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Poorly implemented COVID-19 incentives eroded health workers’ motivation in Africa – Study

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Staff from IDI and the Ministry of Health engage in Personal Protective Equipment demonstrations after a two-day progam to spearhead the rollout of COVID-19 Infection Prevention and Control (IPC) guidelines on 27th April 2020 at the IDI-McKinnell Knowledge Center, Makerere University, Kampala Uganda.
Staff from IDI and the Ministry of Health engage in Personal Protective Equipment demonstrations after a two-day progam to spearhead the rollout of COVID-19 Infection Prevention and Control (IPC) guidelines on 27th April 2020 at the IDI-McKinnell Knowledge Center, Makerere University, Kampala Uganda.

By Okeya John & Davidson Ndyabahika

As the COVID-19 pandemic swept across Africa, it brought with it a wave of unprecedented challenges, impacting economies, social dynamics, and political structures. National healthcare systems were particularly strained, prompting governments to implement various strategies to combat the virus and its repercussions. Among these measures were the introduction of incentives, both financial and non-financial, aimed at boosting the morale of health workers and bolstering the capacity of healthcare systems to respond to health emergencies.

Due to COVID-19’s increased risks and demand on healthcare workers working in already overburdened health systems, incentive packages must be strengthened. Researchers conducted a multi-country qualitative study in DRC, Nigeria, Senegal, and Uganda with funding from the Bill and Melinda Gates Foundation and Gates Ventures/Exemplars in Global Health. The study examined pandemic-related workplace incentives. In 60 virtual interviews via phone and Zoom, ministry officials, policymakers, and health care providers provided important viewpoints.

Entitled “Health Workforce Incentives and Dis-Incentives During the COVID-19 Pandemic: Experiences from Democratic Republic of Congo, Nigeria, Senegal, and Uganda,” the research conducted by healthcare experts delved into the realm of incentive mechanisms, their allocation, and the inadvertent dis-incentives experienced by the health workforce amidst the pandemic response efforts.

The researchers were from Makerere University School of Public Health (Uganda), University of Kinshasa (DRC), University of Ibadan (Nigeria) and University of Dakar (Senegal). The research team comprised Suzanne Kiwanuka, Ziyada Babirye, Steven Kabwama, Andrew Tusubira, Susan Kizito, Rawlance Ndejjo, Marc Bosonkie, Landry Egbende, Berthold Bondo, Mala Ali Mapatano, Ibrahima Seck, Oumar Bassoum, Mamadou Leye, Issakha Diallo, Olufunmilayo Fawole, Segun Bello, Mobolaji Salawu, Eniola Bamgboye, Magbagbeola David Dairo, Ayo Steven Adebowale, Rotimi Afolabi, and Rhoda Wanyenze,

In their work, the scientists authoritatively note that: “Health worker incentives during the COVID-19 response were mostly unplanned, predominantly non-financial, and invariably implemented. Across these countries, there were neither guiding frameworks nor standard pre-determined packages of financial and non-financial incentives for health workers during emergencies.”  

Before the outbreak of the COVID-19 pandemic in December 2019, “Africa already had weak health systems,” they note, citing that the pandemic exposed this challenge, increasing work overload for health workers, mental stress, infections and deaths, who in turn, needed incentives to adequately work to respond and deliver good health outcomes during the emergency.

However, due to the dire working conditions, the Word Health Organization (WHO) had warned that frontline healthcare workers were most at risk of acquiring the deadly COVID-19 virus. In their report, WHO highlighted that between January 2020 and May 2021 alone, over 80,000 to 180,000 health and care workers respectively, had died of COVID-19 globally, calling for urgent need to reverse the tide.

From this study, Senegal faces a doctor and nurse shortage with only 0.38 healthcare workers per 1,000 people, well below the WHO recommendation. By December 2021, Senegal had recorded 75,055 COVID-19 cases and 1,890 deaths, including five health workers. Similarly, Uganda, with approximately 2.58 healthcare workers per 1,000 people, reported 146,030 COVID-19 cases and 3,306 deaths, including 37 health workers.

The researchers also noted that the DRC had 1.05 healthcare workers per 1,000 people, with 79,632 cases and 1,225 deaths, including 35 health workers. Nigeria faced a similar challenge, with 2.0 healthcare workers per 1,000 people, 243,450 cases, and 3,031 deaths by December 2021, including seven health workers. These findings stressed the strain on Africa’s fragile healthcare systems in responding to the COVID-19 pandemic.

“These challenges and consequences resulted in health workers either absconding from duty or in extreme circumstances, resigning from the health profession and opting for alternative professions,” the researchers note in their review of the COVID-19 response in Africa. They state that elsewhere by this time, measures had already been mounted to motivate health workers, necessitating a similar response in the continent.

In the countries where the study was conducted, the strategies adopted by governments and development partners to counter declining health worker motivation included offering financial rewards like allowances and salary increments, and non-financial incentives like adequate provision of medicines and supplies, on the job trainings, medical care for health workers, social welfare including meals, transportation and housing, recognition, health insurance, psychosocial support and increased supervision.

The researchers found that the financial rewards were a big motivating factor for the health workers in these countries in sustaining the health systems and COVID-19 efforts, while the non-financial incentives also contributed to improved health worker determination.

The incentives, although a success, however in their strength lied the weaknesses. The multi-country study reveals that the incentives had the double effect of creating disincentives and demotivating healthcare workers. This was occasioned by the lack of personal protective equipment, transportation to health facilities during lockdown, long working hours, harassment by security forces and perceived unfairness in access and adequacy of the rewards.

The study got its findings from virtual key informant interviews with the staff at ministries of health, policy makers, and health workers. In the study report, health managers and workers in DRC, Nigeria, Senegal, and Uganda confirmed that health workers received monetary benefits as a means of motivation for their effort towards the continuity of health services.

In Senegal, incentives were reported to mostly be financial. However, in DRC, although the salaries of the health workers involved in COVID-19 testing were reported to be similar to all other staff in response committees like epidemiological surveillance, case management, and communication, the government moved to temporarily waiver taxes to bait the COVID-19 health workers during the pandemic.

“Since financial incentives were mostly administered in an ad-hoc manner, some health workers felt they were unfairly distributed and complained about the lack of transparency in the allocation of these incentives. In Nigeria, it was reported that payments did not meet the health worker expectations, while in Uganda, it was reported that allowances were given selectively to some health workers such as those involved in contact tracing, COVID 19 testing, and COVID 19 isolation units but not to others.” The study report reads in part.

Respondents also revealed that although allowances were availed, there was dissatisfaction caused by delays and non-payment. In Uganda for example, the recruitment of additional 700 staff on contract although initially perceived positively, their irregular dismissal following budget shortfalls created discontentment and immense pressure for the government.

Accordingly, the authors observe that the incentive packages in the four African countries were inconsistent, lacked transparency, adequacy, and equity. “Therefore, there is a need to develop guiding frameworks within which governments and partners can deliver incentives and reduce dis-incentives for the health workforce during emergencies.”

The study suggests that during health emergencies like COVID-19, increased risks and workloads should mandate the provision of safety gear and adequate supplies. However, the researchers caution that both financial and non-financial incentives can have unintended consequences if perceived as unfair in their implementation.

They also call for incentives to be pre-determined, equitable and transparently provided during health emergencies ‘because arbitrarily applied financial and non-financial incentives become dis-incentives’, while still holding that the financial incentives are only useful in as far as they are administered together with non-financial incentives such as supportive and well-resourced work environments.

“Governments need to develop guidelines on incentives during health emergencies with careful consideration of mitigating potential dis-incentives. The harmonization of roles across state and non-state sector players in incentivizing the health personnel during health emergencies is paramount.” The study affirms.

Find the detailed scientific study here.

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Davidson Ndyabahika

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MakSPH, DJC Launch Short Course on Health Communication

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June 20, 2025

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The heads of the Department of Journalism and Communication and the Department of Community Health and Behavioural Sciences (centre) with participants from the first cohort of the Health Communication short course at Makerere University. June 5, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa.

By Okeya John and Primrose Nabankema

The intensive one-month course, running for the first time from June 5 to July 24, 2025, is jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC) at the School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa.

It seeks to equip healthcare providers at the community level, public health and environmental health practitioners, communication specialists, health educators, community development officers, social scientists, and policy makers, among others, with strategic communication skills to improve public health messaging, strengthen community engagement, and support evidence-based interventions, ultimately empowering participants to effectively engage communities and improve population health outcomes across Uganda and the region.

Launching the course, the heads of the Department of Journalism and Communication and the Department of Community Health and Behavioural Sciences noted that participants who complete the short course will gain practical tools to influence behaviour change, build trust, and deliver timely, accurate, and relevant health information to the communities they serve. The first cohort attracted more than 60 applicants, with 36 reporting for the opening in-person session on June 5, 2025, at MakSPH in Mulago. Between now and July, participants will undergo a hands-on, multidisciplinary learning experience within the Certificate in Health Communication and Community Engagement program, which combines theory and practice.

Among the participants in the first cohort of the certificate course, designed as a pilot for the anticipated Master of Health Promotion and Communication to be jointly offered by the two departments at Makerere University, is Ms. Maureen Kisaakye, a medical laboratory technologist specialising in microbiology and antimicrobial resistance (AMR), and currently pursuing a Master’s in Immunology and Clinical Microbiology at Makerere. She is driven by a passion to help reverse the rising tide of AMR, a growing global health threat where drugs that once worked are no longer effective. Kisaakye is particularly concerned about common infections, like urinary tract infections, becoming increasingly resistant and harder to treat.

“I enrolled in this course because I’m an advocate against antimicrobial resistance, and it came at a time when I needed to deepen my knowledge on how to implement our projects more effectively and engage with communities. The experience has broadened my understanding of AMR and its impact on society, and strengthened my passion for community-driven health initiatives and advocacy,” Kisaakye said, explaining why she enrolled for the short course.

Ms. Maureen Kisaakye (in white) during a youth-led community AMR and WASH awareness campaign in informal settlements in Kamwokya, Kampala, on 12th April, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa.
Ms. Maureen Kisaakye (in white) during a youth-led community AMR and WASH awareness campaign in informal settlements in Kamwokya, Kampala, on 12th April, 2025.

Kisaakye’s work in antimicrobial resistance extends beyond the lab. Having earned her degree in medical laboratory science from Mbarara University of Science and Technology, she founded Impala Tech Research in 2024 to drive impact and save lives. She has led grassroots AMR campaigns that integrate antimicrobial stewardship with water, sanitation, and hygiene (WASH) education in underserved urban communities, including the informal settlements in Kampala. She also has since designed peer-led initiatives that empower university students as AMR Champions, building a network of informed youth advocates. Kisaakye believes the health communication course will sharpen her ability to design and deliver impactful, community-centred interventions in response to the growing threat of drug resistance.

“The department collaborates with many partners within and beyond the University, including the School of Public Health, where we are working to develop the subfield of health communication and promotion. Our goal is to train specialists in this area and build a community of practice, something we have each been doing in our own spaces. There’s a lot of work ahead, and COVID-19 showed us just how urgently we need a generation trained to do this kind of work, and to do it very well,” said Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, during the opening of the short course on June 5.

Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, underscored the partnership between DJC and MakSPH as a crucial step toward strengthening public health through strategic communication. June 5th, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa.
Dr. Aisha Nakiwala, Head of the Department of Journalism and Communication, underscored the partnership between DJC and MakSPH as a crucial step toward strengthening public health through strategic communication. June 5, 2025.

She assured participants they were in good hands and underscored the importance of the partnership between the Department of Journalism and Communication and the School of Public Health, describing it as a vital collaboration that brings together strategic communication and public health expertise. This dynamic, multidisciplinary approach, she noted, is essential to developing practical solutions that empower communities, strengthen health systems, and ultimately improve livelihoods.

The course offers a hands-on, multidisciplinary learning experience, with participants intended to explore key modules including Health Communication and Promotion, Risk Communication, Smart Advocacy, Community Mapping, Community Mobilisation and Empowerment, and Strategies for Community Engagement. The course combines theory with real-world application, and its assessment includes a field-based project and a final exam.

“You are our first cohort. We are seeing the fruits of our efforts in bringing this short course to life. It was born out of a joint initiative to develop a Master’s programme in Health Promotion and Communication,” said Dr. Christine Nalwadda, Head of the Department of Community Health and Behavioural Sciences. “We carried out extensive consultations with our different key stakeholders during the process and discovered a real need for such a course. It was the stakeholders who even named it; this course name didn’t come from us.”

For Kisaakye, by the end of the course in July, she hopes to have sharpened her skills in health promotion and strategic communication, particularly in crafting targeted messages that help individuals and communities effectively respond to threats such as antimicrobial resistance. She also aims to gain practical experience in designing, implementing, and evaluating community health initiatives that can strengthen her advocacy and drive lasting impact.

Dr. Marjorie Kyomuhendo, one of the course facilitators, engages Mr. Jackson Ssewanyana, a participant in the first cohort of the Certificate in Health Communication and Community Engagement, as Ms. Maureen Kisaakye listens in. June 5, 2025. Intensive one-month course on Health Communication, first cohort June 5 to July 24, 2025, jointly offered by Makerere University School of Public Health (MakSPH)’s Department of Community Health and Behavioural Sciences (CHBS) and the Department of Journalism and Communication (DJC), School of Languages, Literature, and Communication (SLLC), co-designed in 2024 with support from the Rockefeller Foundation through Amref Health Africa, Kampala Uganda, East Africa.
Dr. Marjorie Kyomuhendo, one of the course facilitators, engages Mr. Jackson Ssewanyana, a participant in the first cohort of the Certificate in Health Communication and Community Engagement, as Ms. Maureen Kisaakye listens in. June 5, 2025.

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John Okeya

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Call for Abstracts: 2nd East African Symposium and Expo on Trauma, Injuries, and Emergency Care – 2025

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June 19, 2025

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Kickoff training for teams tasked with collecting data for the Uganda Population-Based HIV Impact Assessment (UPHIA) 2024-2025, held 19th May 2025, Makerere University School of Public Health (MakSPH) Auditorium, Main Campus, Kampala Uganda, East Africa.

The Makerere University School of Public Health (MakSPH) is excited to invite researchers, professionals, and students to be part of an inspiring and impactful event!

Venue: School of Public Health Auditorium, Makerere University Main Campus
Dates: August 7–8, 2025
Theme: “Understanding the burden and impact of injuries in East Africa to improve Emergency Care preparedness, mitigation, and response.”

Submit Your Abstracts Now!

Join the conversation that drives change in trauma and emergency care across East Africa. Share your research, innovations, and insights that can shape the future of healthcare response in our region.

Submission Deadline: July 10, 2025
Submit here: triadcommunications@musph.ac.ug
Register to Attend: https://aapug.org/east-african-symposium-and-expo-on-trauma-injury-disability-and-emergency-care-2025/

Together, let’s drive change and improve lives through research and collaboration. Don’t miss this opportunity to make a difference!

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Scholarship Opportunity: Impact of Food Supplementation

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June 16, 2025

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Dr. Roselline Achola on Graduation day being welcomed by her teachers following her PhD award. 75th Graduation Ceremony, Day 2, CoBAMS, CHS and CoNAS. 14th January 2025, Freedom Square, Makerere University, Kampala Uganda, East Africa.

MAKERERE UNIVERSITY CHILD HEALTH AND DEVELOPMENT CENTER

PhD SCHOLARSHIP FELLOWSHIP TRAINING ADVERTISEMENT

Impact of Food Supplementation on Health, Growth, and Development for Stunted
Children

We are seeking to appoint a full-time PhD Fellow to conduct a randomized controlled clinical trial (RCT) among 300 young children with stunting to assess the effect of Soy Lipid-based Nutrient Supplement with high versus low levels of antinutrients on growth and health of children on a DANIDA-supported project entitled “Climate-resilient soybean for improved growth and health of children in Uganda” (Healthy Soy). The PhD fellow will coordinate the RCT protocol development and its implementation, develop and nest his/her PhD protocol as part-of the RCT study. The PhD student will be hosted at the Child Health and Development Center School of Medicine College of Health Sciences, Makerere University. The PhD student will take part in literature review; designing, planning and conducting of studies; analysing results; writing reports and contributing to technical and policy briefs, journal articles and thesis; project management; organizing research seminars and stakeholder workshops; and guiding junior researchers and teaching. The PhD student will have access to online libraries, scientific databases and software for data analysis throughout their work. In addition, the student will be mentored by national and international researchers to develop scientific research and project management skills with three months stay in Denmark. By the end of the project, the selected candidate will have obtained significant competencies to explain the interactions between nutrition and health of children, growth and development. In addition, the student will gain skills in assessment of body composition, development and conduct of clinical trials design, scholarly writing and presentations, data analysis and interdisciplinary research.

Prospective candidates must:

  • Hold Masters in any of the following or equivalents: Human Nutrition, Dietetics, Public
    Health Nutrition, Medicine in Paediatrics and Child Health, Public Health or
  • Epidemiology with undergraduate training in Medicine and Surgery (MBChB/MBBS/MD).
  • Having publication experience will be an added advantage.
  • Be highly motivated and interested in pursuing rigorous research
  • Be committed to a long-term research career in Human Nutrition and Health
  • Be of untainted integrity
  • Be able to use different software for data analysis and graphics.

Successful fellow will be expected to:

  • Conduct high quality research leading to publications in high-impact journals (must be
    ready to work towards publishing a minimum of one quality paper per year).
  • Contribute to research capacity building including training of undergraduate and M.Sc.
    students in the host department.
  • The project will avail financial support to the successful PhD Fellow for 4 years. Funds
    will cover: PhD tuition for 4 years; monthly stipend; research supplies and reagents;
    conference participation and other research-related costs.

Interested applicants should send an application letter, motivation statement, two
recommendation letters, CV and academic transcripts and certificates for all university
qualifications in an email titled “PhD Fellowship Application – Healthy Soy Project” to
chdc.desk@mak.ac.ug by 26th June 20205.

Female candidates are strongly encouraged to apply. Only shortlisted applicants will be
contacted for interviews.

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