Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district has appealed to Ugandan legislators to support efforts of community health workers (CHWs)/VHTs through appropriating some remuneration for them.
Hajat Nabitaka said she has moved the entire Mukono District during the COVID-19 pandemic period and throughout the taskforces and has since appreciated the great role played by CHWs.
“We thank you so much, you are the frontline soldiers. Because you do sensitize our people in the communities and you are always there throughout. If those in parliament could know what you do, they would speak passionately for you to receive some kind of salary,” said Hajat Nabitaka.
She was speaking at a dissemination workshop for Makerere University School of Public Health’s Cardiovascular Disease prevention program under the SPICES project held on December 8th 2021 at Colline Hotel in Mukono district.
“Sincerely speaking, we have many people who receive a lot of money, yet their out-put is minimal as compared to the work done by VHTs. I am appealing to the Commissioner [NCDs], researchers to advocate for renumeration for VHTs. I think this catchment area of the VHTs is the best. They are the ones who can solve some of the social problems affecting majority of families. Kindly think about the VHTs, keep up training the VHTs and speak for them,” she added.
Hajat Fatuma Ndisaba Nabitaka, the Resident District Commissioner for Mukono district.
Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health says currently, the VHTs are working under non-monetary motivation scheme.
“They have been working and we are discussing their small allowance in the Ministry. The problem is that the numbers are so big. Even when you give them small allowances the budget becomes so big,” Dr. Mutungi observes.
Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health
He further advances that; “But to tell you the truth, the discussion is in the Ministry. I don’t know how it will end but this adds on the evidence that they are so useful and that they need to be motivated.”
The SPICES project Principal Investigator Dr. Geofrey Musinguzi says the study has proven that if well trained, community health workers (CHWs/VHTs) have potential to deliver messages on prevention and control of cardiovascular diseases as well as enhance awareness amongst the various risk factors that raise cardiovascular diseases.
Through VHTs, the SPICES project reached a total of 10,936 people in households in 80 randomly selected villages in Mukono and Buikwe. Dr. Musinguzi contends that, trained VHTs that are trusted in communities are a gateway to increased community knowledge about CVDs and participation.
SPICES project Principal Investigator Dr. Geofrey Musinguzi
“As you observed, out of the many people the y [VHTs] visited, only 1% rejected them in their households. So, 99% were receiving them. So, to us we really think that is one resource that is available. If supported, they can actually deliver more in prevention of cardiovascular diseases,” said Dr. Musinguzi.
Under community intervention model of the SPICES project, Dr. Musinguzi notes that the key enablers of implementing the program is the availability of committed and motivated VHTs, receptive communities, supporting local and religious leaders as well as social gatherings and infrastructure like SACCOs, worship places, local infrastructure such as radios, public address system for health education.
Despite the unprecedented times brought by COVID-19 community health workers with support from SPICES project reached out a number of households in the project area in respect to CVDs. The project sensitized and empowered community health workers and health workers on COVID-19 prevention and subsequently equipped with tools such as facemasks, sanitizers, temperature monitors and standard operating procedures.
“Community Health Workers are largely motivated and over two years working with them, we have actually seen them do a lot of work, deliver these interventions. They have also reached quite a number of people in the households. COVID was a problem in reaching out those places but amidst that challenge, we moved to the community members,” contends Dr. Musinguzi.
Sarah Nalweyiso, a Village Health Team Member in Buikwe District says they (community health workers) received training in September 2020 under the SPICES project on how to continue with the work amidst the pandemic challenges.
“We received gumboots, notebooks, pens, sanitizers and masks,” says Nalweyiso.
The SPICES project Principal Investigator Dr. Geofrey Musinguzi alongside Dr. Gerald Mutungi, assistant Commissioner Health Services- Non-Communicable Diseases (NCDs) department at the Ministry of Health hands certificates to Community Health Workers at a dissemination workshop held on December 8th 2021 at Colline Hotel in Mukono district.
She adds that they trained community members about behavior change and highlighting dangers of excessive consumption of alcohol, benefits of exercising, reducing consumption of cooking oils as well as eating fruits and vegetables.
“When we finished the training, we came back to our villages and started examining people using the risk factor assessment tools to evaluate the risk of cardiovascular disease.”
Esther Namaganda, another VHT member from Buikwe district says; “We moved around our communities mainly to screen the members for risk factors of cardiovascular diseases.”
The poor health seeking behavior was one of the highlighted contributors to delayed presentation to health facilities with cardiovascular diseases.
Dr. Isaac Ssinabulya, Cardiologist at the Uganda Heart Institute -UHI thanked SPICES Project on the great work it has done.
“We conducted research, myself and Dr. Mutungi on non-communicable diseases and established that the highest percentage of the most affected people are in communities, nearly 60%. We only see fewer people in hospitals,” Dr. Ssinabulya.
He adds that there are many people who flock UHI from farther places in this country coming for treatment and end up spending a lot of money, yet the diseases can be prevented.
Dr. Ssinabulya hailed the Community Health Workers for their support in ensuring people are empowered and are able to be screened early enough in order to mitigate the risks associated to advanced treatment of CVDs which include high cost of treatment as well as loss of life.
Pressure is one of the highly prevalent diseases in Mukono and Buikwe at 24%. “This high number requires to ensure that whoever visits our health facilities is screened and are counseled towards keeping healthy lifestyles. Let us work together to reduce the queues of people coming for treatment,” says Dr. Ssinabulya.
Dr Josephine Birungi, a Senior Research Scientist based at Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) in Entebbe underscored the role of VHTs and noted that their work and contribution can be sustained through continuous engagement and training.
Dr Josephine Birungi Research Scientist based at Medical Research Council/Uganda Virus Research Institute (MRC/UVRI) and Dr. Isaac Ssinabulya, Cardiologist at the Uganda Heart Institute -UHI
She commended the VHTs on the good work. “We need to deploy family-centered-approach to educate the masses about these challenges such as NCDs. It will help efforts by SPICES project to continue. For instance if I knew my husband has diabetes, I will not put a lot of salt in food. But if I don’t know, we shall not make a change.”
She tipped both health workers and the Ministry of Health on continuous capacity building as well as sensitization of the masses.
“We need to sensitize the masses. We should reciprocate the attention we give to HIV/AIDs to NCDs. I appeal to all of you to support sensitization of our communities not only about heart diseases but also on other diseases such as HIV/AIDs among others,” Dr. Birungi.
The first day of the case-finding activity began with an orientation session at the Emergency Operations Center (EOC) offices at the Ministry of Health (MoH). The briefing was led by Dr. Wenani Daniel, Lubwaama Bernard, and Mr. Daniel Kadobera, who provided an overview of the current status of the Ebola Virus Disease (EVD) outbreak caused by Sudan ebolavirus (SEBV) in central Uganda. A key focus of the session was adherence to strict infection prevention and control (IPC) measures including maintaining a safe distance, avoiding direct contact, refraining from entering homes, and not eating or drinking in the field.
To enhance efficiency, the team was divided into three groups, ensuring that each group included at least one clinician for proper assessment of inpatient department (IPD) registers and patient files. The groups were then deployed to their respective sites: Saidinah Abubakar Islamic Hospital, Mulago National Referral Hospital, and a buffer zone within a 2km radius around Saidinah Hospital.
The African Field Epidemiology Network (AFENET) is a not-for-profit networking and service alliance of FE(L)TPs, and other applied epidemiology training programs in Africa. Makerere University School of Public Health (MakSPH) is one of four founder members of the network that has since grown to 40 members spanning Anglophone, Francophone, and Lusophone Africa.
On Tuesday January 14, 2025, under the radiant rays of the Ugandan sun, Laura Silovsky crossed the stage at Makerere University’s 75th Graduation Ceremony to receive her master’s degree in Public Health Disaster Management (MDM). Hers is a story of passion, dedication, and curiosity to rewrite the narrative of global education. Among 1,813 master’s graduates, Laura’s story stood out, as a blend of refugee roots, firefighting bravery, and a drive to decolonize learning.
Laura’s journey began long before her arrival in Kampala. Born in the UK to a father who fled from Czechoslovakia’s dictatorship in the 1970s, she grew up understanding displacement intimately. “My father was a refugee. Why would I fear refugees?” she once asked during her research fieldwork in Uganda’s West Nile, where her empathy bridged divides.
“People in Uganda may not expect that a muzungu could be the child of a refugee, but my family experienced displacement from (what was then) Czechoslovakia as well as the effects of the protracted conflict in Northern Ireland. Fortunate to have been born in the UK, I was raised to appreciate that disasters can affect anyone, anywhere, anytime.
After studying Sustainable Development at the University of Edinburgh, I worked on a behavior change project tackling non-communicable diseases in Scotland,” Laura says.
Laura Silovsky outside MakSPH on graduation day.
Her journey twisted through battling Australia’s bushfires and volunteering in a COVID pandemic, but it was Uganda’s welcoming refugee policies and Makerere University’s academic excellence that pulled her in next.
“In 2020, I relocated to Australia, just after the worst bushfires since records began and before the COVID-19 pandemic. The following two years, I qualified as a firefighter and supported bushfire recovery by volunteering with a community-based organization. After gaining some insight into these different disasters, I made the decision to return to higher education, and so I applied for the MDM programme at Makerere in 2022,” says Laura.
Armed with experience in emergency response, Laura was drawn to the field’s multidisciplinary nature and was convinced she needed to expand her expertise beyond immediate recovery efforts. She aimed to explore the full disaster management cycle and the intricate connection between health and environment.
“I needed to combine gaining academic knowledge with developing practical skills, so the field placement offered within the master’s degree in Public Health Disaster Management programme was a major motivator for me,” she shared.
The love for Uganda
Studying at the University of Edinburgh, Laura took a class in Kiswahili, that included a field-based short course on the Tanzanian shores of Lake Victoria. This experience sparked a desire to spend more time in the region, but she knew she needed to expand her skill set in order to genuinely add value to an organisation, if she was on the continent.
“I hoped studying at an East African university would teach me invaluable soft skills needed to work more effectively as an international team member. Makerere University School of Public Health (MakSPH) has a strong reputation, and I wanted to study somewhere that was locally grounded but globally recognized. Uganda’s progressive refugee policies were an added incentive to learn from experts here,” Laura says.
Laura’s intentional choice to decolonize her education
“I came to Uganda to learn from the experts here,” Laura declared, rejecting Eurocentric frameworks. “A big factor for me wanting to study at Makerere University was to decolonize my education, to recognize that the knowledge about responding to public health disasters and supporting refugees is here in Uganda,” she says.
She adds, “When I first arrived, I was quite vocal with my classmates about wanting to challenge that bias and truly acknowledge the wealth of knowledge within institutions like Makerere. The expertise here is invaluable, and I was intentional about decolonizing my education.”
Laura Silovsky with some of the 2022 MDM cohort outside MakSPH building after an exam.
At MakSPH, Laura immersed herself in courses like epidemiology, struggled briefly with statistics, but thrived on critical discussion groups and consultation with lecturers.
Collaborating with classmates from Uganda and across East Africa, she learned Luganda phrases and Somali proverbs, and built a “family” united by late-night study sessions and shared ambitions.
Beyond expectations
For Laura, studying at MakSPH was the best decision she could have made. She is still struck by the faculties’ wealth of academic and professional experience in public health and disaster management.
“I anticipated the programme would focus on applying the knowledge we gain to real-world scenarios. Of course, there were cultural differences that took me time to adjust to. I am grateful to faculty members such as Prof. Christopher Garimoi Orach, for his dedication and support, Prof. Elizeus Rutembemberwa for leading by example and valuing students’ time, and Dr. Justine Bukenya and Dr. Simon Kibira for offering their extensive support as my dissertation supervisors.”
The Fieldwork Attachment that Transformed Laura’s Research Experience
At Rhino Camp refugee settlement in West Nile, Laura’s work took on new meaning. Partnering with the Uganda Red Cross Society, she helped digitize data tools and walked long distances through Tika Zone, inspecting latrines and speaking with South Sudanese girls about their challenges in managing their menstrual health through their project that focused on schools.
Laura Silovsky conducting focus group discussions in a school in Rhino Camp in Northern Uganda with a team from the Uganda Red Cross Society.
“That experience in West Nile influenced my own research ideas, and it was a privilege to later return to Rhino Camp for data collection. I will always remember the long days walking with my research assistants through villages and being graciously welcomed by so many respondents,” she recalls, noting that the experiences crystallized her resolve to advocate for refugee dignity globally.
Life in Kampala
Life in Kampala, with its vibrant energy and unique challenges, was truly a ‘full sensory experience’ for Laura. “My parents live in a small village, so Edinburgh felt like a big city when I moved there. And Edinburgh is much smaller and quieter than Kampala! But on weekends, I loved going downtown to shop at Owino Market or heading to Kyadondo Rugby Club for some pork.”
These spaces were perfect for Laura, offering new cultural experiences, including matooke, a starchy dish not found in the UK, which is mainly eaten in Uganda as a local delicacy and staple meal. Despite the differences in culture, sharing meals with classmates provided Laura with a comforting sense of connection.
Back to academics, navigating the university administrative processes wasn’t seamless initially for Laura, though. She says administrative hurdles such as paper-based systems, could change for the university to comfortably enjoy its strong reputation.
She recalls, right at the beginning, when she couldn’t find sufficient information online to support her to complete her application to join Makerere University. However, she later received support from the University’s International Office that deals with the welfare of international students.
Other university officials, from finance, librarians, program administrators, to academic registrars, played a key role in supporting her in her research and postgraduate training. “The system relies on dedicated individuals,” she noted, calling for digital reforms while praising MakSPH’s “atmosphere of innovation.”
“From my experience, such as when obtaining my transcript, the system relies heavily on individual staff members working around these administrative challenges. I’m grateful for those who helped me navigate this, and I’m interested to see how the university continues its digital transition, as it could greatly streamline processes in the future,” says Laura.
A Bittersweet Graduation Day
On graduation day, Laura’s pride mingled with melancholy. Watching families cheer on graduates, she reflected on classmates sidelined by finances or family crises.
Having gone through the course and interacted with Ugandan students, Laura hints on the common financial and personal challenges preventing many from graduating: family illness, new children, sponsorship falling through.
“I know so many of my classmates had worked so hard and were almost over the finish line but, due to financial challenges or other commitments at home, it wasn’t possible for them to graduate this year,” she says.
“For me, I was able to make the choice to pursue this program before having children, so I had fewer responsibilities at home, and I had also been saving for many years to get the money to pay tuition. Because I knew I had the money for tuition before I started, I could focus on studying. As you know, the reality for many people is that that’s not always possible.
“Small supports can transform student experiences,” Laura emphasized, advocating for systemic empathy. She sees great potential for more pastoral support at the university, citing peers from UCU and Kyambogo who benefited from accommodations like private breastfeeding spaces and flexible deadlines in special circumstances. Such initiatives, alongside financial aid, could significantly improve student welfare.
Still, the ceremony’s electric energy—watched via livestream by her parents in Europe—symbolized hope. “Uganda taught me that collaboration transcends borders,” she reflected.
Laura Silovsky (Right) at the graduation ceremony alongside fellow graduands Juma Said Tusubila and Ssali Abdallah Yahya.
“You could feel this sense of how hard everyone had worked to reach up to that point and that this was really an opportunity for them to celebrate, particularly by having family and friends around to be able to see. I love the PhD awards, when you see the PhD students coming out and their families rushing up to greet them. To me, that’s the best part of the ceremony, because a PhD requires so much work and commitment, and I think it’s really emotional to see everyone share this moment with their support networks,” she says.
Adding that; “…I was so grateful that the ceremony was streamed online. My family were watching live at home in Europe and it was so special that they could see me on camera and participate in the ceremony that way as well.”
Laura noted striking similarities between Makerere and Edinburgh’s ceremonies, especially the moment when students were asked to turn and thank their families, an emotional and powerful tradition.
Looking Ahead
Now in Tanzania, Laura eyes roles with international NGOs, armed with Ugandan-taught pragmatism and a zeal to challenge Europe’s refugee policies. “MakSPH gifted me more than a degree—it reshaped my worldview,” she says.
“As a muzungu with a Ugandan postgraduate education, I feel privileged to have benefitted from different educational perspectives, and I hope that the skills and knowledge I acquired during my time at Makerere will help me to secure a role with an international NGO. After witnessing the incredible support that Uganda provides to refugees, I also hope to advocate for more dignified policies concerning refugees in Europe,” she shares.
“There’s a spirit of innovation and dedication at Makerere, particularly when passionate lecturers like Prof. Orach, Dr. Roy Mayega, or Dr. Victoria Nankabirwa engaged students through discussion and sharing lived experiences. You could really see a different level of engagement within the students as well. Overall, I’ve had such a fantastic experience at Makerere University.”
“I wouldn’t change a thing,” she smiles.“Except maybe convince more Europeans to study here. Africa’s wisdom is the future.”
We are happy to share this exciting PhD studentship opportunity through the NTU-Makerere University partnership under the theme Health Innovation. Starting in 2025, this project will focus on One Health drivers of antibiotic-resistant bacterial infections in rural Ugandan communities.
The research will combine microbiological and public health approaches to explore the prevalence, transmission, and contributing factors of antibiotic-resistant bacteria in these communities. Key research questions include:
What human, animal, and environmental factors contribute to the spread of antibiotic-resistant bacteria?
How can Community Health Workers (CHWs) help mitigate their spread?
Requirements:
Essential: Willingness to spend time in both Uganda and the UK during the project and proficiency in Luganda.