Health
72nd Graduation: Doctoral Citations – CHS
Published
3 years agoon


AGABA Bekiita Bosco
Molecular Epidemiological Surveillance of pfhrp2 and pfhrp3 gene deletions in Plasmodium falciparum parasite populations in Uganda
Mr. AGABA Bekiita Bosco investigated the biological and molecular changes in malaria parasites that make them difficult to be detected in malaria infected individuals. Once these parasites evade detection, individuals remain untreated leading to severe disease and risk of mortality. The results provide the first large-scale evidence reporting the presence of pfhrp2/3 gene deletions in P. falciparum parasites in Uganda and demonstrated that gene deletions are not confined but rather spread across regions. Further, the study showed that these parasites emerge independently and sponteneously. The findings inform national guidelines for malaria case management and policy for the introduction and deployment of new malaria diagnotic tests. The study was funded by the NIH-Fogarty Malaria training grant and the WHO collaborating center in Australia. The work was supervised by Prof. Moses R. Kamya, Prof. Chae Seung Lim, Dr. Adoke Yeka and Dr. Samuel Nsobya.

AMONGIN Dinah
Understanding Trends and Trajectories of Repeat Adolescent Birth in Uganda
Ms. AMONGIN Dinah studied the magnitude and explanation for repeat adolescent birth (i.e. a second or higher order live birth before age 20 years, following a first birth before age 18 years) and its later life consequences in Uganda. Her results revealed high repeat adolescent births (over 1 in 2) with slight decline in the 30 years of observation (1988/89-2016) although more women over the years wanted to have this repeat birth later. Results suggest life-long negative socio-economic and reproductive health outcomes among women with repeat adolescent births compared to those without. Further, escalation of the socio-economic distress following first birth, domestic violence, and partner coercion, predisposed adolescent girls to sexual exploitation and unwanted marriages. Interventions should focus on preventing repeat adolescent pregnancy and increasing opportunities for adolescent mothers, with a primary focus on: improving school retention/continuation, strengthening family planning services, and preventing early marriage. This study was funded by Training Health Researchers into Vocational Excellence (THRiVE-2) and was supervised by Assoc. Prof Annettee Nakimuli, Assoc. Prof Lenka Benova, Assoc. Prof Lynn Atuyambe, and Assoc. Prof Claudia Hanson.

KAPAATA ANDAMA Anne
Genotypic And Phenotypic Characterization Of Hiv-1 Transmitted/Founder Viruses And Their Effect On Cytokine Profiles And Disease Progression Among Acutely Infected Ugandans
Ms. KAPAATA ANDAMA Anne looked at Genotypic and Phenotypic Characterization of HIV-1 transmitted/founder viruses and their effect on cytokine profiles and disease progression among acutely infected Ugandans. Subtype analysis of inferred transmitted/founder viruses showed a high transmission rate of inter-subtype recombinants (69%) involving mainly A1/D, while pure subtype D variants accounted for one- third of infections (31%). The signal peptide-C1 region and gp41 transmembrane domain were hotspots for A1/D recombination events. She documented diversity in the functional protein domains across the Gag-Pol region of the HIV virus and identified differences in the Gag-p6 domain that were frequently associated with higher in vitro replication. She also found that HIV-1 subtype D infections had higher concentrations of different cytokines than subtype Ainfections. cytokines IL-12/23p40 and IL-1α were associated with faster CD4+T cell count decline while basic fibroblast growth factor was associated with maintenance of CD4+T cell count above 350cells/microliter. This work was funded by the International AIDS Vaccine initiative and supervised by Prof. Pontiano Kaleebu, Eric Hunter and Moses Joloba and Dr Jesus Salazar Gonzalez.

BAKESIIMA Ritah
Modern contraceptive use among female refugee adolescents in northern Uganda: prevalence, effect of peer counselling, adherence and experiences
Ms. BAKESIIMA Ritah studied modern contraceptive use among female refugee adolescents northern Uganda: the prevalence, effect of peer counselling, adherence, and experiences. She found that the use of modern contraceptives among sexually active adolescents was very low with less than 10% using a method, and yet they wanted to delay child birth. This highlights a high unmet need of contraceptives in this population. She also found that peer counselling had a positive effect on acceptance of modern contraceptives; participants who received peer counselling were more likely to accept a contraceptive method compared to those who received routine counselling. The commonest reasons for non-acceptance of a method were partner prohibition and fear of side effects. She recommends that refugee adolescents, together with their partners, are further sensitized of the dangers of teenage pregnancy, and the benefits of contraception in preventing teenage pregnancy and associated complications. This research was funded by SIDA and supervised by Assoc. Prof Elin Larsson, Dr. Jolly Beyeza-Kashesya, Prof. Kristina Gemzell-Danielsson, Dr. Amanda Cleeve, and Dr. Rose Chalo Nabirye.

BAYIGGA Lois
Role of Vaginal Microbiome in Host Susceptibility of HIV Infection in Pregnant Ugandan Women: Inflammatory Response and Epithelial Barrier Integrity
Mr. BAYIGGA Lois investigated the virginal microbial diversity and its immune-modulatory effects on host susceptibility to HIV among pregnant women in Uganda. In the results, the vaginal microbiome of pregnant women in the cross-sectional study was categorised into four distinct cervicotypes. In conclusion, African women had a more diverse vaginal microbiome relative to women in the America and Europe as observed in the literature. This work was supervised by Prof. Damalie Nakanjako, Dr. David Patrict Kateete, Dr. Musa Sekikubo and Prof. Deborah Anderson.

MIJUMBI Deve Rhona
Rapid Response Services to Support Policymaking in Uganda
Ms. MIJUMBI Deve Rhona evaluated the rapid response mechanisms aimed at providing evidence for policymaking in Uganda, including their feasibility and establishment, their uptake amongst the users along with these users’ experiences with them. She was able to determine and confirm the feasibility of an RRS in Uganda and map the establishment, growth, and evolution of the service. She was also able to document the important factors that led to the establishment of the service, then used this information to develop a theoretical framework combining the structural and temporal components of the development of an RRS and the factors important at each stage. She also established the important factors that influence the uptake of the RRS amongst its actual and potential users and also explored the users’ experience with the rapid response (RR) briefs produced by the RRS and used her findings to improve these briefs. The findings from this work are important to enable the use of evidence for decision-making at different levels of governance globally, especially in complex situations where time is barred. The work was funded by the International Development Research Center’s International Research Chairs Initiative and supervised by Prof. Nelson Sewankambo, Prof. John Lavis, and Dr. Andrew Oxman.

MUKURU Moses
An analysis of evolutions in maternal health policies and implementation adaptations in Uganda during the MDG period (2000-2015)
Mr. MUKURU Moses analysed Uganda’s maternal health policies introduced during the fifteen years of the Millennium Development Goals (MDG period) to understand policy failure. This followed the persistence of high preventable maternal mortality, which closed at a Maternal Mortality Ratio (MMR) of 368 deaths per 100,000 live births in 2015 below the target of 131 deaths per 100,000 live births. While most studies explain the failure to achieve maternal health policy targets from epidemiological, interventional and health systems perspectives, this study examined how elite interests underpinning maternal health policies, policy design and implementation influenced maternal health policy failure in Uganda. The study found that the failure to achieve policy targets and persistence of high maternal mortality despite introducing fourteen policy shifts emanated from a complex interplay of factors at the policy formulation, design and implementation levels. Policy elites developed policies which mainly served their selfish political and economic interests while paying limited attention to the goal of reducing maternal mortality. The policy instruments introduced were incoherent, inconsistent and incomprehensive to cover all the causes of maternal mortality rendering the policies ineffective in design. Consequently, maternal health policies could not be fully operationalised at the frontline to support timely response to all the emergencies that cause maternal death. The study was funded by DAAD, the Alliance for Health Policy and Systems Research, Switzerland, through the University of Cape Town, South Africa, the “Support Policy Engagements for Evidence informed (SPEED)” and was supervised by Professor Freddie Ssengooba and Dr Suzanne Kiwanuka.

MUSABA Milton
Obstructed labour in Eastern Uganda: risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes
Dr. MUSABA Milton studied the risk factors, electrolyte derangements, and effect of bicarbonate on obstetric outcomes among women with Obstructed labour (OL). Failure of a woman to give birth normally is called OL. It is often associated with poor outcomes for both the mother and baby, if the intervention (surgical) is not timely. In Uganda, one in five maternal deaths and two in five perinatal deaths are attributed to OL. The risk factors were being a first-time mother, using herbal medicines, and being referred in labour. While being married, having a delivery plan, and an educated partner were protective. Perioperatively, multiple electrolyte derangements were common. Perinatal death was four times higher than the national average, and the predictors were being referred and having a high maternal blood lactate level. Sodium bicarbonate infusion had no significant beneficial or harmful effect. Developing birth and complication readiness plans may help to minimize delays and multiple referrals in case of an emergency. To minimize the effects of metabolic and electrolyte derangements in OL, healthcare providers need to ensure that these patients are well rehydrated especially during transfer to a higher facility. This study was funded by NORHED/NORAD and was supervised by Prof. Grace Ndeezi, Prof. Julius N. Wandabwa, Dr. Justus K. Barageine, and Prof. Andrew D. Weeks

NAMAZZI Gertrude
Burden and risk factors for child developmental disability among infants in Busoga region, in Uganda
Dr. NAMAZZI Gertrude investigated the burden and risk factors for child developmental disability among infants in Busoga region, in Uganda. The study revealed a high burden of child developmental disability at population level and among preterm babies. The caretakers of children with developmental disability expressed emotional stress and an impoverishing experience with limited support from the community and the health system. The key risk factors included: birth asphyxia, malnutrition, newborn infections, and a mother having more than three children. The study findings indicate the need to improve the quality of care during delivery and the postnatal period to prevent birth asphyxia, neonatal infections and malnutrition so as to curb the burden of child developmental disability. In addition, parents should limit the number of children to those they are able to nurture and care for adequately. The study recommends to government to improve the health facility readiness to respond to caretakers’ needs and the needs of children with developmental disability so as to empower families, while respecting their beliefs, to cope with adversity. The study was funded by SIDA and was supervised by Prof. James Tumwine, Assoc. Prof. Peter Waiswa and Assoc. Prof. Helena.

NANKYA Mutyoba Eron Joan
Hepatitis B. Among Ugandan pregnant women: Studies on Epidemiology, knowledge, perceptions and behavioural intentions
Ms. NANKYA Mutyoba Eron Joan investigated the epidemiology, knowledge, perceptions and behavioural intentions associated with Hepatitis B among Ugandan pregnant women. The study was conducted among pregnant women attending routine Antenatal Care in public health facilities in Kampala, Wakiso and Arua Districts. In the results, the overall prevalence of Hepatitis B. Virus infection was 6.1%. Pregnant women in Uganda have a high burden of the virus with significant regional differences, low knowledge and inaccurate perceptions of the virus. This study was funded by SIDA and was supervised by Assoc Prof. Ponsiano Ocama, Asoc Prof. Fredrick Makumbi and Assoc Prof. Lynn Atuyambe.

ODEI OBENG-AMOAKO Gloria Adobea
Retrospective analysis of concurrently wasted and stunted children 6-59 months in the outpatient therapeutic feeding programme in Karamoja: burden, characteristics, detection, response to treatment and outcomes
Ms. ODEI Obeng-Amoako Gloria Adobea examined the burden, characteristics and detection of concurrently wasted and stunted among children under 5 years, and their response to treatment and outcomes in the outpatient therapeutic feeding programme in Karamoja. She found that 5% of children under-5 years in Karamoja were wasted and stunted concurrently. Concurrent wasting and stunting was common among children younger than 3 years and particularly males. She identified optimal weight for age z-score (WAZ) and mid upper arm circumference (MUAC) thresholds for detecting children with concurrent wasting and stunting. Nearly half (49%) of children with severe acute malnutrition receiving outpatient therapeutic care were concurrently wasted and stunted and had lower recovery rate. The study will inform decision-making on integrated wasting and stunting prevention and treatment policy and programme. This study was funded by Carnegie Corporation of New York through RUFORUM, UNICEF Uganda; and African Union and European Union-Intra-ACP Mobility Partnering for Health Professionals Training in African Universities (P4HPT) and supervised by Assoc. Prof Charles A. S. Karamagi and Dr. Henry Wamani.
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It is with great pride and gratitude that I present the 2024 Annual Report of the Makerere University School of Public Health (MakSPH). The past twelve months have been a time of remarkable achievements, significant progress, and renewed commitment to shaping the future of public health.
This report captures some of the highlights that reflect the resilience, innovation, and impact that define our community. 2024 was both an extraordinary and transformative year. We successfully concluded our strategic plan and launched a bold new five-year roadmap (2025–2030), positioning us to respond swiftly to the evolving public health landscape.
The year was especially productive—marked by impactful research, evidence generation, and strengthened partnerships across Uganda, the African region, and globally. Our work continued to demonstrate that we do not simply publish findings—we produce evidence that shapes national policy, informs practice, and addresses real-world public health challenges.
I am deeply privileged to lead this vibrant community of educators, researchers, students, and partners. I extend my sincere appreciation to my colleagues for their exceptional commitment—whether delivering outstanding education, driving research and innovation, or creating an inclusive and welcoming environment. I also thank Makerere University Council, the University Management, , our students, alumni, and partners for their unwavering support; each plays a vital role in advancing our mission.
Despite a challenging global context, we look ahead with great optimism. We have equipped our staff and students with the skills and resilience to thrive amidst uncertainty. In 2024, we celebrated 70 years of impact—seven decades of transformative contributions to public health in Uganda, the region, and beyond. Our legacy in HIV/AIDS research, family planning, maternal and child health, infectious disease control (including COVID-19, TB, and malaria), and health systems strengthening is profound.
MakSPH remains a powerhouse of research at Makerere University, consistently attracting nearly half of the University’s research grants. In the past five years, we have worked in collaboration with universities and research institutions across 25 countries in Arfrica and established strong global partnerships, reinforcing our role as a leader in public health innovation and capacity building.
A landmark achievement was our transition into a standalone School in January 2025, following approval by the Makerere University Council. This new status heralds a transformative phase—enabling us to expand our reach, deepen our impact, and respond with agility to contemporary public health challenges.
In line with this growth, we launched our taught PhD program—designed for early-career and mid-career professionals, as well as strategic level leaders, seeking to strengthen their skills in public health research and leadership.
The School is undertaking a major infrastructure project, the construction of our new home at Makerere Main Campus—which is steadily taking shape into a premier centre for public health training, research, and community engagement. This investment will strengthen our capacity to deliver impact in Uganda, and beyond. We hope that the building will ease the critical space needs for our staff, students, and partners. We are grateful to all individuals, agencies, government bodies, and partners who have supported this transformative endeavor. We warmly welcome further support to help us complete this important project and advance public health for generations to come.
As we move forward, our resolve remains steadfast: to shape health outcomes, empower future generations, and strengthen the resilience of communities across Africa and beyond. We thank you for your continued support to Makerere University and the School of Public Health in particular. Together, we are shaping health, empowering the future, and building a brighter tomorrow.
Dr. Rhoda Wanyenze
Professor and Dean, School of Public Health, Makerere University
Health
TB in Prisons Eight Times Higher Risk than General Population in Uganda, Study
Published
2 weeks agoon
May 16, 2025
Nearly half of Uganda’s prison population has latent tuberculosis (TB), according to the latest Uganda National Prevalence Survey on Tuberculosis, HIV, and COVID-19. The survey, released on May 15, 2025, found that active TB cases in prisons stand at 1,900 per 100,000—eight times higher than in the general population.
The survey was conducted by Makerere University School of Public Health (MakSPH) in conjunction with the Uganda Prisons Services (UPS) and the Ministry of Health—with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and technical support from the U.S. Centers for Disease Control and prevention (CDC)—and purposed to have a more profound understanding of TB to help inform public health programs for this high-risk population.
Dr. Simon Kasasa, a Senior Lecturer at MakSPH and Principal Investigator of this study, stressed that “staying for a longer duration, three years and above, posed a greater risk to TB infection in prison.” He also noted TB infection was much higher among male prisoners (48%) compared to female prisoners (38%) and among those of older age, 65 years and above. Meanwhile, the report noted concerns about excessive numbers in prisons as a key risk factor for TB transmission.

UPS consists of 257 prisons spread over 16 administrative regions with an average prisoner population of 56,400 (95% male), accommodation capacity of 16,612 (340%), and 9,904 staff (29% female).
HIV prevalence among prisoners was also alarmingly high at 11%, twice that of the general population. Notably, female persons in prison (PIP) had the highest HIV rates at 21%, compared to 11% for male PIP and just 2% among prison staff. However, the data also showed a significant drop in overall HIV prevalence within prisons, falling from 15% in 2013 to 11% in 2023, with the most dramatic decline among staff, from 12% to 2%.

Dr. George Tumusinze, a Program Manager and Research Associate, pointed out that although 92% of people with HIV in prisons know their status and 99% are receiving antiretroviral therapy (ART), only 70% have successfully reduced the virus in their bodies, highlighting important issues with how well the treatment is working.

Mr. Samuel Akena, the Deputy Commissioner General of Prisons, echoed these concerns by stating that the survey represents a significant milestone for the Prisons, not only in terms of data collection but also in Uganda’s journey towards achieving equity, justice, and the right to health for all. “This survey is historic. It represents one of the most comprehensive efforts to understand the health status of people in prisons in Uganda.” He emphasized the necessity of a collective and bold response, urging that “the time for piecemeal responses is over.”
Dr. Charles Olaro, Director General of Health Services at the Ministry of Health, emphasized the urgency of the situation, stating, “As we gather today to reflect on the findings of this important survey, we must recognize the urgent need for action in our fight against tuberculosis (TB) in Uganda. Despite our efforts, we are still grappling with the burden of this disease, and our progress toward eliminating it by 2030 has not been as swift as we had hoped.” He pointed out that the survey serves as a critical baseline that will shape future responses and guide resource allocation.

HIV prevalence among prison staff members was the lowest, at just 2%, reflecting a significant achievement in workplace health. Dr. Daniel Byamukama, Head of HIV Prevention at the Uganda AIDS Commission, praised prison authorities for their efforts, noting the remarkable progress over the past decade. In the first survey in 2013, only 34% of HIV-positive staff on treatment had achieved viral load suppression. Today, that figure has reached an impressive 100%, underscoring the impact of sustained prevention and care efforts.
While the prison HIV program has shown effectiveness—evidenced by a drop in prevalence from 15% to 11% among the prisoners over the past decade—Mr. Akena stressed the importance of prioritizing gender-responsive strategies in health interventions.
“Diseases do not recognize bars or borders. They thrive in environments where conditions are poor and resources are scarce. Women in prison face disproportionately higher risks, yet often remain invisible in program planning. This is not acceptable. If we are serious about health equity, we must prioritize gender-responsive strategies — within prison health systems and beyond,” Mr. Akena.

CDC Uganda Director Dr. Adetinuke (Mary) Boyd reinforced the significance of the survey in addressing public health risks. “In Uganda, CDC partners are helping to ensure inmates stay healthy during custody. This work facilitates safe reintegration into their communities, mitigates disease transmission to the general population, and reduces public health risks like untreated TB,” she stated. Dr. Boyd highlighted the role of PEPFAR in tackling critical global health threats, asserting that the survey offers helpful data for enhancing health collaboration within this vulnerable population.
The U.S. CDC has been supporting Uganda Prisons Services to provide comprehensive HIV/AIDS, STI, and TB prevention, care, and treatment services for the last 15 years (2010–2025), totaling over $18,046,263 in investment—including $550,000 to this study alone, through the Makerere University School of Public Health. The program supports capacity building, scale-up, and health system strengthening efforts in HIV/TB testing, care, and support for prisoners and prison staff, plus surrounding communities.

With 80% of prison wards overcrowded and 95% lacking adequate natural ventilation, the conditions in which these individuals live exacerbate the spread of infectious diseases, public health specialists have warned. This survey underlines the urgent need for systemic changes within the prison health system, as well as a commitment to uphold the rights and health of all individuals, regardless of their circumstances.
As Uganda grapples with these alarming statistics, the call to action is clear. Stakeholders must come together to implement effective health interventions, improve screening and treatment protocols, and ensure that the rights of incarcerated individuals are respected. The health of the general population is inextricably linked to the health of those within prison walls, and addressing these challenges is not just a moral imperative but a public health necessity.

Professor Rhoda Wanyenze, one of the investigators and Dean of the School of Public Health, asserts that the Survey findings are a wake-up call for stakeholders to prioritize health equity and justice for society’s most vulnerable members.
Prof. Wanyenze advocated for improved TB screening methods and institutionalization of regular mass TB screening using the WHO-recommended advanced diagnostic tools like digital chest X-rays with Computer-Aided Detection (CAD), as well as molecular diagnostics like GeneXpert and TB LAM, noting that traditional symptom-based screening missed nearly half of TB cases. “The use of molecular diagnostics like GeneXpert significantly improved case detection in our study,” she added, emphasizing the importance of timely diagnosis and treatment.

Uganda Prisons Service, in partnership with the Ministry of Health, has so far installed 14 GeneXpert machines in medium- to high-volume prison health facilities.
While some, including Members of Parliament, have raised concerns about the potential infringement on individual rights through mandatory TB testing in prisons, Dr. James Kisambu, the Commissioner for Prison Health Services, noted that it is now apparent, with these findings, for everyone to appreciate that in such confined settings, the risk of transmission is extraordinarily high. TB testing in these settings is not just a medical practice but also a crucial public health precaution that protects both prisoners and the wider community.
“Prisons are high-risk, high-transmission environments where one undetected case can rapidly escalate into an outbreak. In such settings, the right to refuse testing must be weighed against the right of others to be protected from infection. Mandatory TB screening, when done with dignity and linked to prompt treatment, is not a violation of rights — it is an essential public health measure to protect both people in prison and the communities they return to,” said Dr. James Kisambu.

The researchers from MakSPH were; Dr. Simon Kasasa, Associate Professor Esther Buregyeya, Dr. George Tumusinze, Dr. Simon Walusimbi, Dr. Dick Kasozi, Dr. Ronald Senyonga, John Baptist Bwanika, Prossy Nabaterega and Professor Rhoda Wanyenze.
Additionally, the study team from the Uganda Prisons Service comprised of Dr. Leonard Marungu, Charles Butagasa, Dr. James Kisambu and Dr. Johnson Byabashaiza, the Commissioner General of Prisons.
Finally, Dr. Deus Lukoye, Dr. Julius Ssempiira, Charles Kavuma, Rise Nakityo, Samuel Sendagala, Grace Nantege, Lisa Mills, Dr. Lisa Nelson, Kenneth Mwambi from U.S. CDC Uganda/Atlanta and PEPFAR USG agencies, and George William Kasule, Didas Tugumisirize, Dr. Simon Muchuro, Professor Moses Joloba, Dr. Turyahabwe Stavia from the Uganda Ministry of Health National TB and Leprosy Program (NTLP) completed the team.
Health
MakSPH Champions Leadership Boost for Wakiso Health Managers
Published
3 weeks agoon
May 9, 2025
On April 23, 2025, Makerere University School of Public Health (MakSPH) convened district leaders, health managers, and project partners to disseminate the outcomes of a major leadership and management strengthening initiative in Wakiso District, Central Uganda. The one-year project, part of the Global Health Partnerships programme funded by NHS England, was implemented in collaboration with Nottingham Trent University, Nottingham University Hospitals NHS Trust, Wakiso District Local Government, and Uganda’s Ministry of Health.
Launched in 2024, the project titled Strengthening Leadership and Management Among Local Government Health Managers in Wakiso District, aimed to co-design and pilot a leadership and management training tailored to the realities of Uganda’s decentralised health system. The intervention, led by Makerere University’s Dr. David Musoke and Nottingham Trent University’s Prof. Linda Gibson, through the over 15-year-old NTU-Mak Partnership impacting lives in Wakiso, began with a field visit to over 60 public health facilities in the district, a needs assessment within these facilities to identify key priority gaps, and a baseline survey with the health in-charges to establish the initial status of key indicators.
“We have been very fortunate to work with a supportive local government in Wakiso, from the top leadership down. While many projects struggle to engage district teams, our longstanding relationship with Wakiso made collaboration seamless. Although this was our first initiative specifically focused on leadership and management, we hope it will serve as a stepping stone for even more impactful work in the future,” Dr. David Musoke, a Senior Lecturer at Makerere University and the Uganda Project Lead, said during the dissemination workshop, highlighting the key success factors for the leadership and management project.

Initial results from the needs assessment and baseline on leadership and management competencies conducted among Wakiso District health facility supervisors early last year by the project team and shared during the three-day workshop in June 2024, held in Kampala, which kickstarted the six-month structured fellowship programme for 53 health managers in Wakiso, had found critical capacity gaps. Using a tool evaluating 17 leadership and 33 management competencies, only 40% of the managers met the 80% benchmark for leadership, scoring highest in cognitive skills, while just 33% met the required management standard, performing best in self-management and lowest in quality management.
Then, the health facility managers with postgraduate training, longer service, and strong team dynamics, showed overall better performance. While working relationships with subordinates and the district leadership were largely positive, performance was hampered by systemic challenges such as limited resources, low motivation, and weak teamwork. Overall, the study also pointed to a misalignment of expectations between the District Local Government and the Health Ministry, underscoring the need to strengthen coordination to improve services.
The result of this mismatch was to the effect that, as of this time last year, Wakiso District ranked among the bottom 10 on the national health league table, which is an annual Ministry of Health assessment of district performance across key service delivery and patient satisfaction indicators. This was despite Wakiso being Uganda’s most populous district, with over 3.4 million residents today, as it continued to struggle to deliver essential health services to the public. The 2022/2023 Annual Health Sector Performance Report also flagged persistent challenges, including frequent transfers of facility in-charges, overstretched management structures, and weak internal communication and coordination.

It was this stark reality that informed the leadership and management intervention in Wakiso. Officiating the dissemination of the project outcomes, Dr. Sarah Byakika, Commissioner for Planning, Financing, and Policy at the Ministry of Health and a member of the National Oversight Mechanism for the programme, commended the remarkable progress made in just six months, citing visible improvements across the district as a direct result of the intervention.
“I have been involved with this programme right from its inception, and I’m proud that Uganda became one of its major beneficiaries,” Dr. Byakika said with gratitude, commending the strong collaboration between the Ministry of Health, Makerere University, Nottingham Trent University, Nottingham University Hospitals, Wakiso District and the development partners for supporting the initiative. She emphasised the value of this partnership in strengthening leadership and management competencies among Wakiso District health managers to address critical performance gaps in health service delivery.

“Wakiso is Uganda’s largest and most populous district, yet it has long underperformed on key health indices. Despite its semi-urban nature, it faces enormous health service delivery challenges, partly due to the overwhelming burden on its District Health Officer, who oversees more than 60 public and over 340 private health facilities. Many of these private facilities open and close frequently, complicating service oversight,” Dr. Byakika observed with concern.
Her sentiments were echoed by the District Health Officer, Dr. Emmanuel Mukisa, in a message delivered by Wakiso District Biostatistician, Mr. Frank Kakande. He noted that the project had contributed to a noticeable shift in the district’s health system performance, with visible improvements in leadership, communication, and accountability among facility in-charges beginning to translate into better overall health service delivery outcomes.
“You cannot talk about management without addressing performance: they go hand in hand. As someone who sits at the centre of district health data, I can confidently say that performance has improved. During the most recent national local government performance assessment, where I participated in the evaluation, Wakiso District’s health department ranked 18th out of 146 districts. That health ranking is a major achievement. We have consistently performed poorly in the past, but this time, we made significant progress,” Mr. Kakande told the attentive audience, speaking with an air of relief and satisfaction.

The Wakiso District Biostatistician credited part of this progress within the district, from the poor performance last year, to the leadership training and mentorship delivered through the project, citing visible improvements across key health indicators. He stressed the need to sustain this momentum through continued mentorship, internal capacity strengthening, and consistent application of the skills acquired by health managers, particularly in tackling persistent management challenges such as absenteeism, delegation, and accountability.
“Last week, I held a performance review at Kakiri Health Centre III, and the improvements were clear. These management skills are making a difference. You can see the change across indicators. But what matters now is sustainability. The support provided through supervision and mentorship was essential. But it’s up to us to keep the fire burning. We have learned a lot: communication skills, problem-solving, time management, and decision-making. Managers are now communicating better. Even issues like absenteeism are being addressed through proper reporting and action,” Mr. Kakande said.
Earlier, Dr. Musoke, presenting the overall project overview and success, explained that based on initial findings from the baseline and needs assessment, the team co-designed and delivered a structured six-month capacity-building programme targeting 60 health facility in-charges in Wakiso District. The programme blended in-person and virtual sessions, combining practical training with one-on-one mentorship, and included an exchange component between Uganda and the UK to promote international exposure and peer learning. This allowed the health managers to apply new skills to strengthen health outcomes in Wakiso.
“This project rightly focused on addressing gaps in leadership and management. I advocated for including this component in the programme, because our national health review missions consistently show that poor performance often stems from weak leadership and management,” Dr. Byakika affirmed, adding that: “I am pleased to see that nearly all public facilities in Wakiso participated. While the project had a short implementation window, the evaluation already shows encouraging results. Health managers feel more empowered, motivated, and aware of their roles. That’s a significant step.”
For her part, Dr. Sheba Gitta, Uganda Country Director for Global Health Partnerships, formerly Tropical Health and Education Trust, applauded the leadership and management capacity-building initiative in Wakiso as a timely, locally driven intervention. She underscored the value of two-way learning between Uganda and the UK health systems through the programme, noting that Global Health Partnerships works closely with the Ministry of Health to ensure all funded initiatives align with Uganda’s national development priorities.

“What excites me most is that this was not a pre-packaged programme imported from the UK. The training was co-created by partners, based on local realities and needs. That approach reflects strong collaboration between Makerere University School of Public Health and Nottingham Trent University. I thank Prof. Linda Gibson for her continued commitment and Dr. David Musoke for his proactive leadership in bringing this programme to life. Your consistency and quality of work continue to stand out,” Dr. Gitta shared.
While commending the progress made, she cautioned against “pilotism”, as a tendency for promising projects to end prematurely, calling for the model to be scaled up nationally. To support sustainability, she stressed the importance of documenting the training process, outcomes, and costs to inform ministry-level decision-making and long-term adoption.
Dr. Gitta joined Prof. Linda Gibson, the UK Lead for the Project, to encourage the trained managers to become champions of leadership within their facilities and districts, ensuring that the impact of the programme endures beyond its current cycle. She also thanked NHS England and the UK Government for their trust and investment in Uganda’s health system.
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