Health
Health Experts meet at MakCHS to discuss Health Professions Education
On 17th June 2022, health experts met at Makerere University College of Health Sciences (MakCHS) for a half-day symposium, ‘Makerere@100: Advancing Health Professions Education in Uganda’. Theaim of the symposium hosted by Health Professions Education Partnership Initiative (HEPI) in collaboration with The African Center for Global Health and Social Transformation (ACHEST) was ‘to take a look at Health Professions Education (HPE), the past, the present and future in Uganda’. In addition, the symposium was also intended to keep abreast of emerging issues and new trends in a globalised world. The meeting was attended by academia, government institution officials, civil society, researchers and students.
Welcoming participants to the symposium, Professor Damalie Nakanjako – Principal, MakCHS reiterated the aim of the meeting, ‘to review the past, present and future health professions education in Uganda’. Professor Nakanjako stressed the importance of balancing teaching, service delivery and teaching as the three legs of the stable African stool and foundations of HPE. She traced the history of the college since establishment in 1924 as the oldest health training institution in the region and highlighting the major milestones and innovations of MakCHS. ‘The college has a long and distinguished history in health education: it has been involved in health innovations, research, case management, modeling impact and has addressed: infectious diseases and non-communicable diseases” she added. Prof. Nakanjako thanked HEPI and ACHEST for the support given to MakCHS in organising the symposium. The Principal invited the Chief Guest to give his opening remarks.
Professor Mukadasi Buyinza – Director, Research and Graduate Training at Makerere University represented the First Deputy Vice Chancellor/ Academic Affairs, Prof. Umar Kakumba as Chief Guest. In his remarks, Professor Buyinza commended MakCHS for organising the symposium bringing together senior and junior health professionals noting that, ‘There is need to build sustainable health profession networks that serve as forums to share innovative ideas and learning’. He added ‘quality should be considered a priority and we need to focus on professionalism, inclusiveness, communication, etc. in order to promote health education’. Professor Buyinza highlighted the role of Makerere University as we celebrate 100 years noting that during the pandemic, Makerere University responded adequately in a multitude of areas: and advised that moving forward with lessons from the pandemic, we must promote fundamental health education. He applauded the champions behind the HEPI and ACHEST who supported the meeting noting “this is great because for sure times have changed with the Covid-19 pandemic has been a great lesson calling for different approaches in order to strike a balance and this can only be possible with partnerships”. Professor Buyinza called on government and partners to increase funding for health professions education adding that “Investment in education of training of health workers with a weak mindset, will not give us the quality health care and service we require thus a positive attitude among health professionals should be part of their education”. He reiterated that new emerging issues like tele-medicine are here to stay and thus health professionals should be equipped with the competencies to handle them. He also encouraged that we must give back to society and MakCHS is challenged to remain as leader in training health workers. Prof. Buyinza officially opened the meeting thanking the organisers and wished the participants fruitful deliberations noting that he looks forward to receiving the report from the symposium.
Speaking on behalf of the organisers, Professor Sarah Kiguli, Principal Investigator – HEPI welcomed participants to the symposium thanking them for accepting the invitations. She thanked Professor Francis Omaswa, Executive Director – ACHEST for the proposal to hold the symposium and agreeing to partner with MakCHS is hosting the meeting. “I thank previous leaders on whose work we are building what we do today. We can’t advance HPE without strong partnerships: We need to establish and sustain the collaborations”, Professor Kiguli added. She also highlighted the objectives and successes of the HEPI Project so-far.
Deliberations at the meeting were aligned along two panel discussions preceded by keynote speeches by preeminent health professionals; Professor Francis Omaswa and Professor Nelson Sewankambo.
In his keynote speech titled, ‘The Global Health Workforce Crisis: the role of Academic Institutions’, Professor Francis Omaswa shared the global statistics for health professions training and patient ratio noting that it’s not a good picture. He highlighted that populations globally are living longer and require health services. However, in the global north there are less young people to train as health professionals thus recruiters are looking to the global south, Africa and Asia are most affecting because our trained health workers are migrating due of poor pay. On Africa Uganda specifically he said “there are shortages in Africa but our professionals are recruited to serve elsewhere. We don’t have money to employ health workers despite the increasing population”. Professor Omaswa gave the critical success factors for better health services and HPE in Africa including: Political Commitment and good governance; Workforce planning and Enabling Environment. He also proposed key competencies for today’s health work, these are: Work where services are most needed; Respond to health needs of community; Deliver quality care; Clinical excellence; Be leaders and change agents; Self-directed learners and Effective communicators. Professor Omaswa advised that there must be strong link between the health system and health profession education institutions adding ‘stop grumbling and start acting, when we act together we will go much further and achieve more. Let this symposium be the beginning of us as change agents’.
Panelists to discuss Professor Omaswa’s presentation were Professor Elsie Kiguli-Malwadde, ACHEST; Professor Jehu Iputo (Busitema University); Professor Joel Okullo (Uganda Medical and Dental Practitioners Council, Professor Sarah Kiguli (HEPI/MakCHS) and Representative from National Council for Higher Education. A key issue raised from the panel discussion was the need for a link between stakeholders in the HPE sector and a call for education institutions to plan their teaching programmes in response to the health sector.
In his keynote speech titled “Health Professions Education (HPE) in Uganda, past present and future”, Professor Nelson Sewankambo noted that the current curriculum is old and doesn’t reflect health & disease prevention adding that we need to strike a balance between curative, health services & disease prevention. Prof. Sewankambo urged lecturers and staff in health institutions to help the young generation, students in particular, “let’s take the young people by hand to strengthen the future generation, we are not doing what we are supposed to do”, he added. Professor Sewankambo also called for closer working relationships between teaching hospitals and health profession training institutions and echoed Professor Omaswa’s call that staff stop lamenting and get to work.
Panelists to discuss Professor Sewankambo’s presentation were Professor Josephine Namboze, the first female doctor trained at Makerere University; Dr. Safina Museene, Ministry of Education and Sports; Professor Pius Okongo, Health Service Commission and Ms. Elizabeth Ekong Namukombe, Uganda Nurses and Midwives Council. Key issues raised from the panel discussion was a call for research to inform planning for health institutions; revision of establishments at health institutions and job evaluation to reflect current developments; and partnerships between institutions rather than competition.
A wrap-up and way forward from the meeting was presented by Professor Rhoda Wanyenze, Dean – School of Public Health. Professor Wanyenze advised that competencies for health professionals need a critical revision calling for skills aligned to current environment for the products from health training institutions. “When we train people are who are knowledgeable with a lot of theory it’s only as good as having critics, however we need to train skilled people in the health sector”, she added. She highlighted the following issues for consideration as next steps:
- Need for a national Strategy and Plan: Informed by the National Health Policy and Plan as well as emerging issues in health e.g. move towards healthier societies, revitalizing Primary Health Care to drive UHC and comprehensively address health determinants.
- a. Address the numbers, cadre mix and quality with attention to current gaps in development of some professions e.g. nursing, dental, pharmacy, among others
- b. Network with relevant bodies to address the issues within the Qualifications Framework and MOH HRH Plan
- c. Integrate linkages between Health, Education and other relevant sectors in line with the NDP move towards multi-sectoral collaboration
- Strengthen Health Training Institutions
- a. Teaching infrastructure including space, laboratories, simulation and community labs (need collaborations with communities and other organizations for student hands-on learning), and to streamline agreements between teaching institutions and teaching hospitals.
- b. Curriculum aligned to competencies—streamline issues of standardization of curricular within the country and the EAC region, and move beyond knowledge and skills to professionalism and transformative leadership in competences, and integrate the critical components of health promotion and prevention
- c. Trainers: Numbers, mix of disciplines and expertise and quality: Comprehensive training and capabilities in teaching, research and community service as well as leadership and governance; need Education Units to support trainers and Research Units to support research management
- d. Explore inter-sectoral/Interdisciplinary programs—break the silos to appropriately prepare the trainees to work across disciplines and sectors.
- e. Governance and Systems Leadership: Functional, effective and efficient systems with relevant networks for health professional training
- f. Teaching institutions systems for appointments and promotion need a review of the definition of scholarship—beyond PhDs and publications to critical grounding in disciplines, professionalism and leadership in the field
- g. Collaborate with relevant structures within Health, Education and Finance to address the issue of scholarships for graduate students
- Collaboration and networks across universities (south-to-south, within and across countries, north-south), with training hospitals and communities
- Financing: Review and streamline models and level of financing for health training institutions and related regulatory structures such as the Professional Councils
- a. Joint training, research and service collaborations
- b. VC, Deans Forums across universities for experience sharing and joint learning
- Health professionals Forum: Annual meeting to share experiences and learnings, and joint planning as well as engagement and negotiations to improve health professions education in Uganda
- Standards, Quality Assurance and Regulation: Adequately resources and effective regulatory structures and systems—address issues of curricular and examinations standardization and implementation
- Research: Modeling of health workforce needs to inform planning and a review of the state of health in Uganda
- Arrange a follow-up stakeholder meeting to synthesize and follow-up on the actions
Health
Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet
By Joseph Odoi
A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.
This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.
Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”
‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.
Innovation details
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
“While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.
HOW THE SAFEBANGLE TECHNOLOGY WORKS
The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.
All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.
Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.
A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)
| Key Findings | Lessons learned |
| Prevalence of GBV. – Overall prevalence: 34.1% of women and girls reported experiencing GBV. – Among adolescents (15-19 years): Over 50% reported experiencing GBV. | – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors. – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises. – Economic independence proved crucial, enabling women to leave abusive environments. – Involving men and boys as allies in GBV prevention efforts is essential. |
| Age-related trends | – GBV prevalence tends to decrease with increasing age. |
| Physical and health consequences. | – Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access. – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS. |
| Social and economic impact. . | – GBV contributed to family breakups, strained marriages due to financial stress. – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation. – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations. – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment. |
| Psychological effects | – Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse. |
| Long-term effects | – Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues. |
Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.
Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.
One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).
Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.
Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.
Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.
Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.
Lessons learned
The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.
Recommendations
To address GBV against women and girls, the researchers recommend the following moving forward;
- There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
- Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
- Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
- Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
- Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
- Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
- Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
- Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
- Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
- Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
- A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
- Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.
MORE ABOUT THE STUDY
The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof. Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.
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