Health
Makerere & Johns Hopkins Universities Release Report on Speed and Helmet Use in Kampala
Makerere University School of Public Health (MakSPH) and the Johns Hopkins International Injury Research Unit (JH-IIRU) have launched the status summary report 2023; Road Risk Factors for Kampala, Uganda, in partnership with Kampala Capital City Authority (KCCA) and Vital Strategies.
The report was launched at Hotel Africana in Kampala on January 16, 2024. It delineates key findings, including the average speed of speeding vehicles at a high average of 57km/hr, higher speeds on roads partially accessible to pedestrians compared to roads freely accessible to pedestrians. Also, helmet usage remains low among motorcyclists and is almost non-existent among passengers, contributing to a rise in accidents and fatalities since 2020.
There has been a variable trend in the reported numbers of deaths and serious injuries since 2018. Specifically, in 2022, there was a 1% increase in reported deaths compared to 2021, while serious injuries witnessed a 4% decrease during the same period.
In 2018, a total of 294 death were recorded, 315 recorded in 2019 while 236 were recorded in 2020. In 2021, there were 419 road traffic death and 425 recorded in 2022. Motorcyclists accounted for nearly half (49%) of the reported deaths followed by pedestrians made up 44% of deaths. In a bid to improve road safety by providing quality data, the research the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS) made roadside observations on speed and helmet use in Kampala City.
The researchers made six observation rounds citing 500,000 for speed and 600,000 cyclists to determine helmet use. The results, based on data collected between February 2021 and October 2023 indicate that the mean speed among speeding vehicles was high mostly among sport utility vehicles (SUVs) at 10%, sedans/saloons at 9%, minibuses/minivans at 8), and pickup/light trucks at 7%. Five percent of the observed vehicles were exceeding the posted speed limit.
Speeding in Kampala
Presenting findings, Mr. Bonny Balugaba, a Researcher based at the Trauma, Injuries and Trauma Unit of MakSPH noted that the international best practices for speed management recommend a safe speed of 30 km/h on roads where conflicts between cars and unprotected users are possible. Also, 50 km/h speed is recommended at intersections where side-on conflicts between cars may occur. This is particularly applicable in urban areas.
“If in Kampala we are seeing 57km/h speed, it means that we are way above the recommended speed limits and we know that beyond 40km/h, the chances of survival of someone that has been knocked are very minimal,” says Balugaba.
The researchers recommend enforcing a 50 km/h speed limit in metropolitan areas and a 30 km/h limit in places where motorized traffic interacts with bikes and pedestrians. In order to safeguard vulnerable road users, particularly the Ministry of Works and Transport and the Kampala Capital City Authority, it suggests implementing speed-calming techniques including bumps and signage as well as designating low-speed areas.
Investigators further advise the Kampala Metropolitan Traffic Police to increase enforcement, especially on local roads and on vehicles such as SUVs, sedans, pickup trucks, minibuses on routes with limited pedestrian access. It is recommended that public awareness campaigns and enforcement measures regarding the dangers of speeding be regularly monitored and evaluated to ensure continued efficacy.
Balugaba noted; “Mass media is good but if you are telling me the dangers of speed but am not apprehended on speed then it tends to entertainment. You come, entertain me with your campaign and adverts and go away but you are not enforcing.”
Helmet Use in Kampala
Helmet use compliance among motorcyclists was notably low at 39%, and even lower for passengers at 2%. This trend persisted on both local and collector roads (39%) and arterial roads (40%). During weekends, helmet use dropped by 20%. Ride-share motorcycle drivers, particularly Safe Boda, exhibited the highest compliance at 84%, surpassing commercial motorcycle drivers (50%), taxi drivers (55%), and private/government motorcycle users (55%).
From 2020 to 2022, 210 motorcycle occupants and 185 pedestrians lost their lives. Notably, 40% of pedestrian fatalities resulted from collisions with cars, SUVs, or pickups, whereas 36% of motorcycle deaths were attributed to accidents involving other motorcycles.
“We saw that only 2% of the motorcycles are using helmets. This really means that the situation is still bad. We need to put in place measures knowing that helmets save those that are wearing them,” says Balugaba.
Adding that while four of every 10 riders are wearing a helmet but less than one in every 10 passengers has a helmet. “is it that passengers have harder heads than riders? That in case they are involved in a crash, they don’t get affected? These are issues we need to work on.”
While sharing the data outcomes, Dr Raphael Awuah, the African Regional Advisor on Data and Surveillance for Vital Strategies notes that while many of the cities in Africa, pedestrians constitute the majority fatalities, this is different for Kampala. “For most parts of Africa, we see that pedestrians account for most fatalities. However, in Kampala, this is not the case. We see that majority of the deaths are among the motorcyclists and this trend has been observed since 2018. So clearly this emphasizes the need to prioritize the vulnerable road users in Kampala particularly motorcyclists and pedestrians.”
The top five locations for pedestrian fatalities and serious injuries from 2019 to 2022 are high-capacity roads: Kampala Road, Jinja Road, Bombo Road, Entebbe Road, and Masaka Road.
The distribution of motorcycle fatal crash locations does not exhibit any clear pattern, but there is a noticeable concentration on high-capacity highways. Kampala Road, Masaka Road, Bombo Road, Kisaasi Road, and the Northern Bypass are the top five places.
“While it is true that these are high capacity roads, speeding is probably one of the causes of fatalities. I hope we will use this data to inform the discussions, actions, plans, strategies to reduce the outcomes that I have just shared,” observed Dr Raphael Awuah.
The Kampala Metropolitan Traffic Police has been urged to increase the enforcement of proper helmet use, with a focus on passengers, taxis, and commercial motorbikes on arterial, local, and collector roads all week round. Also, KCCA and the Ministry of Works and Transport may want to start public awareness programs promoting the appropriate use of helmets and advocate for sanctions and fines for improper helmet wear in conjunction with coordinated increased enforcement.
“This is about behavioral change. It is extremely difficult. We are all humans. All of us know that speeding is bad for us but when we get behind the wheel, we will still try to speed. All of us know that wearing a helmet will protect our heads, but only 2% of us wear helmets when we are riding on a motorcycle. So what else is needed? Yes, knowledge is important, it is important to tell people why they should be putting on these helmets and the consequences they will face if they don’t wear them but it is also important to have reinforcing mechanism. Yes, mass media campaigns are important but equally important is visible and widespread enforcement,” explained Dr. Abdulgafoor Bachani, Director of JH-IIRU.
On his part, Dr. Fredrick Oporia said “Road safety is an issue of concern to everyone. To improve this safety, we must have high-quality data on the risk factors and share it with our stakeholders. Most importantly, we need local stakeholders who are charged with making laws and policies for the country because this is a systems issue that calls for systems thinking. We must involve the local to get the attention of the international.”
SP. Michael Kananura, spokesperson, Traffic and Road Safety Directorate, Uganda Police Force says there is a regulation on helmet use targeting not only riders but also passengers, although he acknowledges challenges with enforcement. He calls on the public support these public health and road safety measures.
“We really appreciate our colleagues from MakSPH and the rest for this work and the academia generally for the work you are doing in as far as research is concerned and also being able to share with us this data. We also use this data to improve in our enforcements. It guides us on areas of improvement and prioritization. The data really is so helpful to us and we also continue to work to see how we can improve in that area. We have a unit in traffic directorate that is for enforcement basically,” SP Kananura.
Comments from KCCA leadership
Hon. Kizza Hakim Sawula, the lord councilor from Lubaga and Executive Secretary and a Minister for Works and Physical Planning –KCCA noted that one of the causes of this these accidents in the capital city is the poor-quality roads that wear out easily with numerous potholes and the meagre maintenance budget appropriated by parliament to the city authority.
“Can you imagine that each kilometer of the road within Kampala is constructed at an average cost of 14 billion shillings. For the last three budgets, we were getting 78bn but but in the current budget, we received only 43 billion shillings for the entire capital, for the entire financial year for roads, drainages and traffic lights. How many kilometers are we looking at? 3 kilometers for a financial year, 43 billion shillings?
We used to get Shs26 billion from the national road fund, for road maintenance every financial year. You can confirm from the mayors and load counselors here. This time around, we received only 11 billion for all the maintenance. Now, what do we expect out of that money? So, the task is upon the members of the Parliament to improve on the budget. We have 2,110 kilometers of roads within Kampala. Only 654 kilometers are paved, when shall we complete the entire balance? So, we need a budget, enough budget from the members of parliament. When we talk to MPs they only talk about loans we get from development partners which is usually for new roads,” explained Hon. Sawula.
Concerned, Nakawa Division Mayor, Paul Mugambe said it was disheartening that many people continue to lose their lives prematurely. He cited that not every death is predetermined by the Lord. “Driving at excessively high speeds, and resulting in a crash is not the Lord’s decision. Many individuals lose their lives prematurely due to reckless behavior, and it’s truly regrettable.”
Mr. Mugambe urged Police to use the evidence provided to improve on the enforcement of road traffic laws and regulations.
Prof. Elizeus Rutebemberwa, the Deputy Dean, MakSPH thanked the Bloomberg Philanthilopies “for supporting us to help ourselves” and the JH-IIRU for the technical support to the TRIAD unit, the university and many partners. He also noted that the urban population in Uganda is steadily increasing and called for proactive and inclusive urban planning.
“From 2012, the urban population was 20%. In 2022, which is one year and a half ago, it was 26%. So, one in four people in Uganda were in urban areas. Now in 2040 it is estimated that 33 million would be living in urban areas and that would be 46%. So, it’s not getting better, it’s getting worse. So, we need to manage our urban areas so that people don’t shift from the rural areas to come to die in urban areas,” said Prof. Rutebemberwa.
He called on government and the city authority to fast-track mass transport systems to reduce congestion on the roads. “Look at the traffic that come to Kampala. They are in private cars and each one is carrying one person. In very few cases, two people. Now, if you have all those cars for one kilometre stretch, you could actually park all those people in one bus. And you have all space and you reduce the pollution, why should this be difficult for people to know that. For you to have an organized urban area, you need mass transport. You don’t need to research to know that. So why don’t we have them? Some of these things, some of them we talked about in the national drive, dedicated walk lanes.
According to Becky Bavinger, from the public health area of Bloomberg Philanthropies, road traffic injuries are the leading cause of death for people aged 5 to 29. She mentioned that the fatalities from road traffic are at a crisis level in Uganda.
“I want to say this again. This is the leading cause of death. It’s not HIV. It’s not tuberculosis. It’s real traffic injuries for people aged 5 to 29. Those are the young people. We had the mayor talking about the economic impact as well. These are young people going to school, getting trained, coming back into your workforce, starting out in the workforce, and you’re losing their lives. There’s a forthcoming research from the Road Safety Coalition Uganda looking at the loss of GDP from road traffic injuries. In 2017, your government reported 3,500 deaths. The WHO estimated it was double that at about 6,000. It has gone up. In 2021, your government reported 4,159 deaths. Again, the WHO estimated it was about double that at 7,300. This is not good. This is a crisis and we need everyone working together on it,” Ms. Bavinger said.
She noted that Bloomberg Philanthropies will be working over these next two years with KCCA and with the government of Uganda to institutionalize data collection and the surveillance of road traffic injuries and deaths to improve its accuracy.
“These data are critical to forming your decision making. I just want to conclude by saying congratulations to Makerere University, to Johns Hopkins University, but ultimately to KCCA for launching this report, for conducting this research and this is not easy research to conduct. To the stakeholders, use these data. Please, please do not go home and put this report on your shelf. Look through it. Talk to the journalist. Get the media to write stories about this, let everyone know what is happening,” said Bavinger.
A new study conducted in Wakiso district has determined the ideal waist circumference for detecting metabolic syndrome among Ugandan women. Study findings closely align with the International Diabetes Federation (IDF) cut-off for predicting ill health risks.
The researchers at Makerere University’s School of Public Health (MakSPH) aimed to establish an ethnically appropriate waist circumference cut-off point for Ugandan women to enhance early detection and prediction of metabolic syndrome. About 2 in 10 of the women studied in Wakiso district, Uganda, suffer from metabolic syndrome, which is associated with diabetes and heart disease.
Findings indicated that for women aged 18–49 years in the Wakiso district, 80.3 cm is the optimal waist measurement to flag potential metabolic syndrome risks.
The threshold increases with age:
• 79.9 cm for young women (25-34 years)
• 85.6 cm for mid-life (35-44 years)
• 91.1 cm for pre-menopausal women (45-49 years)
Unlike the Body Mass Index (BMI), a calculated measure of weight relative to height used to assess an individual’s weight status and potential health risks, waist measurement better detects dangerous abdominal fat linked to diabetes and heart disease.
Dr. David Lubogo, a lead researcher on this study and Senior Lecturer in the Department of Community Health and Behavioral Sciences at Makerere School of Public Health, noted that with hormonal and physiological changes making women particularly vulnerable during reproductive years, these Uganda-specific benchmarks will help clinics identify at-risk patients earlier, using just a measuring tape.
“Our findings confirm waist measurement as a powerful, low-cost tool for preventive care. While aligning with global standards, we have refined thresholds for Uganda’s context,” Dr. David Lubogo notes.
A cross-sectional study was carried out in Wakiso District from June to August 2021, involving 697 randomly selected women aged 15–49. Participants had lived in Wakiso for at least a year and underwent physical, biochemical, and anthropometric tests to help determine the prevalence of metabolic syndrome (MetS). “We excluded pregnant and postpartum women, alcoholics, smokers, and those with chronic or infectious diseases to ensure accurate results,” explained Dr. David Lubogo.
The study, published in PLOS Global Public Health, underscores the importance of age-sensitive screening in tackling metabolic diseases in sub-Saharan Africa. In response, health officials in the study area should explore practical ways to weave these findings into everyday programs for community health screening.
The study was funded by the Government of Uganda through the Makerere University Research and Innovation Fund (MakRIF) and the Strengthening Education and Training Capacity in Sexual and Reproductive Health and Rights (SET-SRHR) Project in Uganda. Other investigators included Dr. Henry Wamani, Dr. Roy William Mayega, and Professor Christopher Garimoi Orach.
Kampala, 09 April 2025— Makerere University has officially launched the Social Innovation in Health Initiative Community of Practice (SIHICOP)—a new platform designed to connect local health innovators with policymakers, donors, and researchers. The goal: to turn scattered success stories into a powerful, nationwide movement that reimagines healthcare from the ground up.
The launch, held during the 6th National Social Innovation in Health Stakeholders’ Workshop at Hotel Africana in Kampala, drew a dynamic mix of changemakers, health innovators, academics, donors, and government leaders, all rallying around one idea: that equitable, sustainable healthcare must be rooted in communities.
While Uganda has made notable progress, cutting under-five deaths by 66% since 2000, challenges remain. Fifty out of every 1,000 children still die before their fifth birthday. Nearly half suffer from stunting due to malnutrition. In rural areas, pregnant women walk for hours to reach clinics. Across the country, hospitals battle frequent drug shortages.
Dr. Phyllis Awor, Director of the SIHI Uganda Hub at Makerere University’s School of Public Health (MakSPH), emphasized the critical role of social innovation in closing healthcare gaps. “Half of Ugandan children lack basic vaccinations, and 40% face stunting. These challenges demand creative, inclusive solutions co-created with communities,” she said.
“We’ve spent a decade identifying, studying, and strengthening grassroots innovations. Through our six-month fellowship program, we train innovators in monitoring and evaluation, research, communication, impact assessment, and fundraising so their work doesn’t just survive but scales,” she said. “Today, we’re awarding them completion certificates and launching them into a vibrant community of practice.”
Dr. Awor, who is also a Lecturer and Researcher maintains Social Innovation is about solving these real problems with real people. With the support of the Swedish Embassy and the World Health Organization’s TDR program, SIHICOP, she says, will foster peer learning, capacity-building, and scaling of innovations like mobile health platforms and community-based maternal care.
Since 2017, Uganda’s SIHI hub has supported 30 homegrown innovations, impacting tens of thousands of lives. “We’ve identified 21 standout solutions so far,” Dr. Awor shared. “But if we want them to go national, we need enabling policies.”
Globally, SIHI was founded in 2014 to bring together innovators, communities, policymakers, and academics across the Global South. With 15 hubs, including Uganda’s, SIHI has documented over 200 innovations and 40 case studies that demonstrate the power of grassroots solutions to improve health systems.
Dr. Olaro Charles, Uganda’s Acting Director General of Health Services, acknowledged that bureaucracy often stifles good ideas. “Sometimes, a small change in how you look at a problem can produce the best and most marketable solution,” he said.
He spoke from experience. As a clinician, Dr. Olaro led efforts to curb drug theft and stockouts by tightening distribution and boosting accountability. “It’s not like people walk off with whole boxes,” he explained. “But if you have 300 employees and each takes just one dose… that adds up. We introduced medicine returns, round-the-clock pharmacies, and ward-level audits. At first, there was resistance, but it worked.”
Another one of his most memorable innovations was setting up a neonatal unit for premature babies while he was a Medical Superintendent. “I remember a baby who weighed less than a kilo, barely six months old, and survived. We pushed survival rates to 85%. Eventually, we ran out of space. We began asking ourselves: Where had these children been going before? Previously, these children may have died within the community. These are innovations that create real, tangible impact. And I’m sure many of the things you’re doing here are creating similar results.”
He urged the Fellows to treat their innovations like living systems: “If they survive infant mortality, they’ll live longer. These ideas deserve to grow.”
Mr. Tomas Lundström, Health Counsellor at the Swedish Embassy, spoke with deep conviction about Sweden’s long-standing investment in Uganda’s future. “For decades, Sweden has believed in Uganda’s greatest asset, its people,” he said. “Through Sida, we funded the training of over 500 Makerere staff for PhDs. I didn’t start it. I didn’t train your PhDs. The Swedish taxpayers actually funded the training. Now that wasn’t just investment; it was transformation. It’s one reason Makerere is the powerhouse it is today.”
Lundström also shared a memory that continues to shape his view of development. While inspecting UNICEF projects in Zambia in 1998, he recalled visiting five villages where only one had shown some success. A driver suggested they visit the last village, the 5th. “We went. No one was there. We waited, then a man came running, covered in dirt. He was the village chief,” Lundström recounted. “He said something I’ve never forgotten: ‘Thomas, when the rainy season comes, we can’t take pregnant women to the clinic. Do you know where I can learn to build a bridge’?”
“That was different from what I usually hear—‘Can we have some money?’ Real change doesn’t come from handouts. It starts within communities.”
But Lundström warned that international aid is under strain. “We’ve already lost a lot of funding from U.S. and other donors. Ukraine, Sudan—global crises are pulling resources away. We must get creative. We must find new ways to secure resources.”
Still, he was optimistic. “We’re seriously considering continued support for another year. We’re also pushing for deeper collaboration between Makerere and Karolinska Institutet. But it’s up to you too,” he said.
He praised Dr. Phyllis Awor and her team: “What sets them apart is not just competence, but passion. She doesn’t do this because it’s her job; she does it because she believes in it. Because everyone deserves a fair chance, a seat at the table, a bit of hope.”
Makerere University Vice Chancellor, Professor Barnabas Nawangwe, echoed those sentiments, describing the School of Public Health as the university’s “engine of change.” He noted that the School contributes to nearly 30% of all university publications—and brings in 40% of its research funding.
“That’s no accident,” he said. “Public health is critical. Without health, there is no progress. That’s why donors invest in public health issues.”
He described the social innovation initiative as a model for how academia and communities can work together, not just to publish but to transform lives. “When global rankings name Makerere the most community-impactful university, they’re recognizing what happens when scholars step beyond lecture halls. This is what happens when researchers dig deep into the ground to cultivate solutions that transcend national boundaries.
The Vice Chancellor also paid tribute to Sweden’s role in that transformation. “We cannot thank the people of Sweden enough. Their support through Sida trained over 500 of our staff to the PhD level—the largest staff development initiative I’ve seen at any university, anywhere. It came when we needed it most, after the war. That’s why Makerere stands today as a leading research institution in Africa.”
He congratulated the 2024/25 Fellows, praising their inspiring journeys, and commended Dr. Awor and her remarkable team of researchers for achieving what only world-class institutions can: “melding razor-sharp academia with the wisdom of villages, policy muscle with frontline innovations.”
By Joseph Odoi
Every newborn deserves the best start to life. Yet, in Uganda, the burden of newborn morbidity and mortality remains high. The newborn mortality rate stands at 22 deaths per 1000 live births (UDHS 2022). According to most recent UN annual estimates, Uganda records 62,000 deaths around the time of birth. Of these, 32,000 are neonatal deaths, 26,000 are stillbirths and 4,800 are maternal deaths. Majority of the newborn deaths occur within the first week after delivery- a period considered very vulnerable for both the mother and baby.
Uganda’s high fertility rate translates to about 1.7 million births per year; and of these 250,000 babies need special newborn care as they are either born too small or fall sick within the first month of life. This has placed a huge burden on the country and strained the already limited investment for neonatal care.
Despite national efforts, newborn deaths continue to account for nearly half of all under-five deaths in Uganda, according to the Uganda Demographic and Health Survey (UDHS) 2022.
To contribute to addressing this challenge, a coalition of institutions namely; Makerere University School of Public Health, Baylor Foundation Uganda, Adara Development Uganda, Nsambya Hospital, and the Ministry of Health with funding from ELMA Philanthropies launched a national health systems strengthening initiative known as the Uganda Newborn Programme (UNP) in 2022. This program uses a regional approach to improve newborn care in three regions of Uganda namely Kampala, North Central and Western regions.
According to Dr. Monica Okuga, the Uganda Newborn Programme Coordinator at Makerere University School of Public Health (MakSPH), the Uganda Newborn Programme (UNP) made huge strides in providing quality newborn care in 36 health facilities across the three regions of Uganda.
Uganda New Born Programme Achievements
‘’Under the UNP, there have been so far many achievements. Institutional neonatal mortality rate has reduced in the facilities where the program is implemented and this has contributed to overall reduction in neonatal mortality in the regions. For example, Institutional neonatal mortality reduced to 7/1000 and 2/1000 live births by the end of Year 2, down from the baseline rates of 8.4/1000 and 11.9/1000 in Bunyoro and Tooro, representing reductions of 16.7% and 85.3% respectively’’ Dr. Okuga stated.
Dr. Okuga further explained that, ‘’Overall asphyxia case fatality rates across program areas have also reduced from 8.9% to 5%; adherence to infection prevention and control measures has improved across the facilities; and the quality of newborn care provided has also improved.
In addition to revamping many newborn care units, Dr. Okuga revealed that the programme supported the construction of newborn care units, citing Kyegegwa Hospital, Buliisa General Hospital, Masindi General Hospital, and Kyangwali HCIV.
In line with the SDGs programme objectives, specifically SDG 3; Good Health and Well-Being, Makerere University School of Public Health, together with partners including the National Planning Authority (NPA), UNICEF, FHI360, and the Ministry of Health, produced the Situation Analysis of Newborn Health in Uganda-2023 update.
This document has now been taken up by the Ministry of Health and is being used to develop a strategy for implementing the suggested recommendations therein, as well as costing the investment for improving newborn health in Uganda.
The previous newborn situation analysis was conducted 17 years ago in 2008’’ she explained of programme contribution at a multi-sectoral level
Establishment of Uganda’s First Breast Milk Bank
Still under this programme, the first ever Breast Milk bank was established at Nsambya hospital with other donor milk satellite sites at Mengo, Rubaga, Kibuli and Naguru hospitals in Kampala. This donor breast milk has benefited over 275 babies across Kampala and its neighboring districts.
Hospital-to-Home (H2H) Initiative
Another innovation that has been scaled up through the programme is the Hospital to Home (H2H) initiative by Adara Uganda. While many newborn interventions focus primarily on in-hospital care, the Uganda Newborn Programme, in partnership with Adara Development Uganda, pioneered the Hospital-to-Home (H2H) Model, extending its newborn care continuum to the household level. This innovative model ensures that high-risk newborns continue to receive vital support after hospital discharge, addressing the gaps in follow-up care that are common in low-resource settings.
According to Beatrice Niyonshaba, Deputy Director of Maternal, Newborn, and Child Health at Adara Development; “In Uganda, many families struggle to return for follow-up visits due to cost, transport challenges, and lack of caregiver awareness. The H2H model addresses this by involving caregivers early, equipping them with knowledge on newborn danger signs, and ensuring post-discharge follow-up through community health systems like village health teams.”
She adds, “The model not only reduces post-discharge mortality but also builds trust and ownership among families, which is critical but often an overlooked aspect of newborn survival in low-income settings. ‘’We also run regular community sensitization and awareness initiatives about the causes and survivability of small and sick newborns, preventative measures, as well as the services”. The model was initially piloted at Kiwoko Hospital, with strong support from both healthcare staff and the community. This phase allowed for continuous refinement and strengthening of the model, ensuring it met the needs of both families and healthcare providers.’’ Ms. Niyonshaba explained of the H2H Model uniqueness
Currently, the model is being implemented in Nakaseke hospital, a government facility. This will provide insights for scale up to other government facilities. The programme has seen tremendous success due to the engagement and motivation of CHWs, who are provided with incentives, extensive training, and ongoing support. Regular check-ins and monthly meetings ensure these workers remain accountable and connected to the Programme’s objectives.
Challenges in Newborn Care
According to Dr. Monica Okuga and Prof. Peter Waiswa, the Uganda Newborn Programme team lead from MakSPH, in spite of the many achievements, several challenges persist. They explain that many health facilities in Uganda were built without infrastructure to support Newborn Care Units (NCUs). There are no standard floor plans for these units. In many facilities, the neonatal care units are housed in improvised rooms, while in some cases, completely new NCUs are built.
However, even where NCUs are present, they are often let down by an unstable power supply, despite the fact that most equipment in the NCUs require consistent electricity to function. In addition, there are other health system challenges such as insufficient drug supplies from the government, inadequate staffing, and the low involvement of medical officers in neonatal care. Internal rotation of already trained nurses to other units further worsens the situation. Other issues include untimely or late referrals of mothers and babies, as well as challenges with the low quality of data produced in these units.
In terms of lessons learnt while implementing the UNP, The Uganda Newborn Programme team observed and noted several key lessons during the implementation of the programme
- The importance of leadership engagement in the uptake of interventions is very critical. The leaders to be engaged not only include those at the facility level but also those at the district level. The support of political district leaders such as the Chief Administrative Officer (CAO) is also very crucial. One way of engagement is through sharing performance dashboards with key indicators to the District Health Officers (DHOs), CAO, and Health Facility In-charges.
- There is a need for continuous engagement of district leadership for sustainability in public health facilities, especially the human resource aspect for established Newborn Care Units (NCUs).
- There is a need to intervene across the board/spectrum of the health system. Addressing one challenge, for example, the provision of equipment, may not result in the required benefits without addressing human resources and skills.
- Using a regional approach to care, which includes all hospitals and high-volume health centres, is a more rapid and cost-effective way to scale up maternal and newborn care. It also improves access, quality, and referral, thus reducing unnecessary mortality.
- Regional Local Maternity and Neonatal Systems (LMNS) provide avenues/platforms to share lessons and share feedback to teams/facilities on gaps identified.
- Targeted mentorships not only maintain skills but also support teams in innovating for problem-solving.
- Continuous engagement of medical officers in facilities creates buy-in and brings them on board to support and bridge gaps in newborn care in the neonatal care units.
In terms of sustainability, the team stated that the programme’s design took into account the potential for continuation beyond the initial funding from ELMA Philanthropies. From the outset, the Ministry of Health was actively involved in the co-creation of the programme. The programme also made effective use of existing staff and infrastructure to enhance the quality of newborn care. While there was occasional catalytic provisions of drugs and equipment, the programme primarily relied on the government’s drug supply and delivery systems to ensure long-term sustainability.
About The Uganda Newborn Programme (UNP)
The Uganda Newborn Programme (UNP) has been actively working since its launch in July 2022, with the goal of significantly improving the care for small and sick newborns across the country. With support from ELMA Philanthropies, the programme has brought together a consortium of partners, including Makerere University School of Public Health, Baylor Uganda, Adara Uganda, and Nsambya Hospital, in collaboration with the Ministry of Health.
The programme is focusing on 20 high-burden districts across three regions of Uganda ie Western, Kampala, and North-Central, serving approximately 1.5 million births annually. Since its inception, the programme has been making strides in enhancing the capacity of health facilities, including the refurbishment and equipping of 30 specialized neonatal care units. These units are designed to meet the needs of small and sick newborns, in line with the National Essential Newborn Care (NEST) Toolkit.
Key activities that have been rolled out include
- Training and mentorship of Health Workers; More than 800 health workers have been trained and mentored in essential neonatal care practices such as neonatal resuscitation, Kangaroo Mother Care (KMC), Continuous Positive Airway Pressure (CPAP), and infection prevention and control. This has significantly improved the clinical competencies of healthcare providers in the management of small and sick newborns.
- Strengthening Infection Prevention and Control; The programme has focused on improving infection control measures at hospitals, which is critical in managing the high rates of sepsis and other infections among newborns.
- Effective implementation of newborn resuscitation and warm transport: This includes establishing standardized protocols and providing essential equipment like mabu bags plus masks, CPAP machines
- Improving Data Utilization; Efforts have also been made to ensure that health workers are using data-driven evidence for decision-making. Monthly perinatal death audits and support for data quality review have allowed for continuous improvement in service delivery.
- Enhanced Postnatal Care; Community-based postnatal care using Village Health Teams (VHTs) being trained to conduct home visits for newborns discharged from neonatal units. This helps ensure that infants receive timely follow-up care in the critical days after discharge.
The programme is set to run up to July 2025, and by then, it aims to have reached 120,000 small and sick newborns, helping to reduce newborn mortality by 40% in the target regions.
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