Uganda has made notable progress in increasing coverage of Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services over the past two decades, but overall progress remains uneven due to inadequate investment and funding for health, fragmented and disorganized healthcare systems, gaps in evidence-based policy, and weaknesses in policy implementation.
In an effort to catalyze policy improvement in Africa, the International Development Research Centre (IDRC) of Canada and the Malaysia-based United Nations University International Institute of Global Health (UNU-IIGH) have agreed to co-fund a program of work aimed at promoting Maternal, Newborn, Sexual and Reproductive Health (MNSRH) policy improvement and development in five African countries, including Uganda.
On Wednesday 18th January 2023, a partner engagement meeting was held in Kampala to conduct a situational analysis of the Reproductive, Maternal, Newborn, Child, and Adolescent Health (RMNCAH) services in Uganda and discuss challenges in policy formulation, implementation, and evaluation.
In his opening remarks, Prof. Charles Ibingira highlighted the challenges in policy formulation, implementation, and evaluation in RMNCAH services.
“Our targeted outputs are; updated/improved versions of existing policies, or new policies, an improved MNSRH research-policy-practice system (including better coordination and communication between commissioners, producers, and users of research), case studies of catalyzing policy improvement in Africa – CPIA model, and two structured courses for a cohort of young professionals in policy analysis and implementation research,” Prof. Ibingira highlighted.
Prof. Charles Ibingira, the team lead on the project takes notes during the RMNCAH partner’s engagement.
The session was moderated by Professor Elizeus Rutebemberwa, the Deputy Dean, School of Public Health assisted by Dr. Josaphat Byamugisha, of Obstetrics & Gynecology and the Director, Makerere University Health Services with assistance from Professor Lynn Atuyambe.
Professor Elizeus Rutebemberwa, the Deputy Dean, School of Public Health moderates the session.
According to Dr. Sarah Byakika, the Commissioner Health Services Planning, Financing, and Policy at the Ministry of Health, there is a need to evaluate program indicators on a regular basis.
“The challenge is that when it comes to monitoring and evaluation, and following up on why we are not achieving targets, there is a big gap. We produce annual sector performance reports but don’t give time to reviewing this performance. People always just go back home and wait for the next report,” remarked Byakika.
Further adding; “We are good at designing policies but are struggling when it comes to learning from them.”
Dr. Sarah Byakika, the Commissioner Health Services Planning, Financing, and Policy at the Ministry of Health.
Dr. Moses Walakira, the family planning program specialist at the United Nations Population Fund (UNFPA) decried the absence of a joint multi-sectoral action plan when it comes to addressing RMNCAH issues.
“How do we work collaboratively to address structural barriers? Who are the gatekeepers? And how do we target them together? Harmonization of perspectives and commitments at different levels is so important, otherwise, we shall remain fragmented in our policy implementation,” said Dr. Walakira.
Dr. Moses Walakira, the family planning programme specialist at the United Nations Population Fund (UNFPA).
Ms. Friday Madinah, a Senior Youth Officer from the Ministry of Gender, Labour and Social Development, advises that when dealing with issues related to young people, women, children, and people with disabilities, the Ministry of Health should involve the Ministry of Gender, Labour, and Social Development, as they also have the necessary linkages and structures to assist in implementing these policies.
Ms. Friday Madinah, a Senior Youth Officer from the Ministry of Gender, Labour, and Social Development speaking at the event.
“When issues of young people, women, children and even those of people with disabilities are being handled, it is mostly the Ministry of Health taking charge yet we at the Ministry of Gender, Labour and Social Development also have the linkages and structures to help in implementing these policies. Please bring us on board, and make use of our competencies in these areas,” says Madinah.
Dr. Olive Sentumbwe, Family Health, and Population Adviser, at the World Health Organization (WHO), also underscores the need for a platform for the RMNCAH team to utilize in discussions with the other key players in regard to the kind of support they can provide.
Dr. Olive Sentumbwe, Family Health and Population Adviser, at the World Health Organization (WHO) speaks at the partners engagement.
“The platform is crucial when it comes to accountability; following up/asking other sectors, and Ministries whether our policies and action points are being implemented. We also need different platforms at the different levels of government so there is an understanding of policies and their implementation processes by the different beneficiaries,” she said.
According to Dr. Jessica Nsungwa, the Commissioner for Maternal and Child Health at the Ministry of Health of Uganda, accountability ought to be mutual in order for policies to be successful.
“Government should be accountable to its people, but the people also need to be accountable to the government. For example, we bought a bunch of COVID-19 vaccines using government money but people refused to come for them and some of those doses ended up expiring,” Dr. Nsungwa attests.
Dr. Jessica Nsungwa, the Commissioner for Maternal and Child Health at the Ministry of Health of Uganda.
The Minister of Health Dr. Jane Ruth Aceng reported in June 2022 that 2.6 million doses of the COVID-19 vaccine expired due to a lack of interest and misinformation. This highlights the need to improve cooperation and coordination between the public, private sectors, and community to improve access to maternal, newborn, sexual, and reproductive health.
Participants holding a discussion at the RMNCAH partners’ engagement meeting.
Hon. Dr. Bhoka Didi George, a public health specialist, area MP for Obongi County in Obongi District, and a member of the Committee on Health in Parliament reminded the team that the current public health law in Uganda is obsolete, dating back to the 1930s.
“From a legal and regulatory framework point of view, there is a lot of room for improvement. What we have is a national policy, not a law. Therefore, we cannot hold the government accountable in case they fail to deliver on Maternal, Newborn, Sexual, and Reproductive Health for example. We need an enabling legal and regulatory framework,” Hon. Dr. Bhoka.
Hon. Dr. Bhoka Didi George, a public health specialist, area MP for Obongi County in Obongi District, and a member of the Committee on Health in Parliament.
Dr. Richard Mugahi Adyeeri, the Assistant Commissioner Ministry of Health in charge of Reproductive Health advises the localization of policies to suit Uganda’s population needs at the implementation of RMNCAH services.
“One district with five million people, but only one DHO [District Health Officer] can’t have the same issues as a district with only 60,000 people for example. Let us have policies that are not only culturally, but also socially sound,” Dr. Mugahi said.
Dr. Richard Mugahi Adyeeri, the Assistant Commissioner Ministry of Health in charge of Reproductive Health.
Prof. Ibingira stresses that the engagement was quite central to the responsibility of individual stakeholders, which is proper service delivery for the health improvement of Ugandans.
“You have given us a lot of information on the issues we are tasked with, regarding policy formulation and implementation. We are now going to do the analysis by looking at the different existing policies so we can come up with strategies instrumental to accelerating policy improvement. We hope a lot is going to change, and that other countries will learn from us. Thank you very much,” Prof. Ibingira.
The CPIA partnership operates in five countries and is coordinated by the UNU-IIGH, which leads to the conceptualization and evaluation of the program’s model. Makerere University leads the implementation of the CPIA model and operational plan in Uganda, and the project aims to benefit staff and students through visiting fellowships, internships, and Ph.D. research opportunities.
Students and researchers from Makerere University and other institutions pitched 12 innovations addressing challenges in healthcare, clean energy, agriculture, waste management and community resilience during the inaugural Falling Walls Lab Kampala, held at the School of Public Health Auditorium, Makerere University.
The competition brought together emerging innovators to present solutions to practical challenges through a three minute pitch, followed by questions from a panel of judges.
Modelled on the Falling Walls format that originated in Berlin, the event required each participant to identify a “wall” a problem or barrier, and demonstrate how their innovation seeks to break it down.
Mudhasi wins with newborn jaundice screening device
Andrew Mudhasi of Makerere University emerged as the overall winner with a score of 90 per cent for a low cost medical device designed to improve newborn jaundice screening across different skin tones.
Overall competition winner Andrew Mudhasi (left) receives his first Place award certificate for his innovation
Mudhasi explained that the device uses optical sensor technology and a skin tone targeting algorithm to provide a rapid reading, with the aim of helping nurses and clinicians identify jaundice more efficiently.
During questions from the jury, Mudhasi said the device had not yet been tested on actual babies but had undergone laboratory testing using simulated skin tones.
He reported an accuracy rate of 94 per cent when the device was compared with laboratory spectrophotometers.
The innovation is intended initially for use in clinics and hospitals, with Mudhasi saying the team is also considering a version that could eventually allow mothers to screen babies at home.
Mudhasi’s innovation has previously received recognition at the African Business Concept Challenge and the iF Design Student Award, according to his presentation.
Rhonda’s innovation tackles diaper waste
Rhoda John of the University of Nairobi emerged in second place with 89.6 per cent for an innovation addressing the problem of used diaper waste.
Rhondah John pitches her innovation repurposing diaper waste into soil moisture retention
Under the theme “Breaking the wall of diaper waste and drug soils,” Rhonda explained that her team extracts sodium polyacrylate, the absorbent polymer found in diapers, and replaces the sodium with potassium.
The resulting potassium based superabsorbent material is designed to act as a “water battery” in soil by absorbing and retaining water for plants during dry periods.
John said testing showed a 99 per cent increase in germination and a 23 per cent increase in drought resistance.
The innovation also seeks to reduce the amount of used diapers ending up in landfills and the environmental effects associated with their decomposition.
During the question and answer session, John explained that her team was working with government environmental officials in Nairobi on a pilot collection system to address the challenge of gathering used diapers at scale.
Mahera takes third place with herbal peptic ulcer treatment
Stuart Mahera of Makerere University finished third with 86.2 per cent for a herbal formulation targeting peptic ulcers.
Stuart Mayira (left) receives his 3rd Place award certicate at the school of Public Health Auditorium.
Presenting under the theme “Breaking the wall of Nature and Modern Medicine,” Mahera argued that conventional treatment for peptic ulcers can involve multiple medicines and may be associated with side effects and antimicrobial resistance.
His proposed formulation, MARAC capsules, is intended as a monotherapy, combining properties required for peptic-ulcer treatment in a single capsule.
Mahera said his team had carried out quality control work, including characterisation and dose quantification, and had conducted preclinical trials on laboratory mice.
He also told the jury that an application had been submitted to the National Drug Authority as the team awaits the next stage of the regulatory process.
According to Mahera, the proposed seven day treatment would cost about Shs21,000, compared with the existing 14 day treatment approach.
Innovators present solutions to practical challenges
The remaining presentations covered a wide range of challenges.
Esther Nakungu of Utamu University presented Agri-Track, a digital record keeping solution intended to improve visibility, accountability and management of farm operations and financial information.
Dr. Jimmy Chachiga, a Makerere University participant, presented a solar photovoltaic cooker with a heat storage system designed to provide a cleaner and more reliable cooking option during both sunny and non sunny periods.
His presentation focused on reducing dependence on biomass fuels and addressing the challenges associated with intermittent solar energy.
Abdul Noor Luttamaguzi, a PhD student and senior government fisheries officer, presented a mobile application aimed at helping fish farmers and extension officers report, track and manage disease outbreaks.
Henry Duke Tamale presented a herbal cream targeting antibiotic resistant biofilm infections associated with diabetic foot ulcers.
Marvin Seruwu proposed adapting existing near infrared brain monitoring technology to help detect extra-axial brain bleeds in health facilities where access to CT and MRI equipment is limited.
His proposal seeks to repurpose existing technology towards a diagnostic need that could be particularly important in settings where advanced imaging facilities are not readily available.
Kennedy Kisame presented a poultry alert and diagnosis system combining satellite weather information with computer vision disease detection. The proposed system could be accessed through a smartphone application, SMS or USSD, making it potentially usable by farmers with limited internet access.
Frank Atwiine proposed a solar powered mobile diagnostic van designed to bring ultrasound and other diagnostic services closer to rural communities.
Johnson Makmot, a software and blockchain developer, presented a platform that combines GPS tracking and blockchain-based tokens to incentivise and verify plastic-waste collection in Kampala.
Dr. Nelson Ndugu, from a partner university, presented an artificial intelligence tool designed to translate agricultural research publications into local Ugandan languages and generate voice notes for radio-based extension delivery.
The final presentation came from Dr. Juliet Akola, a Ugandan post doctoral researcher at Mangosuthu University of Technology in South Africa.
Akola presented a community digital resilience initiative focused on mapping risks in Kampala’s informal settlements, including flooding, fire, poor sanitation, waste management and inadequate infrastructure.
Her proposal seeks to combine local community knowledge with geographical information systems and link identified risks to action plans involving municipalities and other stakeholders.
Nawangwe calls for more investment in innovation
Closing the event, Prof. Nawangwe congratulated all the participants and described their presentations as an important beginning for Makerere University, Uganda and the wider region.
Vice Chancellor, Prof. Banabas Nawangwe giving his remarks
Drawing on his experience attending the Falling Walls conference in Berlin, the Vice Chancellor said initiatives of this nature are important because innovation will play a major role in determining the future of countries.
He encouraged participants to make their pitches more precise by clearly identifying the problem they are addressing, explaining their proposed solution and demonstrating what they have already achieved.
Prof. Nawangwe also welcomed the participation of innovators from other universities and countries, noting that the Kampala event had attracted participants beyond Makerere.
He thanked the Africa Office of the Falling Walls Foundation for its role in bringing the initiative to Makerere and encouraged continued support for innovation.
The Vice Chancellor further linked innovation to Uganda’s growing youth population and the need to develop home-grown solutions to address challenges such as youth unemployment.
The inaugural Falling Walls Lab Kampala ultimately provided a platform for innovators to move ideas beyond the classroom and laboratory and demonstrate how research, technology and creativity can be applied to challenges affecting communities.
What will it take for Uganda’s health financing to match the scale of its ambitions? How does a nation ensure that the systems it builds are ones the government can fully own, sustain, and grow? And who are the leaders being shaped today to carry this work into the future?
The inaugural issue of the Makerere University School of Public Health (MakSPH) newsletter follows these questions through six months of research, partnership, and institutional growth. Inside: MakSPH’s role in the national dialogue on sustainable health financing; the milestone handover of 16 MakSPH-METS digital health systems, built over 15 years, to Ministry of Health stewardship; and the research and academic investment shaping the School’s next phase of growth.
The edition also covers Vice-Chancellor’s Research Excellence Awards for MakSPH faculty, a new CARTA doctoral cohort, progress on the School’s new building, fresh leadership in the Department of Disease Control and Environmental Health, expanding partnerships in malaria, environmental health, and maternal care, and MakSPH students stepping into leadership across Makerere‘s 92nd Guild Government.
Research has the greatest value when it moves beyond publication to improve lives.
At Makerere University’s Centre of Excellence for Maternal, Newborn and Child Health (MNCH Centre) housed at Makerere University School of Public Health, research, partnerships and innovation are being translated into action to strengthen reproductive, maternal, newborn, child and adolescent health (RMNCAH) in Uganda and beyond.
Welcome to the September MNCH Centre e-Post 135.
This month, we spotlight how evidence is informing action across reproductive, maternal, newborn, child and adolescent health (RMNCAH) at the centre.
Explore how Centre researchers and partners are advancing innovations to reduce early perinatal mortality, how Makerere University through the Centre and WHO are strengthening capacity to monitor health inequalities, and how the Centre and its partners are leveraging AI to strengthen health systems and improve malaria surveillance.
Discover what these innovations could mean for scale, stronger health systems and greater impact.