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AFREhealth Competitive Funding Award call 2022-1

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Supporting Health Professions Interprofessional Research and Education for AFREhealth Member Institutions, Using Funds from NIH Grant R25TW011217-3

Background:

Starting 2018, The infectious Diseases Institute (IDI) at Makerere University received an NIH grant R25TW011217-3 to support the development of an African Forum for Research and Education (AFREhealth) whose secretariat was established at the Kwame Nkrumah University of Science and Technology in Ghana. AFREhealth continues to strengthen health professions’ research and education in Africa while impacting people’s lives.

Request for Applications:

The AFREhealth Secretariat invites competitive applications from African universities to undertake innovative priority research, training, and education programs which include the development of evidence-based guidance documents in health professions education and research relevant to the African context. Applications that involve more than two AFREhealth universities will be prioritized. The funding awards are for a project period not exceeding twelve months at the end of which there should be demonstrable products including at least one submitted manuscript to a peer-reviewed journal that acknowledges the funding support. Satisfactory accountability of funds endorsed by one’s parent institution is an absolute requirement after completion of the project. For this round, up to 20 competitive applications may be awarded.

Application Due Date: April 29, 2022, at 12.00 midnight GMT

Inquiries

Please address questions and inquiries to the AFREhealth Secretariat at awards@afrehealth.org

Click here to view the detailed call.

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Infrastructure Expansion for MakSPH, Vital for Uganda’s Public Health System – Prof. David Peters

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Ambassador of the Netherlands to Uganda H.E Dr. Karin Boven alongside the Makerere University leadership at the launch of the Auditorium, phase 1A of the construction on 15th March 2024. Main Campus, Makerere University, Kampala Uganda, East Africa.

Kampala— Professor David Peters, Dean of the Faculty of Health at York University, Canada, has hailed Makerere University School of Public Health (MakSPH) as a global leader and a cornerstone of Uganda’s public health system. He emphasized the school’s vital role during the launch of its new state-of-the-art auditorium on March 15, 2024, part of its ambitious expansion plans to bolster Public Health capacity, training, research, and service across Africa.

Drawing from extensive experience in global health systems, Professor Peters emphasized the critical role of Makerere University in driving forward public health initiatives in the region.

The ambitious MakSPH new home building construction broke ground on 28th February, 2020. The project that seeks to address the increasing demand for public health education and research, with an estimated cost of $10 million USD.

While making a case for the building, the Netherlands Ambassador to Uganda then, Henk Jan Bakker, announced the Dutch contribution to a tune of $420,000 through the Hague based Dutch organisation for internationalisation in education Nuffic and through the SET-SRHR project at Makerere University. This contribution was channeled to towards the construction of a state-of-the-art Auditorium, which is part of building design.  Infrastructure forms the foundation of a healthy community and indeed as noted by Ambassador Henk, “Public Health is not only Uganda’s concern but also a global epidemic thus worth investing in.”

“I want to say how grateful I am to have been able to work with colleagues at Makerere University for now over two decades,” said Professor Peters.

Professor David Peters, YorkU Health photo
Professor David Peters, YorkU Health photo

Adding that; “The School of Public Health is responsible for educating and training critically needed public health workers for conducting critical science-based research that really addresses the origins of public health problems as well as for the prevention and intervention for diseases and disabilities and because it strengthens the practice of public health through knowledge translation.”

Professor Peters highlights the School of Public Health’s critical role in addressing historical and current public health challenges, including population growth, urbanization, inequity, justice, commercial influence, climate effects, and technological changes.

“And this is huge cost to the population, whether it be a maternal child, chronic diseases or aging, but also on epidemics and the costs, literally the catastrophic costs of health spending,” he said.

For Prof. Peter, while ideas on medicine and disease have really spread across countries and regions for millennia, efforts at public health and global level are really relatively recent from the last few centuries.

In the 19th century, historical concerns revolved around epidemics, famine, and conflict, closely linked to trade and environmental disruptions impacting industry and agriculture. This prompted nations to collaborate in safeguarding trade and preventing disease spread, laying the groundwork for international health regulations and the establishment of the World Health Organization (WHO).

Global public health education emerged from these efforts, rooted in scientific advancements like the germ theory and influenced by colonialism. Global health initiatives aimed to address health issues in other populations, with the Rockefeller Foundation playing a significant role in supporting and establishing schools of public health. The first, Johns Hopkins, founded in 1916, paved the way for numerous others worldwide, totaling around 35 new schools of public health, alongside several medical schools.

In modern global health, scientific advancements applied in resource-limited settings have saved countless lives. However, Professor Peters contends that this focus on biomedicine and technology, while successful in tackling specific health issues, often neglects broader local health system challenges.

Works on the main entrance for the main block for the new building taking shape with slab works on top. This section will act as a reception area and host a lobby. Main Camupus, Makerere University, Kampala Uganda, East Africa.
Works on the main entrance for the main block for the new building taking shape with slab works on top. This section will act as a reception area and host a lobby.

He further notes that vertical and horizontal approaches, though effective at times, fail to address the comprehensive needs of communities and systems. Additionally, the dominance of Western institutions in global health perpetuates a crisis-driven mentality, prioritizing quick wins over sustainable, community-centered strategies.

This approach, exemplified during crises like the Ebola outbreak in West Africa, sidelines long-term planning and neglects social determinants of health.

Dr. Peters, also the former senior public health specialist with the World Bank argues that while science drives progress, it comes at the expense of sustainability, coherence, and holistic health approaches, favoring curative care over prevention, a perception he believes needs to change.

Looking ahead in global public health education, Professor Peters acknowledges Makerere University‘s leadership in this field and its ongoing commitment. He highlights the university’s efforts to tailor institutional design and curriculum to local needs, particularly evident in the Master of Public Health program at Makerere School of Public Health, including distance learning options.

Emphasizing the need for innovative teaching methods, such as active learning and interdisciplinary approaches, Professor Peters stresses the importance of practical experience and IT integration.

Renowned for his collaborative efforts in advancing health policy and systems research, implementation science, and enhancing institutional capacity in health systems, Professor Peters advocates for professionalism grounded in competencies. He champions collaboration among health and education stakeholders, policymakers, communities, professional organizations, and academia to drive the evolution of global public health education.

“You need to be socially relevant, coherent and accountable. This does mean that physical infrastructure is needed. Our twinning operation between Makerere and Uganda. We need the buildings for teaching, community convening and group work, but also for research wet labs, specimen storage, computing, for use of big data and for the IT infrastructure,” said Prof. Peters.  

Learning between collaboration across institutions and linking global to local is really critical. He contends that Makerere School of Public Health is an essential to the public health system and a leader in this as well.

An overhead shot of works on the main entrance for the main block for the new building taking shape with slab works on top. This section will act as a reception area and host a lobby. Main Campus, Makerere University, Kampala Uganda, East Africa.
An overhead shot of works on the main entrance for the main block for the new building taking shape with slab works on top. This section will act as a reception area and host a lobby.

Taking inspiration from a program at the College of Health Sciences, funded by the Bill and Melinda Gates Foundation, which aimed to enhance all health schools at Johns Hopkins and Makerere University, Professor Peters emphasizes the broader scope of the initiative beyond mere technological advancements.

Dubbed the “grander challenge,” the project focused on institution-building, innovation, and human resource development for sustainable healthcare delivery. Makerere University seeks to be a transformative institution, fostering academic excellence and innovation while driving positive health outcomes in Uganda and the broader East Africa region.

“See the Makerere School of Public Health as transformational and being able to develop and generate knowledge, develop capabilities at individual levels as well as the leadership and organizational levels to model best practices and to support organizations and to develop partnerships to stimulate change,” he says.

He notes that there is a strong investment case for infrastructure at Makerere University. “It provides education training, it conducts research, it strengthens practice. If you see it as an essential part of infrastructure, here’s something that colleagues in North America put together around, this is around the National Academy of Sciences saying that ‘investment in schools of public health should be seen as analogous to government support for public goods like national defense and transportation infrastructure. It is that important.’”

According to Professor Peters, a global review found similar things how what they do in terms of education and research but also towards sustainable development goals and what it does globally. And that you need funding, human resources, agency, collaborations, and infrastructure in being able to do that.

“We need your time, your talent and your treasure to be able to contribute to Makerere School of Public Health. I want to thank you and to finally say that Makerere School of Public Health needs you, but we all need Makerere School of Public Health,” Professor David Peters.

An aerial view of the new MakSPH building taking shape with slab works on top. Main Campus, Makerere University, Kampala Uganda, East Africa.
An aerial view of the new MakSPH building taking shape with slab works on top.

In 2021, the USAID ASHA Program awarded $1.1 million to create an augmented reality solution for Makerere University‘s new School of Public Health. Partnering with Johns Hopkins University under the leadership of Prof. David Peters, this funding aims to launch the Makerere University Centre of Excellence for Global Health.

Since 2000, Johns Hopkins has engaged in 48 collaborative research and training projects valued at over $6 million, spanning various fields such as doctoral training, medical education, laboratory training, and health systems development, including projects like the Asha Grant.

Caitlin Kennedy, a Professor of International Health, Social, and Behavioral Interventions at Johns Hopkins, expressed excitement about the university’s involvement in the building collaboration and eagerly anticipates exploring the new space and further nurturing partnerships cultivated over the years.

“I would like to send a sincere thanks to the Asha Grant and USAID for the amazing financial support. I hope others will see projects like this, and be inspired to provide more funding for public health infrastructure,” said Prof. Caitlin.

Caitlin Kennedy extends gratitude to everyone involved in bringing the building to shape, from the visionaries to the diligent planners and builders. She also thanks the faculty, staff, and students who will transform it into a vibrant learning environment.

“We at Johns Hopkins are really looking forward to continuing to do great public health collaborations with you in that space for many years to come. Thank you so much. Everyone and congratulations enjoy the space.”

Caitlin Kennedy, Professor of International Health, Social, and Behavioral Interventions at Johns Hopkins.
Caitlin Kennedy, Professor of International Health, Social, and Behavioral Interventions at Johns Hopkins.

Funds raised so far

Currently, we’ve raised a total of $4,804,314, but we still face a deficit of $5,195,686 for the construction. We’re grateful for contributions from various sources: MakSPH Staff Community ($46,043), MakSPH Departments ($144,972), Private Institutions/Companies ($52,528), Other Individuals ($131,949), and a generous donation of $675,000 from Makerere University. Additionally, MakSPH has committed $2,133,822 from internally generated funds, while the Rockefeller Foundation contributed $100,000 towards furnishing the auditorium. Your support is crucial in making a meaningful impact and driving transformation. Join us on this journey by contributing through https://sph.mak.ac.ug/givedonate.

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First-Ever Harmonized Health Facility Assessment by MakSPH and MoH Reveals Improvements in Uganda’s Overall Health Services

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The Minister of Health-Hon. Dr. Jane Ruth Aceng Ocero (Right) shakes hands with Prof. Christopher Garimoi Orach during the launch event on 12th March 2024. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.

By Julius Tukacungurwa & Davidson Ndyabahika

The first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by MakSPH and the Ministry of Health (MoH) has illuminated significant advancements in Uganda’s healthcare landscape. This ground-breaking survey, which serves as a robust benchmark for evaluating health services across the country, offers a comprehensive overview of service availability and readiness within Ugandan health facilities. 

The HHFA, a successor to the esteemed Service Availability and Readiness Assessment (SARA) tool endorsed by the WHO, probes into four critical modules: service availability, service readiness, quality of care and safety, and management and finance. 

Focusing initially on service availability and readiness, the HHFA embarked on a cross-sectional analysis of 642 facilities in April 2022, spanning National Referral Hospitals (NRHs), Regional Referral Hospitals (RRHs), General Hospitals (GHs), primary healthcare facilities at levels II, III, and IV.

The findings, while highlighting disparities in service availability and facility capacity across different healthcare sectors, underscore a promising trajectory towards enhancing overall health services nationwide.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH), led the team that conducted the survey. He presented the report which was subsequently launched by Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero on Tuesday 12th.March.2024 during the 10th Annual National Health Care Quality Improvement Conference at Imperial Resort Beach Hotel, Entebbe.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe.

The findings of the HHFA report indicate that Reproductive Maternal Newborn Care and Adolescent Health (RMNACH) services were available in most health care facilities across the country. In Uganda, healthcare facilities offer a wide range of essential services, including pediatric care, antenatal and postnatal care, malaria prevention during pregnancy, and newborn care, with over 95% providing these services according to the report. Findings also show that continuous antenatal care is available in about 79% of facilities, while skilled delivery services are offered in 89%. Additionally, family planning, emergency obstetric care, immunization, and adolescent health services are widely accessible, with percentages ranging from 77% to 91%.

During the launch event, Dr. Aceng underscored the significant steps made by the health sector in meeting crucial performance benchmarks. These include a notable 47% reduction in Maternal Mortality between 2016 and 2022, a commendable 12% decrease in Under 5 Mortality over the same period, and a promising 7% decline in Infant Mortality rates as highlighted in the Uganda Demographic Survey (UDHS) Report 2022.

“As you might know, overall, the health sector has made good progress towards achieving the key performance indicator targets. I wish to appreciate each one of you for the job well done,” said Dr. Aceng. 

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024.

Adding that; “The Ministry of Health continues to make big investments in the national health system. Mulago National Referral Hospital, Mulago Specialised Women and Neonatal Hospital, and several Regional Referral Hospitals have received infrastructure development including installation of modern medical equipment.

There is also deliberate effort to improve access to health service, delivery to the community through purposeful upgrade of some HC IIs to corresponding equipping and general review of the human resource requirements in the health sector. There is also deliberate effort to improve access to health services, delivery to the community through purposeful upgrade of some HC lIs to HC Ills with corresponding equipping and general review of the human resource requirements in the health sector.”

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher.

The also study highlights a significant increase in Uganda’s general service index, rising from 48% in 2018 to 59% presently. Utilizing a similar survey methodology, researchers observed notable improvements in the availability of health interventions across various domains. Particularly in Reproductive Maternal Adolescent Health services, higher provision rates were evident, especially at higher-level health facilities. Moreover, delivery assistance at Health Centres IIIs and above by skilled attendants has become standard practice, with nine out of ten cases receiving skilled care. 

Immunization services have also witnessed widespread availability, notably in hospital settings. However, while all surveyed facilities now offer malaria treatment services, access to non-communicable disease management, such as cancer diagnosis and treatment, remains limited, and readiness to provide transportation services for community members in need is inadequate.

According to Professor Orach, the Ministry of Health should strengthen and improve diagnosis and treatment of cancers generally across the country, especially at the National and Regional Referral Hospitals so that many more people at community levels can access the services. He also notes that the Ministry needs to quickly do everything possible to strengthen the transportation systems for patients from communities to reach and access health services.

Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023.

The research noted that salary enhancement is a step in the right direction for improving how health workers perform. “We need to enhance that by ensuring that, ‘the health system, which is a complex system’, when we enhance salaries, we still need to continue to monitoring the health workers, we still need to continue to provide other requirements for the performance of health services, like drugs should be available,” noted Professor Orach. 

Adding that; “Transport should be available, other ways of ensuring that their performance can be up to the expected standard. So, in other words, that’s an important step and we must thank the government for what they’ve done here for we should still support them in other ways and monitor them closely to ensure, guidelines are available for services, that drugs are available, so that they can continue to provide good services.” 

“Our findings also show that for instance, the private health practitioners are not carrying out a lot of immunization, but government health facilities and private not for profit facilities are providing immunization services. This means that the private health practitioners don’t focus on immunization since it may not be bringing them money, they sought the ministry to engage with them to ensure that they’re brought on board so that they can provide their services in an integrated manner,” he noted. 

During the event, Associate Professor Peter Waiswa from the Health Policy, Planning and Management Department at MakSPH delivered a keynote address on ‘Understanding Health Systems Strengthening in a resource limited set-up.’  Professor Waiswa has had research work in maternal, new-born and child health in low and middle-income countries.

Stakeholders during the launch of the report in a group photo. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Stakeholders during the launch of the report in a group photo. 

According to Dr. Diana Atwiine, the Permanent Secretary of the Ministry of Health, this health facility assessment and report will significantly enhance MoH’s institutional capacity for strategic planning and policy development in Uganda’s health sector.

“The Makerere University School of Public Health (MakSPH) Team led by Prof. Christopher Garimoi Orach is appreciated for spearheading the entire process of undertaking the HHFA and developing the report. The MoH is very grateful for the diligent work well-done by the various actors that included the technical officers, research assistants and the administration staff to have the final report meticulously developed,” said Dr. Atwiine. 

Dr. Henry G. Mwebesa, Director General of Health Services, emphasizes the pivotal role of robust health systems in achieving lasting health advancements. He underscores that the findings will facilitate the country’s ability to track health service progress, advancing towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This data supports evidence-based decision-making, fortifying national health system planning and policy-making.

“This HHFA report is recommended for use by the various key stakeholders including health service managers, district leaders, ministry of health officials, both government, private sector, civil society organizations and development partners at different levels to inform and improve planning and implementation of effective health services delivery in Uganda,” says Dr. Mwebesa. 

Photos by Julius Tukacungurwa.

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MNCH e-Post Issue 122: Integrated Intervention Package Increases Health Facility Births – New Study

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Pregnant woman with midwife. Photo by Iwaria Inc. on Unsplash

By Joseph Odoi

In a significant stride towards improving maternal healthcare outcomes, a recent study conducted by researchers has shown that an integrated intervention consisting of peer support, mobile phone messaging, and provision of mama kits at the household level is successful in increasing the proportion of facility-based births. This groundbreaking research comes at a time when Uganda is still grappling with a very high maternal mortality ratio estimated at 336 deaths per 100,000 live births and neonatal mortality rate also at 22/1000 live births.

In the 2024 BMJ Published study titled “Can an integrated intervention package including peer support increase the proportion of health facility births? A cluster randomized controlled trial in Northern Uganda by researchers namely;  Dr. Victoria Nankabirwa and a team including David Mukunya, Grace Ndeezi, Beatrice Odongkara, Agnes A Arach, Vicentina Achora, Levi Mugenyi, Mohammad Boy Sebit, Julius N Wandabwa, Paul Waako, Thorkild Tylleskär, and James K Tumwine, sought to evaluate the effect of the integrated intervention package on increasing the proportion of health facility births compared to routine government health services. Read More

Click here to View the full MNCH e-Post Issue 122

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