The Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative on August 13, 2026 brought together stakeholders from five first-referral hospitals in Uganda to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care.

Funded by the Wellcome Trust through a 2023–2029 Discovery Award, AFRHiCARE is a partnership between Makerere University, the University of the Witwatersrand, the KEMRI-Wellcome Trust Research Programme and the University of Oxford. The initiative seeks to generate evidence to inform the future development of first-referral hospitals, with a focus on service delivery, health workforce dynamics, leadership, management, governance and technology.

In Uganda, the study is being implemented at Kawolo Hospital, St. Joseph’s Hospital Naggalama, Adjumani Hospital, Kiryandongo Hospital and Masindi Hospital. The hospitals play a critical role within the Primary Health Care (PHC) system, linking lower-level health facilities to higher-level referral services.

The stakeholder meeting provided an opportunity for the participating hospitals and other stakeholders to move beyond receiving research findings to interrogating the evidence, sharing experiences and identifying actions that can be implemented at hospital, district and national levels. This approach is central to AFRHiCARE, which uses stakeholder engagement to promote cross-learning and support hospitals to develop quality improvement actions.

Evidence from the health workforce

One of the key areas presented was the status of the health workforce across the five hospitals. The first-round assessment surveyed 609 frontline health workers. It examined staffing, job satisfaction and professional quality of life.

The findings show a significant staffing gap. Against the 2023 staffing norm of 343 staff, all five hospitals were operating at less than half of the recommended level. Masindi Hospital had the largest gap, operating at 37.6% of the norm, while Adjumani, Kiryandongo, Kawolo and Naggalama were at 48.1%, 48.7%, 44.9% and 44.6%, respectively.

However, the findings suggest that staff retention is relatively good in the public hospitals. The main challenge appears to be recruitment and filling vacant positions rather than widespread staff turnover.

Health workers identified promotion, workload and salary as the lowest-rated aspects of their jobs across the five hospitals. Overall job satisfaction ranged from 59% in Masindi to 71% in Naggalama.

Despite these challenges, the findings reveal strong commitment among health workers. Compassion satisfaction was high, with many reporting pride in their work. At the same time, workload emerged as a major concern.

Strong relationships among colleagues were also identified as a key strength, suggesting that teamwork and peer support remain important sources of resilience within the hospitals.

Strengthening hospitals within the health system

Speaking during the dissemination, Dr. Raymond Tweheyo, Co-Principal Investigator and Research Manager for AFRHiCARE Uganda, noted that first-referral hospitals have often been neglected in critical areas, including staffing, financing, infrastructure, leadership, management and governance.

He said these gaps affect hospitals’ ability to deliver services effectively and respond to the needs of the communities they serve.

Dr. Tweheyo re-echoed a message from the Principal Investigator, Professor Frederick Ssengooba, on the importance of situating the district hospital at the apex of the PHC network. This perspective recognises that challenges experienced at district hospitals may be linked to weaknesses elsewhere in the health system.

For example, weak referral systems, shortages of health workers and capacity challenges at lower-level facilities can increase pressure on first-referral hospitals. Addressing these problems therefore requires system-level solutions involving multiple actors.

The AFRHiCARE protocol similarly identifies persistent challenges around resource constraints, service delivery, workforce wellbeing, leadership and management, governance, technology and the ability of hospitals to meet changing community needs.

From research to action

Participants discussed priorities including filling critical staffing gaps, improving transparency and equity around promotion, addressing excessive workloads, strengthening referral systems and reducing the pressure created when patients bypass lower-level facilities. The meeting also considered which challenges can be addressed by hospitals and which require action from district authorities and the Ministry of Health.

The Makerere University School of Public Health (MakSPH) has formally transitioned leadership of the Department of Disease Control and Environmental Health, with Dr. David Musoke taking over from Dr. Esther Buregyeya, who served as Head of Department for more than nine years.

The handover marked both an appreciation of Dr. Buregyeya’s tenure and a renewed call for the Department to strengthen its position as a leading centre for Environmental Health, Occupational Health, Disease Control and Prevention.

Dr. Buregyeya, who took over the leadership of the Department in January 2017 and served until May 2026, described her tenure as a period of significant growth in teaching, research, community engagement and staff development. She emphasised that the achievements were a result of shared leadership and the collective efforts of Department members, School leadership and partners.

Among the key milestones during her tenure was the strengthening of the Department’s academic portfolio. The Department completed the review of the Bachelor of Environmental Health Science curriculum and supported the development of the Master’s programme in Environmental and Occupational Health. It also contributed to the development of the PhD by coursework and expanded online learning materials and short-course offerings, including training in Water, Sanitation and Hygiene and Occupational Health and Safety.

The Department also made progress in strengthening its laboratory capacity. With support from the School leadership, equipment was procured for the Environmental Health laboratory, which is currently based at Kasangati. The Department has also benefited from equipment donated through partnerships.

Another significant achievement highlighted during the handover was the development of human capacity. Several staff and research associates have pursued doctoral training, strengthening the Department’s pool of researchers and future academic leaders. Dr. Buregyeya noted that building this capacity was essential to ensuring continuity and preparing the next generation of faculty.

Dean commends leadership and mentorship

The Dean of MakSPH, Prof. Rhoda Wanyenze, commended Dr. Buregyeya for her leadership and credited the Department with developing a strong culture of mentorship and nurturing young professionals.

Prof. Wanyenze noted that although Disease Control is one of the School’s original departments, its membership has remained relatively young, with many emerging professionals being mentored and supported to grow within the School. She particularly applauded the Department for attracting and retaining talented Environmental Health graduates and for creating opportunities for research associates to contribute to the School’s work.

She also welcomed the establishment of the Master’s programme in Environmental Health, describing Environmental Health as an important frontier for public health. She challenged the Department to consider developing a PhD pathway in Environmental Health and to build a coordinated research agenda examining the links between the environment, infectious diseases, non-communicable diseases and broader health systems.

Prof. Wanyenze further called for greater investment in Occupational Health, noting the importance of workplace health, mental health, physical health and occupational safety, particularly as Uganda’s informal sector continues to grow. She also urged the Department to strengthen entomology and related research in vector-borne diseases.

A new chapter under Associate Professor David Musoke

Receiving the responsibility, Associate Professor David Musoke described his appointment as both an honour and a homecoming. He completed his Bachelor’s degree in Environmental Health at Makerere and later worked in the Department of Health Policy, Planning and Management before returning to Disease Control, where he has spent much of his professional career.

Assoc. Prof. Musoke paid tribute to Dr. Buregyeya, whom he described as a mentor and an example of shared leadership. He noted that during her tenure, the Department had grown from having a single undergraduate programme to developing a Master’s programme, contributing to PhD training and expanding its research portfolio into new and emerging areas. He also recognised the growth of early-career researchers, many of whom have progressed through doctoral training and into academic roles.

He pledged to build on these achievements while working closely with Department members, the Dean and other School departments. He also acknowledged the confidence placed in him by colleagues during the selection process and committed to working collectively to advance the Department.

A call to define the Department’s future

While celebrating the Department’s achievements, Prof. Wanyenze challenged the new leadership to develop a clear strategic agenda that distinguishes and strengthens the Department’s areas of expertise.

Prof. Wanyenze urged the Department to take forward the urban health agenda, particularly in light of Uganda’s rapid urbanisation and the emerging challenges associated with waste management, environmental health and the delivery of preventive health services in urban settings.

She further called for deliberate investment in people, infrastructure, research and partnerships. In particular, she encouraged the Department to use the new School infrastructure to develop a laboratory and to strategically support PhD training in areas where expertise is currently limited.

“You don’t have to carry this burden alone. There are people who can support the growth of the department,” Prof. Wanyenze said in encouraging the new leadership to build on the expertise already within the Department.

The handover concluded with the formal transfer of responsibility, followed by a presentation to Dr. Buregyeya in appreciation of her service and a cake-cutting ceremony bringing together the outgoing and incoming Heads of Department and members of the Department.

The Makerere University-Behavioral and Social Science Research (Mak-BSSR) in HIV Training Program, in partnership with the University of California, San Francisco (UCSF), invites applications for Post-doctoral, PhD, Master’s and Fellowship-level training opportunities in Behavioral and Social Sciences Research (BSSR) with a focus on HIV.

This is a five-year research training program on the HIV cascade, funded by the Fogarty International Center (FIC) of the National Institutes of Health (NIH).

Research priority areas for the training opportunities are; 1) Intersectional stigma, 2) Alcohol/substance use; 3) Mental health (psychosocial health), 4) Limited social support, social isolation and loneliness and impact on HIV outcomes, and 5) Ageism and HIV.

Please see downloads for detailed information.

Apply Before: Monday, 31^st August, 2026 at 6:00PM EAT.