By Samantha Agasha and Davidson Ndyabahika
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.
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.
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. 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.
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.
“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.
“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.
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.
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.
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.
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.
Mak’s GMI Labs Authorized to Conduct DNA Paternity Testing
The Genomics, Molecular, and Immunology Laboratories (GMI Labs), operating under the auspices of the Makerere University Biomedical Research Center (MakBRC), have achieved another significant milestone in their journey of diagnostic excellence. The labs, renowned for their pivotal role in infectious and non-infectious disease research, have received official approval from the Director General Health Services at the Ministry of Health (MoH), Uganda, to conduct DNA Paternity Tests.
Situated at the Dept of Immunology & Molecular Biology under the School of Biomedical Sciences at the College of Health Sciences, Makerere University, the GMI Labs have been at the forefront of cutting-edge research, diagnostic testing, and training initiatives. Their remarkable contributions during the COVID-19 pandemic, where they conducted nearly a million PCR tests, underscored their unwavering commitment to public health and scientific advancement. The labs’ exemplary performance and reliability were further highlighted by their successful management of two critical COVID-19 prevalence surveys. The findings of these surveys served as foundational data for crucial decisions guiding the country’s lockdown strategies and phased reopening, earning commendation from the President and the Ministry of Health.
This latest authorization from the Ministry of Health marks a significant expansion of the GMI Labs’ diagnostic capabilities. With the approval to conduct DNA Paternity Tests, the labs are now equipped to offer a crucial service addressing the need for accurate and reliable genetic testing for determining biological parentage. In a letter dated 22nd November 2023, the Director General Health Services emphasized the laboratory’s rigorous adherence to international standards, proficiency in molecular biology techniques, and their proven track record in delivering precise and credible results. This approval further solidifies the labs’ position as a trusted institution for advanced genetic diagnostics in Uganda.
Prof. Moses L Joloba, the Director of the GMI Labs, expressed immense pride in the team’s dedication and expertise that led to this authorization. He highlighted the labs’ commitment to upholding the highest standards of ethical practice, confidentiality, and accuracy in DNA paternity testing, ensuring the delivery of dependable results crucial for legal, personal, and familial purposes.
The inclusion of DNA Paternity Testing within the GMI Labs’ list of services aligns with their overarching goal of advancing healthcare through state-of-the-art diagnostics, research, and education. This milestone represents not only a significant achievement for the labs but also a valuable resource for individuals seeking reliable and comprehensive genetic testing services. As the GMI Labs continue their unwavering commitment to excellence in healthcare and research, this new capability reaffirms their pivotal role in advancing the frontiers of molecular diagnostics and genetic testing in Uganda, working closely with reputable institutions such as Makerere University Hospital and other top-notch health facilities.
MNCH e-Post Issue 121: Learning from Nsambya Hospital Human Milk Bank to inform national scale-up & save preterm babies
Welcome to this exclusive interview with Prof. Peter Waiswa, lead expert from the Makerere University Centre of Excellence for Maternal, Newborn, and Child Health. Dr. Victoria Nakibuuka from St. Francis Nsambya Hospital, and Dr. Jesca Nsungwa from Ministry of Health Uganda. In this video, they discuss a groundbreaking innovation in Uganda’s healthcare landscape: the country’s first-ever human milk bank at St. Francis Hospital Nsambya. This initiative represents a significant stride towards improving the survival rates of premature and vulnerable infants by ensuring access to essential breast milk, even when mothers are unable to produce enough. Watch Video
METS Newsletter October 2023
The Monitoring and Evaluation Technical Support (METS) Program is a 5-year CDC-supported collaboration of Makerere University School of Public Health (MakSPH), the University of California San Francisco (UCSF) and Health Information Systems Program (HISP Uganda).
Highlights of the METS October 2023 Newsletter
- Strategies for Enhanced Disease Surveillance and Public Health Response in Uganda
- The MoH Department of Integrated Epidemiology Surveillance & Public Health Emergencies (IES&PHE) Head, Commissioner Allan Muruta (Dr) visited METS to acquaint himself with the various surveillance activities supported by the Program.
- Commissioner Muruta emphasized the need to build the capacity of districts and regions to conduct surveillance activities by training the relevant staff and establishing surveillance focal points at health facility levels.
- He further emphasized the importance of linking laboratory data to the District Health Information System (DHIS2) and ensuring that different systems are interoperable.
- Improving quality of data for HIV testing services (HTS) through regular assessments
- MoH has been conducting Data Quality Assessments and Improvement (DQAI) activities to inform program planning, monitoring, and performance management. HIV testing services (HTS) inter was conducted in 16 regions, 81 districts, and 111 health facilities in partnership with 26 Implementing partners.
- The HTS DQA has improved data management, infrastructure, and understanding of indicators. Specific staff assignment at each HTS entry point has proven effective, and use of the UgandaEMR system for reporting has yielded positive results.
- Shaping Uganda’s Healthcare Data Landscape
- METS has maintained a strong collaboration with the Ministry of Health (MoH) providing invaluable technical support in developing various strategic guidelines for the country. These guidelines include the Uganda Health Information Exchange and Interoperability (HIE) Guidelines, the Uganda Health Data Protection and Confidentiality (HDPC) Guidelines, and the Uganda Health Data Sharing, Access, and Use Guidelines.
- HIE and HDPC guidelines have received the endorsement of the Health Information, Innovation and Research (HIIRE) Technical Working Group (TWG), awaiting presentation to the senior management team at the MoH for final approval.
- Empowering Health Professionals: PrEP Training in Hoima District
- MakSPH-METS has taken a proactive stance in supporting Monitoring and Evaluation (M&E) for key populations through the development, management, and conducting trainings on the use of the PrEP tracker system across various agencies.
- METS conducted a 5-day training on the KP/PrEP Tracker system in Hoima district. Moving forward, facility staff will be able to enter data on PrEP services into the system in a timely manner, analyze the data, and use it for program improvement.
- HIV testing services (HTS) Data Quality Assessments and Improvement DQAIs
- Interagency cervical cancer on-site mentorships
- Orientation in KP tracker-Soroti
- TDY from CDC headquarters visit to METS
- M&E orientation meetings for new Implementing Partners
- Planning meeting for Cross Border Data Sharing-Busia
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