Health
An Indigenous Community-Led Model to Address Type 2 Diabetes: Through Evidence Informed Cross-Cultural Learning and Adaptation in Uganda
By Joseph Odoi
Globally, an estimated 462 million individuals are affected by type 2 diabetes, corresponding to 6.28% of the world’s population. In high-income regions like Europe, of all persons with Type 2 Diabetes Mellitus (T2DM), 39.3% are undiagnosed. Low-income countries in Africa have the highest prevalence of undiagnosed diabetes, estimated at 66.7%. In Uganda alone, a steady increase in the number of diabetes cases has been observed in various regions
Despite the increasing burden of Type 2 diabetes in the country, there is hardly any Community-led Behavioral Science oriented change model to address the risky factors that increase chances of developing Non-Communicable Diseases including Type 2 diabetes among Rural Population in Uganda.
To counter this implementation science – practice gap, researchers from Makerere University led by Dr Juliet Kiguli have embarked on a journey to develop and pilot-test a community-led Behavioral Change Model in Teso, Lango, Busoga and among the Samia cultural groups in Uganda. This Development follows a study by Makerere University researchers with funding from Government of Uganda and Makerere University Research and Innovations Fund (Mak-RIF) who sought to understand the patterns of socio-cultural norms in two high incidence districts namely, Busia and Bugiri, in Eastern Uganda.
While facilitating at the cross-cultural learning event in late July 2023, Ramadhan Kirunda one of the Co-Principal Investigators noted that addressing Type 2 Diabetes requires a cross-cultural approach where communities take lead in identifying drivers of T2D and also share what works in context to their areas.
Ramadhan noted that the team is developing a behavioral change approach for type 2 diabetes risky factors because this condition is a behavioral and lifestyle disease. We are planning to engage religious leaders, cultural leaders, local leaders (LC1s), health workers, para-social workers, VHTs, husbands, wives, and in-laws in co-designing and co-implementing this change behavioral change approach. This intervention is designed to look at the community and the affected people as implementers as opposed to looking at them as beneficiaries of the intervention – hence the potential for sustainable change is high. In addition, it targets some duty bearers and thus social accountability for healthy behaviours can be enhanced. This study started as an “exploratory to co-design to pilot testing to implementation” study, making it one of the few that directly link research and practice.
At this event, Dr. Gerald Mutungi, Assistant Commissioner of Non-Communicable Diseases (NCDs) at the Ministry of Health, emphasized the seriousness of Type 2 Diabetes and its significant consequences. He highlighted the urgent need to address this issue effectively.
Dr. Mutungi further noted that ‘’While there are established interventions recommended by the World Health Organization (WHO) and other advising agencies, it is encouraging to see efforts being made to find local solutions for Type 2 Diabetes’’. He added that this study is of great importance as it will provide us with valuable insights into the factors contributing to the increase of Type 2 Diabetes in our local communities. Furthermore, it will enable us to understand the perspectives of local stakeholders and leaders, informing us about effective strategies specific to our context, rather than simply adopting approaches from countries like Switzerland or the USA.
Regarding the factors contributing to the rise of Type 2 Diabetes, Dr. Mutungi said, “Ugandans are continuously eating poorly. They say they are eating well but eating badly by consuming processed foods, fried foods, and fast foods.” He also highlighted the issue of physical inactivity, stating, “Ugandans are becoming physically inactive because they are using motorized transport even where they could have walked. They spend a lot of time in offices and go to sleep.”
On the significance of the study, Dr. Gerald noted, report from the study will inform programming and action around Type 2 Diabetes in Uganda.
Andrew Ochole, the Deputy Prime Minister of the TESO Cultural Union, expressed his sincere appreciation to Makerere University and the Fidelitas Scientific Execution Facility for their pioneering efforts in conducting the first-ever Type 2 Diabetes Study in the Teso Region.
’Despite Type TWO Diabetes being a killer, No Type TWO Diabetes Research has never been done in TESO and no one has been coming up to find local ways of lowering even when we have peculiar and shared norms that facilitate Type 2 Diabetes, I’m happy that Makerere University has taken up this initiative and we are ready to take it up as a community’’ explained Ochole.
He further reaffirmed TESO’s commitment to collaborate with researchers and development partners, such as Fedelitas, who are working alongside Makerere University in this study adding that Teso Cultural Union is prepared to actively disseminate the study’s innovations to educate and raise awareness among its community members in an effort to address Type 2 Diabetes.
In his remarks, the District Health Officer (DHO) of Busia District, Dr. Fredrick Ouma, emphasized the importance of recognizing that the world is a global village, with norms that cut across boundaries adding that there is an alarming prevalence of non-communicable diseases (NCDs) in Uganda which can’t be ignored.
To address these health challenges, the DHO stressed the need to develop and disseminate messages that can effectively raise awareness and educate the community about Type 2 Diabetes.
Additionally, Dr. Ouma emphasized the importance of sharing original and accurate information as reliable data is crucial for making informed decisions and designing effective interventions to address the health needs in the community.
In terms of Lifestyle, He urged participants to be role models by engaging in continuous exercise and adopting healthy lifestyles. By embodying these behaviors, health workers can inspire others in the community to follow suit and become agents of change according to him
According to Dr Juliet Kiguli – the Principal investigator, notes that this study is intended to change the implementation landscape for NCD programs. She underlined the importance of connecting research with indigenous local organizations like Fidelitas Scientific Execution Facility (Fidelitas), who can support research uptake, further resource mobilization and support scale-up of the innovations developed by researchers.
In his closing remarks at the Workshop, Mr John King Odolon, the CEO Fidelitas Scientific Execution Facility, emphasized the importance of active participation from all participants to drive change in addressing Type 2 Diabetes – noting that the participation and zeal should continue upto field level. He urged them to play their respective roles effectively, recognizing that collective efforts are needed to make a significant impact.
Looking ahead, Odolon mentioned that the valuable lessons learned from the Workshop would be disseminated across the four regions. This dissemination aims to ensure that the insights gained from the study reach a wider audience and contribute to addressing Type 2 Diabetes on a broader scale.
As part of the study, researchers actively engaged with various health stakeholders. These stakeholders shared their experiences and insights regarding the behavioral factors influencing Type 2 Diabetes. Their input and expertise added valuable perspectives to the study, enhancing its comprehensiveness and applicability.
More about the study
In the next phase, the team working with Fidelitas is going to pilot test the intervention, through piloting and spreading the type 2 diabetes desired future state messages for social norms change. This will be done through a quasi-experimental implementation research intervention in the four regions of Busoga, Teso, Lango and the Samia cultural groups. Stay tuned for the results, learning brief and a publication!
Health
Makerere University Explores Strategic Partnership with Tsinghua University in Safety Science, Disaster Resilience and Public Health
Makerere University has taken a significant step toward strengthening global research collaboration following a high-level meeting between Vice Chancellor Prof. Barnabas Nawangwe and a delegation from Tsinghua University’s Hefei Institute for Public Safety Research, one of China’s leading centres of excellence in disaster prevention, public safety, and emergency management. The engagement marked a renewed commitment to advancing scientific cooperation between the two institutions, particularly in addressing complex environmental and public health challenges that continue to shape national and global development.
A Partnership Anchored in Shared Challenges and Global Priorities
In his remarks, Prof. Nawangwe emphasized that the concept of comprehensive public safety, spanning natural disasters, epidemics, infrastructure failures, and social risks, is increasingly relevant to all colleges and disciplines at Makerere. Uganda’s experience with epidemics such as Ebola, cholera, and COVID-19; frequent landslides in mountainous regions; flooding events; and rising traffic-related incidents place the University in a unique position to contribute applied research, community-based insights, and local knowledge to a global scientific dialogue.
He noted that the Tsinghua presentation revealed new areas of alignment, particularly in epidemic modelling, early-warning systems, and integrated emergency management, areas where Makerere’s public health scientists, medical researchers, and social scientists have extensive expertise.
“This collaboration offers meaningful opportunities for nearly every college at Makerere,” he noted. “Public safety touches the environment, public health, engineering, social sciences, ICT, humanities, and urban planning. The challenges we face as a country make this partnership both timely and essential.” Prof. Barnabas Nawangwe noted.
Tsinghua University: A Global Leader in Comprehensive Public Safety.
The delegation from Tsinghua University outlined China’s national investment in Public safety over the past two decades, an effort driven by the recognition that life and security are the foundation of sustainable development. Tsinghua’s Hefei Institute for Public Safety Research has developed nationally recognised research platforms and large-scale simulation facilities dedicated to Natural disaster modelling (earthquakes, landslides, floods, typhoons, Infrastructure and urban systems safety, Public health emergencies and epidemic preparedness, Early-warning, monitoring, and emergency communication, Traffic and transportation safety, Post-disaster reconstruction and resilience planning.
Their systems currently support over 100 provincial and municipal emergency management centres in China, underscoring their global leadership in practical, scalable solutions for disaster risk management. The delegation reaffirmed that Uganda’s lived experience with multiple hazards presents opportunities for meaningful knowledge exchange. They expressed particular interest in learning from Makerere’s work on epidemic response, community health systems, and the social dimensions of disaster management.
Emerging Areas of Partnership
The meeting identified several promising pathways for long-term collaboration:
1. Joint Research in Disaster Risk Reduction and Climate-Related Hazards
Both institutions expressed readiness to co-develop research projects on landslides, floods, urban resilience, and multi-hazard modelling, drawing on Tsinghua’s advanced simulation technologies and Makerere’s environmental expertise and geographic field realities.
2. Public Health Emergency Preparedness and Epidemic Response
Makerere’s renowned public health schools and research centres will collaborate with Tsinghua on epidemic prediction, early-warning systems, and integrated preparedness frameworks, leveraging Uganda’s decades of experience managing high-risk disease outbreaks.
3. Infrastructure and Urban Safety, Including Traffic Systems
With Uganda experiencing rapid urbanisation and high rates of motorcycle-related road incidents, Tsinghua shared insights from China’s own transformation, including infrastructure redesign, transport modelling, and public transit innovations. Collaborative work in this area would support city planning and road safety interventions in Kampala and other urban centres.
4. Academic Exchange and Capacity Building
Both sides expressed interest in student exchanges, staff mobility, co-supervision of postgraduate research, and specialised training programmes hosted at Tsinghua’s world-class safety research facilities.
5. Development of a Joint Public Safety Laboratory at Makerere
The institutions are exploring the establishment of a collaborative safety research platform in Uganda. This initiative could serve as a regional hub for innovation in emergency management, environmental safety, and technology-driven risk assessment.
Towards a Long-Term, Impactful Collaboration
The meeting concluded with a shared commitment to develop a structured partnership framework in the coming months, supported by both universities and aligned with Uganda–China cooperation priorities. Both teams acknowledged that the partnership must yield tangible results that enhance community resilience, bolster national preparedness systems, and foster scientific capacity for future generations.
Prof. Nawangwe commended Tsinghua University for its willingness to co-invest in research and capacity building, noting that such collaborations position Makerere not only as a leading research institution in Africa but as an active contributor to global scientific progress.
“This partnership has the potential to transform our understanding of the science of public safety to deliver solutions that safeguard lives.” Prof. Barnabas Nawangwe noted.
“It aligns perfectly with Makerere’s mission to be a research-led, innovation-driven university responding to the world’s most urgent challenges.” He added.
As part of this strategic partnership engagement, Makerere University will, on Wednesday, 17th December, co-host the Makerere University–Tsinghua University Symposium on Public Safety and Natural Disaster Management. The symposium will run from 8:00 AM to 2:00 PM in the University Main Hall, Main Building.
This symposium represents a deepening of collaboration not only between Makerere University and Tsinghua University, but also a broader strategic partnership between Uganda and the People’s Republic of China.
During the event, H.E. Zhang Lizhong, Ambassador of the People’s Republic of China to Uganda, together with the State Minister for Higher Education, Government of Uganda, will officially launch the China–Uganda Belt and Road Joint Laboratory on Natural Disaster Monitoring and Early Warning. The Laboratory will be hosted at Makerere University, positioning the University to play a central role in strengthening Uganda’s and the region’s capacity for natural disaster preparedness, public safety, and emergency management research.
Caroline Kainomugisha is the Communications Officer, Advancement Office, Makerere University.
Makerere University on 11th November 2025 marked a significant milestone as the Health User Committee (Mak-HUC)—established by the Vice Chancellor in 2022 as part of his strategic mandate to strengthen and oversee the University’s health service delivery—formally handed over its three-year report. The event highlighted the committee’s achievements in guiding, monitoring, and improving Makerere University Health Services, presenting a record of progress that has reshaped confidence, strengthened systems, and expanded care for staff and students.
A Call for Integrated and Sustainable Health Services
The Vice Chancellor Prof. Barnabas Nawangwe emphasized the need for a more integrated, efficient, and sustainable approach to delivering health services for Makerere University staff and students. He noted that while the University does not receive supplies from the National Medical Stores system, its community remains entitled to quality care, urging renewed consideration of how essential services—such as drug access, surgical limits, and special medical cases—can be better supported. He highlighted the importance of practical costing models, especially for extending care to staff dependents, and called for flexibility in managing exceptional cases like complex surgeries or referrals abroad.
The Vice Chancellor also underscored the urgent need to modernize the University Hospital, proposing that Makerere begin incrementally establishing a teaching hospital using existing facilities and leveraging expertise of highly qualified consultants the College of Health Sciences (CHS). He reiterated that government budget ceilings remain a major constraint, but encouraged the committee to develop a concept that could be presented to Council and later supported through strategic engagement with the Ministry of Finance, Planning and Economic Development. Throughout his remarks, he applauded the Mak-HUC for its work and reaffirmed that even with the creation of a professional hospital board, the committee must remain central in representing service users.
Aligning Health Services with Sustainable Insurance Models
Prof. Bruce Kirenga the Principal College of Health Sciences responded by clarifying the committee’s efforts to align Makerere’s health services with real insurance models, including cost projections for covering additional family members and encouraging voluntary staff contributions where necessary. He acknowledged the complexity of expanding service coverage—especially in cases of chronic illness or high-cost procedures—but emphasized the committee’s commitment to cautious, sustainable planning. He confirmed that the College is working closely with the Hospital to improve services, attract specialists, and integrate students into the health system, a model that naturally draws academic staff into clinical roles without imposing unrealistic obligations.
Prof. Kirenga also noted the College’s ongoing assessments of facility needs, including dialysis, ICU expansion, and equipment placement, stressing that the ultimate goal is a unified, well-structured health network across the University. He welcomed the Vice Chancellor’s support for transforming existing facilities into a teaching hospital and pledged to refine proposals that reflect both current realities and long-term institutional needs.
Committee Chair Reflects on Three-Year Achievements
Dr. Allen Kabagyenyi, Chair of Mak-HUC, reflected on the three-year journey with gratitude and pride, noting that the committee not only fulfilled its terms of reference but exceeded expectations. She highlighted major gains made under the Vice Chancellor’s support, including transforming the University Hospital into a self-accounting unit—an intervention that unlocked smoother financial management and accelerated service delivery. Dr. Kabagyenyi commended the strong collaboration with the Hospital administration, Human Resources Directorate, and other units, which ensured staffing stability even during institutional transitions.
She pointed to the expansion of referral partnerships—now totaling 29 health facilities nationwide—as a crucial achievement that guarantees continuity of care for staff and students wherever they are. She also emphasized the committee’s work in guiding policies for specialized treatment and cross-border care, strengthening fraud-prevention systems, and advancing digital transformation through an integrated health information system and the new Makerere University Health Services (MakHS) website. Dr. Kabagyenyi noted that these improvements have directly benefited staff and enhanced the overall quality of care, supported by close collaboration with the College of Health Sciences and access to some of the country’s best consultants. She concluded by underscoring the ongoing need for a comprehensive University Health Policy and expressed deep appreciation to the Vice Chancellor and University Management for their unwavering openness and support—attributes she credited for the committee’s success.
Highlights of Service Growth and Infrastructure Upgrades
The Chief, Makerere University Health Services, Prof. Josaphat Byamugisha, highlighted the significant progress achieved under the Health User Committee’s oversight, noting especially the steady rise in service utilization and renewed confidence among staff and students. He emphasized that trust in the University Hospital has grown organically—built not through advertising, but through improved patient experience, stronger systems, and word of mouth.
Prof. Byamugisha pointed to major achievements such as expanded Out-Patient Department (OPD) attendance, better student access to care, enhanced infrastructure including modernized theatres capable of complex procedures, and upgraded laboratories supported through framework agreements that ensure continuous equipment renewal. He noted that specialized clinics, increased inpatient capacity, and expanded referral networks have strengthened the Hospital’s reach and responsiveness. The Hospital is also taking on more research work and clinical training, partnering with units such as optometry, internal medicine, and the Clinical Trials Unit, with new collaborations—like the MasterCard Foundation—driving further growth.
He reaffirmed that the long-term vision of establishing a fully-fledged Makerere University Teaching Hospital is taking shape through coordinated efforts with the College of Health Sciences. Prof. Byamugisha credited the Vice Chancellor’s support for enabling these strides and expressed deep appreciation to all stakeholders contributing to the continued improvement of health services for the entire University community.
DICTS Unveils Modular Information System & Health Services Website
The Directorate for ICT Support (DICTS) presented the newly developed Makerere University Integrated Health Management Information System (MakIHMIS), designed around a modular system that streamlines all hospital processes. The platform integrates eight functional modules, including registration, triage, clinician workflows, inventory and medicines management, pharmacy dispensing, laboratory information management, user management, and linkages to both the Academic and Human Resource Management Information Systems ACMIS and e-HRMS respetively. Most of these modules are already active, enabling smooth patient registration, accurate record-keeping, real-time inventory tracking, and seamless access to student and staff data without duplication. Only two modules—land and insurance—remain under development before the system becomes fully end-to-end. The MakHS website on the other hand features information about hospital services, events, research activities, and staff profiles, offering both the university community and the public a centralized and efficient digital gateway to the hospital’s operations.
The term of the outgoing committee has officially concluded, and preparations are now underway for the incoming committee to assume its duties and continue advancing the work ahead.
Health
Proceedings of the National Annual Communicable and Non-Communicable Diseases and 19th Joint Scientific Health Conference 2025
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