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Study to Address the Social drivers of Mental Illness Launched in Uganda by Kennesaw State University & Makerere University

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A new 5-year study has been announced to determine the link between social drivers and mental health among young women who live in the slums of Kampala in Uganda.  Kennesaw State University (KSU) received the five-year $3.3 million award from the National Institutes of Health (NIH) and has partnered with Makerere University to conduct this interdisciplinary project.  

Mental illnesses are understudied, and scarce services lack evaluations, particularly in low-resource settings such as slums. In response to the vulnerable state of adolescent girls and young women in the urban slums, the team of researchers are implementing this five-year project named “TOPOWA” (The Onward Project On Well-being and Adversity), which means to “keep pushing forward and never giving up”, in the Luganda language.

Makerere University through the School of Public Health is teaming up with two U.S universities, Kennesaw State University (KSU) and Georgia State University (GSU) in the U.S. to implement the research component of the study. The Uganda Youth Development Link (UYDEL), a community-based organization in Kampala will lead the intervention components.

Some of the beneficiaries of the TOPOWA Project attend a tailoring course.
Some of the beneficiaries of the TOPOWA Project attend a tailoring course.

First of its kind, “the TOPOWA project will examine if a community-based intervention program comprised of vocational training, entrepreneurship and economic empowerment, team building through sports, and psychosocial support (“Socioeconomic Strengthening Targeted Training: “SeSTT”). leads to better mental health outcomes among disadvantaged women living in slums” said Dr. Monica Swahn, the Principal Investigator of the study.

The TOPOWA research project will focus on young women ages 18-24 years, the age period when most mental health symptoms are manifested and expressed. If the study shows that the intervention makes a difference in mental health outcomes (i.e., anxiety, depression, suicidality and substance use symptoms and disorders) for young women, it can address the tremendous unmet mental health needs in Uganda. The study will also increase the understanding of the community and neighborhood characteristics of the urban slums where the young women reside.

It was launched on Tuesday March 8, 2022, on International Women’s Day, a global holiday celebrating the social, economic, cultural, and political achievements of women. Speaking at the launch, Dr. Swahn, the Principal Investigator, and also Professor and Dean of the Wellstar College of Health and Human Services at KSU said “TOPOWA was in support of global action to advance gender equality and the empowerment of women and girls”

Dr. Swahn, the Principal Investigator, and also Professor and Dean of the Wellstar College of Health and Human Services at KSU
Dr. Swahn, the Principal Investigator, and also Professor and Dean of the Wellstar College of Health and Human Services at KSU

She also noted that this was a ground-breaking study, with investigators representing diverse expertise from three universities.

“Our TOPOWA project is ground-breaking because we look at the social drivers of mental illness and how to mitigate them. We conceived this project before the pandemic, but now with the pandemic, we know more than ever how mental health has been understudied and the growing scope of unmet need in the community,” she said.  Dr. Swahn also added that, “We don’t have enough interventions for mental health in particularly among vulnerable populations in low-resource settings. So, what we have learnt post-COVID is that we need to find scalable interventions to better support mental health for women who live in poverty, particularly women who live in slums.”

Using a multicomponent 27-month, parallel prospective cohort design of young women, the study team will recruit 300 participants from three selected UYDEL study sites in Banda, Bwaise and Makindye to determine the pathways and mechanisms of mental health outcomes.  The study will involve focus groups, a Photovoice project, community mapping, surveys, use of sleep wearables, saliva and stress reactivity to detect and determine stress levels of the young women.

The investigators will measure stress though threat reactivity in fear conditioning tests, ratio of salivary cortisol, dehydroepiandrosterone (DHEA) and α-amylase, and sleep quality by deploying Fitbit wearable sensors for each study participant as well measuring environmental stressors through geotrackers.

“We will ask these young women to wear these Fitbits. These will pick up on the measure of sleep. We know that when people are stressed, they have poor mental health, but also, they have poor sleep,” said Prof. Swahn.  She adds that these Fitbit devices are worn just like a wrist watch. “They will give us a lot of insight to what happens at night when people are sleeping. The women may or may not be sleeping as well as they should. So again, it’s another marker of stress, their well-being and physical health. It really adds another important innovative component of the study. We looked for other studies across the sub-Saharan Africa and have not found any studies that use this technology in this type of setting so these gadgets will give us a lot of insight.”

Some of the young women beneficiaries of the project entertain visitors at the Bwaise UYDEL site
Some of the young women beneficiaries of the project entertain visitors at the Bwaise UYDEL site

Dr. Catherine Abbo, an Associate Professor of Psychiatry at Makerere University College of Health Sciences, and Co-Investigator of the TOPOWA study, says depression and other mental health issues are on the rise in Uganda, though they continue to go unrecognized.

“These women actually don’t even reach the clinic but people just suffer while they are in the communities. There are different anxiety disorders. So, the current estimates from the previous research shows about 1 in every 4 people have mental health issues,” Dr. Abbo says.

Asked about what could be the drivers of mental health in young adults, Dr. Abbo contends some of the drivers are psychosocial arising from the environment we live in while others maybe genetically predisposed.

Dr. Catherine Abbo, an Associate Professor of Psychiatry at Makerere University College of Health Sciences, and Co-Investigator of the TOPOWA study.
Dr. Catherine Abbo, an Associate Professor of Psychiatry at Makerere University College of Health Sciences, and Co-Investigator of the TOPOWA study.

“If you are going to live in an environment that is poverty stricken, you are going to live in an environment where you are not going to access education, you are not going to have support that you need to be mentally healthy, you become vulnerable to getting mental illness and that is the environmental aspect. And then we have individuals, who, because of their genetic makeup, may develop cause mental illness,” she said.

According to Dr. Abbo, the wearables are new technologies and that this is the first of its kind to be used in research in Uganda. “You know sometimes people go jogging and have phones that take the number of their steps, heart rate, so in the general population we have gadgets that can measure some aspects of body reactions but particularly in this case, it’s going to measure sleep patterns, that signify stress levels.”

Mr. Rogers Kasirye, UYDEL’s Executive Director, argues that many a time, intervention projects have been implemented among youth but they fail because of the inability to tackle underlying issues affecting the young people. He says this study to investigate the mental health status of the young women will go a long way in impacting the way such initiatives can be implemented to achieve greater success.

Executive Director of UYDEL, Rogers Kasirye.
Executive Director of UYDEL, Rogers Kasirye.

According to Mr. Kasirye, for over 25 years, UYDEL has worked with young people in the in the slums of Kampala and impacted many young people through their skilling and rehabilitation programs. He pointed out that  that a majority of the young people in slums face a lot of challenges including poverty, lack of shelter while others have long lost contact with their families.

“But we don’t go beyond to investigate and support their psychosocial needs. From experience, some people who come to our facilities have alcohol and other problems. Many times, they are even failing to sleep. Some even come to the Centre and tell you that they have not had a meal. You know what it means to sleep on an empty stomach. Others say they lost contact with their families while others say they have been sexually abused and others raped. In other words, they have a mountain of psychosocial needs that must be addressed. With this project, we hope to track girls for several years to match the research findings with empowerment interventions,” said Mr. Kasirye.

TOPOWA Study PI Prof. Monica Swahn interracts with Makerere University School of Public Health team. In the photo, Dr. JB Isunju, Mr. Charles Ssemugabo and Ezekiel Musasizi.
TOPOWA Study PI Prof. Monica Swahn interracts with Makerere University School of Public Health team. In the photo, Dr. JB Isunju, Mr. Charles Ssemugabo and Ezekiel Musasizi.

Ms. Anna Kavuma, the Deputy Executive Director, UYDEL says the COVID-19 pandemic has had a toll on mental health issues among young women by increasing their vulnerability.

She notes that whereas the boys have equally been affected by the pandemic and could have pushed them to high stress levels, girls have a high level of vulnerability with responsibilities such as bringing up the children, dealing with pregnancies, accessing medical supplies as well as shelter.

Ms. Anna Kavuma, the Deputy Executive Director, UYDEL.
Ms. Anna Kavuma, the Deputy Executive Director, UYDEL.

“It’s quite difficult for the girls. It’s an understatement for me to say that they are not highly affected by mental issues in Uganda, that is why this project is coming in to understand that. For instance, if we gave young girls vocational skills and training in beauty and cosmetics, or any other vocational skilling, will it help reduce on these stresses that they have? Will it help address the underlying factors that they are facing? Will it help to improve  the way they sleep? Will it help improve  the stress levels? These are areas we are trying to study and we are hopeful that the results of the study will inform not only programming and practice but also inform policy environment as well,” said Nabulya.

The project’s intervention arm will look at skilling the adolescent girls and young women with the cost-effective beauty training, which the researchers say is also very easy to implement. Dr. Swahn, the PI noted, “We are hoping that if it’s shown to be effective, that is something that can be implemented in other communities and we know that many are offering vocational training but they have not been evaluated the way we are doing it with a very vigorous scientific protocol.

The TOPOWA Research team.
The TOPOWA Research team.

Dr. Rhoda Wanyenze, Professor and Dean, Makerere University School of Public Health thanked Prof. Swahn and UYDEL for partnering with MakSPH to implement this important project citing that the School was ready to work with the team.

“Mental health for young people is such an important area and very timely coming after the challenges and stress from the Coronavirus pandemic! We are excited to partner with you on this project,” said Prof. Wanyenze.

The TOPOWA Research Team is composed of nine investigators spanning two continents and three universities.  The Project’s Principal Investigator (PI) is Dean and Professor Monica Swahn of Kennesaw State University. The Co-Investigators of the project include Dr. Cathy Abbo, Dr. Godfrey Bbosa, Dr. John Bosco Isunju, Charles Ssemugabo and Dr. Eddy Walakira from Makerere University, Dr. Ebony Glover from KSU and Dr. Rachel Culbreth and Dr. Karen Nielsen from GSU.

TOPOWA Pictorial.
TOPOWA Pictorial.

The Executive Director of UYDEL, Rogers Kasirye, leads the implementing partner whose mission is “to enhance socioeconomic transformation of disadvantaged young people through advocacy and skills development for self-reliance”.  

The TOPOWA Project Advisory Board is composed of members from the Kampala City Government, the Ministry of Health, the Ministry of Gender Labour and Social Development as well as the Dean for the Makerere University School of Public Health.

Davidson Ndyabahika is the Communications Officer, MakSPH/TOPOWA Project

Article originally posted on MakSPH website

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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

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