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Mak School of Public Health, Ministry of Health to Conduct National Mental Health Integration Study

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As mental health gains recognition as a critical aspect of overall well-being, a pioneering study is set to delve into its integration in schools, communities and healthcare units across Uganda. 

With funding from the World Bank, this landmark study titled; “Assessing the Extent of Integration of Mental Health Services into Primary Healthcare, Community and Schools” will focus on four purposively selected districts in Uganda – Adjumani in the Northern region, Bushenyi in Western Uganda, Kapchorwa in Eastern Uganda, and Butambala in Central Uganda. 

With the potential to revolutionize mental health practices in schools, this study will through rigorous research and analysis shed light on the implementation and impact of mental health integration initiatives in schools, uncovering new insights that could shape policies and practices for generations to come.

A team of stakeholders at the Inception Meeting.
A team of stakeholders at the Inception Meeting.

Latest data from the international Burden of Disease Study indicates that mental illness and substance use disorders account for 3.35% of the total disease burden in Uganda. According to the latest WHO data, at least 7.4% of Ugandans are affected by common mental disorders particularly depression, anxiety and alcohol use disorders.

Comparable to high-income countries, depression and generalized anxiety disorders in Uganda, are prevalent at 5.3% and 4.1% respectively. Uganda ranks among the top five countries globally with the highest depression prevalence. Poverty, HIV infection, disasters, and adverse environmental conditions are factors that increase the risk and consequence of mental health conditions in Uganda.

It is against this background that the World Bank Group solicited for consultancy services for a nation-wide study to assess the extent of integration of mental health services into primary healthcare, schools and communities.

Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, stated that the study will reveal the prevalence and types of mental health issues in these settings and their impact on community well-being.

This study that will be conducted by a team of mental health experts from the Ministry of Health and Makerere University School of Public Health. This study will assess the availability, access, and quality of mental health services in PHC, communities, and schools.

The study’s Principal Investigator Dr. Nakku further emphasized that the research will assess existing services, identify gaps/barriers, and explore opportunities/challenges in integrating mental health into primary healthcare and schools. This will involve examining policies, resources, support systems, and obstacles to integration.

Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, 2023.
Dr. Juliet Nakku, Senior Consultant Psychiatrist and Executive Director of Butabika National Referral Mental Hospital, during an inception meeting of mental health stakeholders on April 13, 2023.

Over the last 20 years, Uganda has taken measures to enhance its healthcare system and promote better health outcomes for its population. In 1996, the government-initiated efforts to integrate mental health into primary healthcare, providing training for general healthcare workers to identify and address common mental health disorders.

Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health, emphasizes that there is increased risk of mental health problems among specific sub-populations, including children, the elderly, refugees, and individuals in uniform.

Dr. Lukwata asserts that the government is addressing mental health through policies that highlight its importance as a fundamental component of health at all care levels. These policies promote decentralization, integration of evidence-based services, and partnerships to increase mental health knowledge and service provision.

Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health speaks during the inception at MoH.
Dr. Hafsa Lukwata, Assistant Commissioner for NCDs and Mental Health at the Ministry of Health speaks during the inception at MoH.

She further stresses that mental health conditions impact individuals throughout their lifespan, affecting quality of life. This includes early childhood, adolescence, pregnancy, adulthood, as well as specific groups such as men in uniform, workplace populations, and the elderly who are at an increased risk for mental illnesses.

Uganda, according to Dr. Hafsa invested USD 25m in 2009 to improve mental health facilities and provide training for health workers, with support from the African Development Bank.

“We have set up several health facilities and trained numerous health workers with the support of the African Development Bank,” says Dr. Hafsa. “However, there have been no studies to assess the impact of these investments. Routine data from the Ministry of Health Management Information Systems (HMIS) indicates an increase in new patients treated for mental health conditions.”

She adds that improvements have been made to the structure of mental health care at all levels to increase the number and mix of mental health professionals.

Despite progress, as noted in the 2018 report of the Sectoral Committee on Health, Uganda still grapples with a significant mental health treatment gap of 85%, leaving only 15% of those in need with access to care. Primary healthcare facilities often refer individuals to higher-level tertiary care, and mental health stigma persists, with limited awareness among the general population, as highlighted by the World Bank.

To bridge the gap, WHO suggests integrating mental health services into PHC systems in countries like Uganda. However, challenges such as prioritization, poverty, cultural differences, health system issues, medication supply, workforce shortages, and inflexibility pose barriers to this integration.

A team of researchers, stakeholders including MoH, World Bank, at the Inception Meeting.
A team of researchers, stakeholders including MoH, World Bank, at the Inception Meeting.

Dr. Nakku acknowledges that mental health has received policy priority in Uganda, but gaps remain in delivering services at primary care, community, and school levels, leaving some populations underserved.

“Mental health problems are risk factors for various public health concerns, such as road traffic accidents and injuries. The role of alcohol and substance use in these issues is significant. Integrating mental health into primary health care may be a cost-effective solution with desirable treatment outcomes. There have been efforts to integration. We now want to assess the extent of integration into PHC, communities and schools in Uganda,” explained Dr. Nakku.

The study aims to evaluate the Knowledge, Attitudes, and Practices (KAP) related to mental health care/services among a total of 1380 individuals, including 45 students/pupils from each of the 33 schools. The assessment will focus on both teachers, learners’ senior women teachers, school nurses and matrons.

Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH outlined how the study will use qualitative and quantitative data to comprehensively understand mental health integration in Uganda. He provided specifics on the quantitative component, including the study population, sample size, sampling procedure, and data analysis plans. He stressed that the collected data will yield indicators for developing a composite measure of integration, stratified by primary healthcare, communities, and schools.

Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH speaks during the inception meeting.
Dr. Fredrick E. Makumbi, an Associate Professor of Biostatistics at MakSPH speaks during the inception meeting.

“This study is quite interesting because we have primary health care units as a study population. We shall randomly pick study participants from the villages and schools served by the health care units. We also have plans to construct an Integration of Mental Health Services/Care Composite (IMHC) based on scores from the items/indicators of integration at each of the 3 levels. Each indicator present will be scored ‘1’ else ‘0’, and a total score will be obtained as the sum of all individual indicator scores. The proportion of schools/communities/PHC facilities generated will be based on an agreed cut-off,” explained Dr. Fred Makumbi, a Co-Principal Investigator of the MHISU study.

Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study highlighting that mental health was “an integral part of our lives.” Accordingly, she stressed MakSPH’s commitment to increasing mental health knowledge through research and expressed her delight in partnering with Butabika Hospital, citing their history of effective teamwork. “The School of Public Health will document the learnings from this study and this study is not a one-off.”

Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study.
Professor Rhoda Wanyenze, the Dean and study Advisory team member expressed her enthusiasm for hosting a study.

Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences, provided insights on the qualitative component of the study during the discussion. He emphasized the purpose of describing and providing context for integration, and how the study team aims to explain trends, relationships, consistencies, and inconsistencies through the numerous question items they have put together.

“We think if we are able to go to very many sub-populations that we have marked out for purposes of collecting this qualitative data, we shall be able to provide context and meaning according to the data sources themselves so that we have better appreciation of what is going on,” says Dr. Muhwezi.

Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences.
Dr. Wilson Winstons Muhwezi, an Associate Professor in the Department of Psychiatry at Makerere University College of Health Sciences.

Dr. Muhwezi expressed excitement to be part of a study that recognizes the value of qualitative data in increasing the wealth of knowledge. “As far as I am concerned, I am very excited about this study because rarely do we get to do studies where the qualitative approach is given prominence like the quantitative approach. I think we will get good information when we come from the field.”

Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health, expressed the Ministry’s keen interest in the upcoming study on Ugandan mental health during an inception meeting chaired on their behalf. He emphasized that understanding the mental health needs of Uganda will lead to better interventions and contribute to achieving Sustainable Development Goal 3 – Good Health and Well-being.

Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health.
Dr. Oyoo Charles Akiya, the Commissioner NCDs-Ministry of Health.

According to Dr. Oyoo, Ministry of Health will support the study team and that it was eager to learn more about the study and how they can be of service. He expressed gratitude to the World Bank, MakSPH, and Butabika Hospital for their contribution to improving mental health care in Uganda.

Dr. Hafsa Lukwata speaks during the inception at MoH.
Dr. Hafsa Lukwata speaks during the inception at MoH.

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Davidson Ndyabahika

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Makerere University’s Prof. Peter Waiswa Appointed to WHO Technical Working Group on Essential Child Health Services

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Prof. Peter Waiswa (C) with participants at the World Health Regional Summit on 29 April 2026 in Nairobi Kenya. Photo: MNCH. Makerere University Center of Excellence for Maternal, Newborn and Child Health (MNCH), based at the Makerere University School of Public Health in Kampala Uganda

Makerere University’s Professor Peter Waiswa has been appointed to the World Health Organization (WHO) Technical Working Group of Experts tasked with developing the Essential Child Health Services (ECHS) framework.

The appointment, communicated in an official letter dated October 21, 2026, and signed by Dr. Pascale Allotey, Director of WHO’s Department of Sexual, Reproductive, Maternal, Child, Adolescent and Ageing Health, runs until December 31, 2027.

The technical working group will support WHO in defining a core package of essential health services for newborns, older children and adolescents, alongside practical approaches for delivering these services effectively and equitably to improve their health and well-being.

As a member of the working group, Prof. Waiswa will contribute scientific and technical expertise to the development of the framework. His responsibilities will include participating in technical consultations, reviewing draft documents, providing written feedback and contributing to consensus-building on key technical issues.

The group is expected to hold approximately five online meetings between November 2026 and mid-2027. Members will serve in their individual capacities as independent experts rather than as representatives of their respective governments or institutions.

The appointment builds on Prof. Waiswa’s longstanding service and contributions to WHO. He previously served for seven years on WHO’s Strategic and Technical Advisory Group of Experts (STAGE) on Maternal, Newborn, Child and Adolescent Health and Nutrition, with his tenure concluding in June 2026.

Congratulations Prof. Peter Waiswa.

Mak Editor

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Mak Staff Receive Prestigious International “Future of the Field” Recognition in Global Research Administration Class of 2026.

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Mr. Mordecai Tayebwa (L) and Ms. Bonny Tusiime(R)

Makerere University proudly celebrates the recognition of Mr. Mordecai Tayebwa, Senior Grants Manager, Makerere University Lung Institute and Ms. Bonny Tusiime, Grants and Contracts Officer, Makerere University College of Health of Sciences (MakCHS) as recipients of the prestigious Future of the Field Award of Society of Research Administrators International (SRAI), an international recognition that Honors emerging leaders making outstanding contributions to the advancement of research administration. This year’s ‘Future of the Field’ honorees were formally recognized at SRAI’s Annual Meeting held in Honolulu, Hawaii, USA in October, 2026.

The Future of the Field Award recognizes professionals who demonstrate exceptional leadership, innovation, and commitment to strengthening research management and administration. The award celebrates individuals whose work is shaping the future of the profession by improving research support systems, fostering collaboration, and advancing excellence in research administration.

At Makerere University, Mr. Tayebwa and Ms. Tusiime have played key roles in strengthening grants and contracts management, supporting researchers throughout the grant lifecycle, promoting compliance with sponsor requirements, and contributing to the development of sustainable research management systems. Their efforts have enhanced institutional capacity to attract, manage, and administer competitive research funding while ensuring accountability and excellence. Commenting on the recognition, the award recipients expressed their gratitude for the opportunity to contribute to the growth of research administration. “This recognition reflects not only our individual efforts but also the collaborative environment at  MakCHS and Makerere University. It inspires us to continue strengthening research administration and supporting researchers in generating impactful scientific discoveries that improve lives.” They said.

The achievement highlights the growing international recognition of research administration professionals in Africa and underscores Makerere University and MakCHS’s  general commitment to building strong research support systems that enable world-class research. This also reflects the institution’s investment in professional development and its dedication to advancing research excellence through effective grants management.

Commenting on the award, Dara C. Little, President, (SRAI) said “In a field as dynamic and rapidly evolving as research administration, the need for visionary,adaptable leaders have never been greater,” . “SRAI’s Future of the Field recipients represent the next generation of changemakers – those who will not only navigate complexity but shape the future of our profession. To embrace change, is to lead your innovation, resilience, and leadership are exactly what this moment demands. Rise to the opportunity and you will do great things!”

Makerere University congratulates Mr. Mordecai Tayebwa and Ms. Bonny Tusiime on this significant achievement and wishes them continued success as they contribute to shaping the future of research administration both regionally and globally

Zaam Ssali
Zaam Ssali

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Mayuge Study Finds NCD Risks Emerging in Adolescence, and Shows Early Action Can Help

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Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Prof. David Guwatudde, Principal Investigator (centre), and Dr. Justine Bukenya with researchers and stakeholders at the ARISE-NUTRINT dissemination meeting in Iganga, 1 October 2026.

Adolescence is a consequential period for health, when diets, behaviours and other risks can form and persist into adulthood. In Mayuge District, new evidence from Makerere University School of Public Health is showing how some of these early vulnerabilities could contribute to the later risk of non-communicable diseases (NCDs), and what can change when interventions begin early.

The evidence comes from the ARISE-NUTRINT project, a three-year EU-funded study led by Prof. David Guwatudde and Dr. Justine Bukenya. The project examines health and behavioural risks among adolescents and young adults, with a particular focus on nutrition-related NCD risks, and tests interventions designed to improve nutrition fluency and diet quality.

The work comes against a substantial NCD burden in a country where 73.2% of the population is below 30. WHO estimates that NCDs accounted for 42.2% of deaths in Uganda in 2023, while the country’s latest national NCD risk-factor survey found significant risk factors persisting in the population, with little overall change from the previous survey in 2014. Together, the evidence strengthens the case for prevention much earlier in life.

“There is strong evidence from literature demonstrating that most behavioral NCD risk factors, including nutrition-related, are established during childhood, persisting into adulthood. This may lead to development of actual NCDs if such risks are not reversed early,” Prof. Guwatudde said.

The study, he explained, linked assessment of young people’s health risks with developing responses suited to their circumstances. Since enrolling 1,206 participants aged 10–24 in Mayuge District in March 2024, the team has conducted three annual rounds of data collection, with young people and local stakeholders also helping evaluate interventions to reduce the risks identified.

Prof. David Guwatudde (right) addresses stakeholders alongside the ARISE-NUTRINT study team in Iganga on 1 October 2026.

A problem that starts early

The findings, shared with community and district stakeholders in Iganga on October 1, 2026, show that some vulnerabilities were already evident at baseline. Nearly one in three participants had anaemia, 49% had low nutrition literacy, while about one in ten reported symptoms of anxiety and a similar proportion reported depressive symptoms.

Anaemia, a condition in which the blood does not have enough healthy red blood cells or haemoglobin to carry adequate oxygen around the body, was highest among the youngest participants. Overall, 375, or 31%, had anaemia, rising to 35.7 per cent among 10–14-year-olds, compared with 18.9% among those aged 15–19 and 10.6 per cent among young adults aged 20–24.

Nutrition presented another challenge. At baseline, 49% of participants had low nutrition literacy and 13% had poor overall diet quality. Low nutrition literacy was associated with more than four times the odds of poor diet quality.

Gaps also emerged in sexual and reproductive health knowledge and behaviour. About 14 per cent of participants did not know that HIV cannot be transmitted by sharing food with a person living with HIV, 10% believed a condom could be used more than once, and 13 per cent did not know pregnancy could occur during first sexual intercourse. Among 168 participants who reported having had sex, more than half reported using no method to prevent pregnancy during their first or most recent sexual intercourse.

Mental health findings added another dimension. Anxiety symptoms were reported by 10 per cent of participants, depressive symptoms by 9.5% and loneliness by 6.3 per cent. Among 534 participants aged 13–24 assessed for suicidal ideation, 1.9% reported suicidal thoughts.

Together, the baseline findings show that vulnerabilities extended beyond any single health issue. For nutrition, the study went further to examine what shaped everyday food choices and whether those influences could be changed.

Nutrition literacy goes beyond knowing which foods are healthy. It includes understanding nutrition information and applying it to everyday choices. The study found those choices were also shaped by parents, peers, food vendors, culture, prices, seasons, and what was available locally. Improving diets, therefore, required reaching beyond individual knowledge to the households and communities where food choices are made.

What early action changed

The baseline evidence informed the Adolescent Nutrition Fluency Intervention. Working with adolescents and young adults, caregivers, Community Health Workers (CHWs), district teams and other stakeholders, the project adapted nutrition messages to local foods, language and household realities. Ten trained CHWs delivered nine monthly household sessions covering balanced diets, physical activity, vitamins and minerals, meal planning and anaemia prevention.

The household approach reached young people in and out of school. The nutrition literacy, diet-quality and intervention analyses form part of the PhD research of Mr. Thomas Buyinza, supported through ARISE-NUTRINT. At endline, participants who received the sessions recorded higher nutrition literacy and overall diet-quality scores.

“The improvement in nutrition literacy and diet quality suggests that practical education, grounded in local foods and household realities, can support healthier choices among adolescents and young adults. In addition, involving parents and caregivers is important because they influence what families buy, prepare, and eat,” Dr. Bukenya said.

She stressed that nutrition education needed to be complemented by better access to affordable, nutritious foods. Dr. Bukenya also called for continued follow-up, including the use of nutrition and dietary data from DHIS2, to assess whether improvements were maintained and guide district planning.

Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.
Dr. Justine Bukenya emphasises family involvement in nutrition education and access to affordable, nutritious foods during the ARISE-NUTRINT dissemination meeting in Iganga on 1 October 2026.

Changes in other outcomes were mixed. Participants reporting no physical activity fell from 22.6% to 7.4%, while those active on four to seven days a week increased from 46% to 54.8%. But activity duration did not improve: those reporting more than 60 minutes a day declined from 28.2% to 21.1%. Underweight fell modestly from 6.2% to 5%, while overweight and obesity did not change significantly.

Anaemia recorded the largest change, falling from 31.1% before the intervention to 9.9% afterwards. During the intervention period, participants received weekly iron and folic acid supplementation and deworming alongside nutrition education on iron-rich foods, dietary diversity and practices that improve iron absorption.

Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.
Illustration of the ARISE-NUTRINT household approach: ten trained community health workers delivered nine monthly nutrition education sessions to adolescents and young adults, involving parents and caregivers. AI-generated illustration.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, said the findings reflected problems recognised locally and highlighted the need for a response involving families and other stakeholders.

“There is a serious challenge that needs to be tackled with many stakeholders, with parents at the centre because these are children. We also learnt that many parents, I think, lack the skills to communicate with their adolescents,” she said.

Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.
Mayuge District’s Assistant District Health Officer, Ms. Elizabeth Kawaala, speaks during the dissemination of ARISE-NUTRINT study findings in Iganga on 1 October 2026.

She said the findings had been shared with colleagues and described integrating health education and sensitisation into services. She also called for departments to use the evidence when planning activities in their workplans.

Beyond Mayuge

Seen alongside Uganda’s 2023 STEPS survey, the Mayuge findings add an earlier-life dimension to the national evidence. Makerere University School of Public Health contributed to both studies, with Prof. Guwatudde contributing to the national STEPS survey and now leading ARISE-NUTRINT. While STEPS found significant NCD risk factors persisting among adults, ARISE-NUTRINT shows that some behaviours and vulnerabilities relevant to later NCD risk are already evident during adolescence and young adulthood. The Mayuge research goes further by testing what can change when interventions begin during this period.

The findings leave Mayuge with more than a measure of the problem. They show where vulnerabilities are emerging, what changed when interventions were introduced and where challenges remain. For ARISE-NUTRINT, the evidence now turns attention to which approaches can be sustained and how lessons from Mayuge can inform efforts to support healthier transitions from adolescence into adulthood.

John Okeya

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