or postnatal care were weighed, yes, but not always counselled. Infants were measured, but follow-up was irregular. Nutrition existed, but it was not always integrated.

“I kept asking myself,” she recalls, “not whether nutrition interventions exist, but how well they are embedded in routine care, and what prevents health workers from delivering them consistently.”

That question shaped her PhD research at Makerere University’s School of Public Health, where she examined the integration of Nutrition Assessment, Counselling, and Support (NACS) into routine health services in the Tororo and Butaleja districts in Eastern Uganda.

At its core, NACS integration is deceptively simple: assess nutritional status at every health point, provide tailored counseling, and link clients to support within the same system and beyond. But in practice, it tests the very backbone of health systems: workforce capacity, financing, governance, supervision, and community linkages.

“When NACS is well integrated, health facilities can identify nutrition risks early, prevent deterioration, and provide timely support rather than responding only when malnutrition becomes severe,” she says.

Inside Resource-Constrained Health Facilities

What Dr. Namukose found was not a clear story of failure or success, but something in between. Many health facilities were offering basic nutrition education and assessments, and health workers were clearly trying their best. However, long patient queues, limited time, and a shortage of basic tools and job aids often hindered counseling and follow-up. Food demonstrations were rare. Growth monitoring was inconsistent. Efforts to improve quality occurred only sporadically.

In facilities without trained nutritionists, nurses, and midwives, already stretched thin, took on nutrition work alongside many other duties, leaving little room to support mothers and children in a steady, continuous way.

And yet, her findings revealed something deeply hopeful: “facilities with knowledgeable, motivated, and supported health workers delivered better nutrition services, even within the same constraints.” To Dr. Namukose, this showed that leadership, mentorship, and attitude mattered. Where nutrition was treated not as an extra task but as essential care, outcomes began to improve.

One of the strongest findings from Dr. Namukose’s research was that even when nutrition services were only partly integrated, they still made a visible difference. Mothers gained weight more steadily during pregnancy and in the early months of breastfeeding. Babies were born heavier and grew better in their first months of life. Across health facilities with more fully integrated nutrition services, children consistently showed healthier growth patterns.

These were not just numbers on a page; babies started life stronger, and mothers were better supported to care for them.

“To me,” she explains, “the improvements in maternal weight gain reflected the value of regular assessment and context-specific counseling. For infants, the better growth outcomes showed that a package of nutrition interventions, delivered consistently, can make a real difference during the most critical window of life.”

It was clear evidence that nutrition integration works effectively, though gradually and significantly.

The Fragility of Progress

Dr. Namukose’s research also exposed how fragile these gains remain. Weaknesses in financing and governance emerged as the greatest threats to sustainability. Nutrition services often depended on unpredictable partner funding rather than routine government budgets. Essential supplies, anthropometric tools, job aids, and therapeutic foods were frequently unavailable or externally dependent.

Her study captured glaring governance gaps that compounded the problem. For instance, nutrition was not always clearly positioned within accountability structures, and this, according to Dr. Namukose, often led to limited supervision and weak performance monitoring. Many districts lacked dedicated nutritionists altogether.

She notes that community follow-up was essential for sustaining behaviour change after clinic visits, especially for those who suffered most. Village Health Teams and care groups struggled without supervision, feedback mechanisms, or resources.

“Most nutrition-related behaviours, such as maternal diet, infant and young child feeding, and care practices, are shaped and sustained within households and communities,” says Dr. Namukose.

She contends that nutrition integration cannot rely on projects but must be embedded in systems.

A PhD Written in the Margins of Life

Conducting this research while holding a senior national leadership role in the Ministry of Health was, by her own admission, one of the hardest things she has ever done.

Dr. Namukose did not request study leave. Partly self-sponsored, she worked full days at the Ministry of Health, then wrote at night, often between midnight and 4:00 am, and again in the early mornings, on Saturdays, and on borrowed hours of Sunday.

“There were days when I sacrificed sleep completely,” she says quietly.

National emergencies such as COVID-19, Ebola, and MPOX repeatedly interrupted her doctoral journey, drawing her back into crisis response. To her, returning to her PhD after each interruption felt like re-entering a conversation mid-sentence, struggling to find the thread.

At one point, she simultaneously prepared for a Top Management Committee presentation, attended a doctoral committee meeting, and sat for Health Service Commission promotional interviews.

“The pressure from the supervisors kept me on my toes. The PhD forum was another motivating factor, consistently sharing updates, books, courses, encouragement, and invitations to PhD defenses. Peer support was tremendous. Without a supportive family, you can’t make it,” she remarks.

A Career That Prepared the Ground

Dr. Namukose’s PhD sits atop a formidable professional foundation. She holds Bachelor’s and Master’s degrees in Agriculture from Makerere University, a Postgraduate Diploma in Food and Nutrition Security from Wageningen University in the Netherlands, and a Postgraduate Diploma in Business Administration from Makerere University Business School. She has undergone extensive training in nutrition leadership, research methods, health systems, and quality improvement across Africa, Europe, and Asia.

Within the Ministry of Health, she has served as a Public Health Nutritionist, Senior Nutritionist, Principal Nutritionist, and now Assistant Commissioner, coordinating national nutrition interventions, designing training modules, mobilising resources, and overseeing district implementation.

She has played key roles in multi-million-dollar initiatives, from HIV-Free Survival programmes to Integrated Child Health Days, public food procurement policy, and the scale-up of Multiple Micronutrient Supplements (MMS) for pregnant women.

Her research has been published in leading peer-reviewed journals, including PLOS ONE and BMC Health, Population and Nutrition, ensuring that her findings speak both to policy and global evidence.

On a mission to keep research from gathering dust

Now a Doctor of Philosophy, Dr. Namukose has determined that her work will not sit quietly on a shelf. Her findings have already informed Uganda’s Health Sector Nutrition Strategic Plan, strengthening the case for financing, governance reform, and recruitment of skilled nutrition cadres. She continues to champion platforms, such as national nutrition symposia, that bring student research into policy dialogue and implementation spaces.

“Very often, excellent student research is left on the shelves. I plan to allocate some days during these symposia to nutrition students to showcase best practices and innovations,” she says.

Adding that, “I urge mothers and their infants to actively engage in self-care, growth-promotion, and monitoring activities to improve their own health and that of their children.”

Central to her recommendations is a call to embed nutrition services within routine health and community systems, with sustained government leadership, financing, and competent human resources.

Integration, she insists, is not achieved by guidelines alone, but through continuous engagement with frontline health workers and communities.

As graduation day approaches, Dr. Namukose’s thoughts turn outward. To frontline health workers delivering nutrition services under pressure, her message is one of respect and reassurance. Even with limited resources, the assessments they conduct, the counselling they provide, and the care they offer can change outcomes.

“Endeavor to participate in training programmes whenever available to bridge gaps in nutrition knowledge and skills, including on-the-job and rotational training to support cost-effective and efficient nutrition service delivery,” she asks.

To mothers and caregivers, she urges active engagement in self-care, growth monitoring, and nutrition programmes, especially those strengthened through digital innovation.

And to policymakers, her research offers both evidence and urgency that nutrition integration is no longer optional but foundational to maternal and child health.

Dr. Namukose (c) flanked by her supervisors, Associate Professor Suzanne Kiwanuka (L) and Dr. Wamuyu Gakenia Maina, in a cake-cutting ceremony shortly after her PhD defense on October 15, 2025.
Dr. Namukose (c) flanked by her supervisors, Associate Professor Suzanne Kiwanuka (L) and Dr. Wamuyu Gakenia Maina, in a cake-cutting ceremony shortly after her PhD defense on October 15, 2025.

When Dr. Samalie Namukose walks across the stage at Freedom Square, followed by applause, the true weight of that moment lies in health facilities where nutrition is no longer an afterthought. In mothers whose pregnancies are better supported. In infants whose growth curves bend upward, quietly, decisively.

Among the 185 PhDs conferred at Makerere University’s 76th graduation, the School of Public Health Communications Office shares her story, which is a reminder that the most transformative scholarship is not always loud. It builds patiently, between policy meetings and midnight writing, between emergencies and examiners’ comments, until it transforms systems and lives from within.

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Davidson Ndyabahika

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