Health
Genetics & Genomics Research Dissemination; Makerere Bioethicists Emphasize the Importance of Community Engagement
By Joseph Odoi
As Genetics research continues growing in Uganda, Bioethicists from Makerere University College of Health Sciences have stressed the importance of community engagement, genetic counselling and Public sensitization when conducting Genetics research in Uganda.
These recommendations were made at a research dissemination workshop held on the 8th December 2022 at Makerere University College of Health Sciences.
While presenting findings of the ELSI-UG project titled “Ethical and social issues in informed consentprocesses in African genomic research”, the Project Principal Investigator -Associate Professor Mwaka Erisa Sabakaki from College of Health Sciences, Makerere University in a special way welcomed participants to the dissemination. He noted that involving communities in genetics and genomics research is very important when it comes to enhancing the understanding of genetics and genomic information by the general public.
‘’There has been an exponential increase in genetics and genomic research in the last two decades.
However, this field of research is complex and is poorly understood by various research stakeholders. One way of enhancing understanding of genetics and genomic information by the general public is through community engagement. It is therefore crucial that communities are meaningfully involved in research processes right from conception. Community engagement provides a two-way communication channel through which researchers gain better understanding of community priorities, preferences, traditions, practices, and cultural sensitivities.’’ explained Prof. Mwaka.
He equally highlighted the need for translation of scientific language into local languages, genetic counsellors and consent in Genetics research adding that community engagement is crucial in building equitable research collaborations and trust between researchers and research communities.
Genetic and Genomics
According to National Institute of General Medical Sciences, Genetics is the scientific study of genes and how certain qualities, conditions or traits are passed from parents to their off springs. Genomics on the other hand involves using information about genes to: identify genetic disorders including future diseases so that doctors tailor treatment for individuals.
In same spirit, Dr. Moses Ochan, the Vice Chairperson of the Makerere University Research and Ethics Committee stressed the importance of sensitization of communities and researchers before any study is undertaken. According to him, sensitization enables communities understand the advantages and disadvantages of participating in a study thus making informed decisions.
In this United States National Institutes of Health funded study that sought to explore the knowledge,perceptions and experiences of stakeholders; researchers, bioethicists, REC members, research participants and caregivers/guardians on the informed consent process, and the ethical, legal and social implication of genomic research, 243 protocols were analyzed involving both local and international researchers
Findings
Return of individual genetic results to research participants
- Of 122 parents/caregivers of adolescents in the study, 77.1 % expressed the desire to receive all results of their children’s genetic/genomic results.
- 71.3 % of parents/caregivers agreed that children should be able to take part in research testing for genetic conditions that begin during childhood, even if there is no treatment that can alter the course of the condition
- 85.3 % of parents/ caregivers expressed the desire to know genetic research results about children to see if they are more likely to get a disease in the future.
- 71.3 % of parents/ caregivers agreed that Children should be able to take part in research testing for genetic conditions for which there is a treatment that begins during childhood that can alter the course of the condition
- 62.3 % of parents/ caregivers agreed that children should be able to take part in research testing for genetic conditions that start in adulthood and have no treatment that can alter the course
- 89.4 % of parents/ caregivers agreed that children should be able to take part in research testing for genetic conditions that will arise in their adult years, only if there is treatment or prevention that should begin in childhood
On the most important issues parents should consider in deciding whether or not to get genetic research results, 81.2% cited distress knowing that there are potential problems for other family members. Additionally, 45.0 % of parents and caregivers noted that receiving their child’s genetic results might worry their family; and 27.8% worried about stigma and discrimination
To address this, 69.2 % of parents and care givers said genetic counselling should be offered prior to a sample being taken to do genetic research
On perceptions on returning individual results of genomic research, parents and caregivers indicated that It is the researchers’ moral obligation to return clinically significant results; as such, genetic results should be communicated to them by the study doctor. Most parents preferred being informed first before involving the children; and some mothers expressed the desire to exclude the child’s father from these discussions until they (mothers) have understood the implications of the results in question.
On the role of children in making decision makings on whether to regarding return of genetic results or not, there was no consensus on the ideal age for disclosure of results. Some parents and caregivers pointed out that involvement of children in these discussions should depend on child’s character, level of understanding and ability to cope with the implications..
On handling findings that have familial implications, there were mixed feelings about involving other family members. Parents, especially mothers expressed fear of attribution. They thus suggested that the biological parents of the child should be the first ones to receive these results and then decide whether to involve other family members.
On the perceived challenges to return of results, parents and caregivers cited protracted delays in communicating genetics/genomics results; difficulty in tracing the child’s family, especially when the parents die and they are being cared for by other caregivers; risks of knowing unpleasant findings and paternity disputes.
Parents and caregivers offered several suggestions for the safe return of results of paediatric genomic research and these included the need to organize peer support and sensitization activities for adolescents participating in genetic studies; feedback of results should be done by a multidisciplinary team comprising of clinicians, genetic counsellors, the child and parents. All concurred that other family members should be involved at a later stage.
Informed consent and sharing of biological samples in collaborative genomic research and biobanking
On consent to future use of samples, 88.8% of the 187 researchers that participated in the study indicated that there is need to provide donors with the option to consent. 62% indicated that informed consent forms should include multiple options regarding the types and conditions of future research for which the samples may be used (tiered consent). 6.2% said that participants should only consent for the current study, and any future studies on the stored samples would require re-consent. However, the majority of researchers felt that the need to reconsent places an unacceptable burden on the researchers (62%) and is prohibitively costly (59.4%)
On informed consent experiences and practices, it was found that most principal investigators (12/15) were not well conversant with the informed consent procedures of their respective studies because they delegate this to study coordinators and nurses/nurse counsellors. Most nurses/nurse counsellors lacked basic knowledge and understanding of genetics, including the risks of genetic research.
On Information disclosure, researchers noted that genetic research is complex and oftentimes research participants do not adequately understand the information disclosed them during the consenting process. They thus recommended the use of an iterative approach that encourages consultation with family and/or people research participants trust, use of simple language, use of visual aids and other media, and objective assessment of comprehension. The also reiterated the need for translating informed consent documents into local languages and the use of peer educators. Researchers emphasized the role of community engagement in community education and sensitization, ensuring that researchers respect local cultural values and beliefs, and dispelling of superstitions and misinformation.
- The perceived challenges to the informed consent process included, the poor quality and inaccuracy of translations of ICF into local languages, inadequate understanding of informed consent, limited understanding of genetics by communities and some research team members, lack of professional genetic counselling services in Uganda, and mistrust of foreign collaborators.
On Export of human biological materials (HBM), researchers had a positive attitude towards the export of samples and expressed a desire for collaborative partnerships in genetics/genomic research and bio banking that are characterized by mutual respect and equity. However, they raised several concerns:
- They seem not to be well conversant with the guidance provided by the national ethics guidelines on bio banking and
- They all concurred that material transfer agreements (MTA) are key in the transfer of human biological materials across the national borders. However, they surmised that these MTA are unfair and tend to favour international Collaborators. They felt that local researchers and research institutions are not empowered enough to bargain favorably during MTA negotiations. They also indicated that the national ethics guidelines are vague on role of RECs in MTA and data sharing agreement development. Furthermore, they indicated that Uganda lacks appropriate enabling ethical and legal frameworks to protect the interests of local scientists and research institutions
- On sharing of the benefits of research, the researchers felt the ground was not leveled and there was neither equity nor fairness in sharing of GBR benefits in international collaborative research. They attributed this to the lack of scientific integrity and questionable research practices by collaborating researchers, lack of effective communication between collaborating partners, denial of access to shared data and samples by Northern collaborators, and felt that the oversight function of UNCST during MTA implementation is limited.
To address the issues at hand around genetics and genomics research, they made the following recommendations;
Recommendations to enhance comprehension of informed consent for genetic/genomic research and biobanking
- Escalating community engagement: to sensitize the general public and educate them on genetics research and its implications
- Iterative approach to informed consent where participants are given ample time to read/be read to consent information, ask questions, make consultations with family and trusted persons
- Encouraging the use of simple language and various media during information disclosure.
- There is need for harmonization of translations. A dictionary of translated key scientific and medical terms/concepts in research and clinical care in local languages should be developed
- Develop specific national guidelines for genetic and genomic research in Uganda.
- Research ethics committees should be trained in the basics of genetic research in order to ensure that they appreciate the ELSI and are competent enough to review genetic research.
- The use of checklists for assessing understanding of consent should become mandatory and should also be included in the national ethics guidelines.
- All stakeholders should read and understand the available national and international guidelines, policies, and regulations pertaining to genetics/genomic research and bio banking before negotiating Material transfer agreements.
- Research ethics committees should be empowered to review and monitor the execution of MTAs during research implementation, and this should be clearly stipulated in the national ethics guidelines.
- The national research regulators and individual institutions should join forces and devise mechanisms for tracking and monitoring the use of exported HBM and data.
- Encouraging meaningful involvement of communities in Material transfer agreements negotiations, particularly regarding sharing of the benefits of research.
- There should be capacity building for clinical genetics, particularly clinical geneticists and professional genetic counsellors
- Community engagement activities should be scaled up to prepare communities for the return of genetic research results as and when they are available
More about the Project
This project explored the knowledge, perceptions and experiences of stakeholders on the informed consent process, and the ethical, legal and social implication of genomic research. The goal of the project was to contribute to a better understanding of the ethical legal and societal issues associated with genomic research in low resource settings. The study employed both quantitative and qualitative methods of data collection and analysis. Prospective evaluation was done using questionnaire surveys; focus group discussions; in-depth interviews; direct observation of informed consent processes; and assessment of the quality of informed consent
This study was funded by United States National Institutes of Health through The Human Heredity and
Health in Africa (H3Africa) initiative which is spearheading bio banking and genomics research in Africa for Africa.
The study was conducted between November 2018 to 2022 by a team of researchers led by Associate Prof. Erisa Mwaka as Principal Investigator.
Research team:
- Associate Prof. Erisa Mwaka
- Dr. Ian Munabi
- Assoc. Prof. Joseph Ochieng
- Dr. Janet Nakigudde
- Prof. Nelson Sewankambo
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.
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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