Health
Mak Researchers Partner with Safe Bangle Technologies to Roll out a Real-Time Domestic Violence Reporting Bracelet
By Joseph Odoi
A Consortium of Researchers from Makerere University School of Public Health/Resilient Africa Network (MakSPH/RAN), Medical College of Wisconsin (MCW), Somero Uganda together with Safe Bangle Technologies have rolled out a real time domestic violence reporting bracelet.
This roll out was made possible with support from the United States Agency for International Development (USAID) under the PARTNERSHIPS FOR ENHANCED ENGAGEMENT IN RESEARCH (PEER) program and the National Academies of Sciences.
Dr. Juliet Kiguli, the Principal Investigator from Makerere University, along with Dr. Roy Mayega, Deputy Chief of Party at RAN, and Dr. Agnes Nyabigambo, the study coordinator, initiated the PEER program to identify entry points for testing SafeBangle Technologies (a social enterprise based at Resilient Africa Network (RAN) with a mission to create a safer and more secure environment for women and children through innovative, affordable, and creative technology solutions to curb GBV in Africa.) wearable safety bracelet in the informal settlements. This decision stemmed from findings of increased intimate partner violence (IPV) and gender-based violence (GBV) in three informal settlements in Kampala, Uganda, following a longitudinal study, geospatial mapping, and interviews. The project, titled ‘The Impact of the COVID-19 Pandemic on Gender-Based Violence among Women and Girls in Informal Settlements in Kampala,’ highlighted the urgent need for affordable and immediate reporting mechanisms for violence.”
‘’While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used incorporated the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time’’ explained Dr. Kiguli.
Innovation details
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
“While developing SafeBangle, we tested with the users in both rural and urban contexts. We piloted the innovation around Kampala with support from Digital Human Righs Lab and Naguru Youth Health Network as well as it in five districts of Karamoja region with support from Save the Children and Response Innovation Lab. Right now it has become handy in Kamapala‘s informal settlements. We envision a future where SafeBangle becomes a standard tool in the fight against GBV, ensuring every woman feels safe and secure as it has the potential to transform how we respond to GBV in Africa” added Kabali.
HOW THE SAFEBANGLE TECHNOLOGY WORKS
The SafeBangle is wearable technology similar to a smartwatch that sends an alarm by SMS to people chosen by a woman herself if she feels threatened.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV among at-risk women in informal settlements Of the 72 adolescent girls and women who received the SafeBangle, 22 activated the reporting button, resulting in 19 receiving immediate and appropriate support, including counseling, police intervention, and health services.
All adolescent girls and women who experienced GBV received a phone call from Somero Uganda to discuss the most appropriate intervention, including counseling, police cases being handled by the probation office, referral for health services, and post-exposure prophylaxis. All the GBV survivors received support and are still receiving continuous follow-up.
Researchers conducted a survey among 644 girls and women in Kinawataka (Nakawa Division) and Bwaise (Kawempe Division) to gain insights into awareness and understanding of sexual and gender-based violence among adolescent girls and women in informal settlements. The survey measured socioeconomic factors, mental health symptoms, and exposure to GBV. Focus group interviews were conducted with a separate sample of women over 18 in the settlements to explore responses to GBV.
A tabular representation of the key findings and lessons learned from your study on gender-based violence (GBV)
| Key Findings | Lessons learned |
| Prevalence of GBV. – Overall prevalence: 34.1% of women and girls reported experiencing GBV. – Among adolescents (15-19 years): Over 50% reported experiencing GBV. | – The pandemic highlighted the need for accessible and comprehensive support services for GBV survivors. – Schools emerged as crucial safe spaces for girls, emphasizing their well-being during crises. – Economic independence proved crucial, enabling women to leave abusive environments. – Involving men and boys as allies in GBV prevention efforts is essential. |
| Age-related trends | – GBV prevalence tends to decrease with increasing age. |
| Physical and health consequences. | – Women and girls suffered physical violence, injuries, and deaths, primarily from domestic violence and unsafe abortions due to limited healthcare access. – GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS. |
| Social and economic impact. . | – GBV contributed to family breakups, strained marriages due to financial stress. – Economic hardships forced some women and girls into transactional sex, exposing them to further health risks and exploitation. – Pandemic-related job losses and economic constraints increased financial dependence on abusers, trapping women in violent situations. – School closures and increased household responsibilities limited women’s job opportunities and subjected them to sexual harassment. |
| Psychological effects | – Survivors experienced guilt, shame, anxiety, fear, and suicidal thoughts due to ongoing abuse. |
| Long-term effects | – Post-COVID-19, survivors faced disrupted education, early marriages, pregnancies, social stigma, and persistent mental health issues. |
Reproductive Health Consequences: GBV resulted in unintended pregnancies, unsafe abortions, and increased risk of sexually transmitted diseases (STIs) like HIV/AIDS.
Family Breakdown: The rise in GBV led to family breakups as women fled abusive relationships. Marriages were strained due to increased financial stress.
Transactional Sex for Survival: Desperate for basic needs due to job losses and economic hardship, some women and girls resorted to transactional sex, exposing them to further health risks and exploitation.
One study participant stated, “The time of COVID-19 was so terrible for some of us. We in fact got a lot of diseases from it because you would want to get food and didn’t have money. That way you would be forced to get a man who would use you and pay.” – (FGD_Girls_19–24years_Kinawataka).
Economic Effects: COVID-19 restrictions caused job losses and limited economic opportunities, particularly for women in the informal sector. This increased financial dependence on abusers and trapped women in violent situations.
Limited Access to Employment: School closures and increased household chores limited women’s ability to seek employment, perpetuating gender inequality in the workforce. Some faced sexual harassment from potential employers.
Psychological Effects: Survivors of GBV experienced guilt, shame, anxiety, fear, and even suicidal thoughts due to the constant threat and unpredictability of abuse.
Post-COVID Effects: GBV survivors faced long-term consequences, including disrupted education, early marriage, early pregnancy, social stigma, and persistent mental health issues.
Lessons learned
The pandemic highlighted the need for accessible and comprehensive support services for survivors of GBV, the significance of schools as safe spaces for girls, and the need to prioritize their well-being during crises. Economic empowerment emerged as a significant protective factor for women and girls. Those with greater economic independence were better equipped to leave abusive environments and secure their safety and well-being, while dependent ones suffered abuses. Engaging men and boys as allies in the fight against GBV and involving them in prevention efforts can help promote positive behavior change and foster more equitable relationships.
Recommendations
To address GBV against women and girls, the researchers recommend the following moving forward;
- There is need to integrate technology-driven solutions like SafeBangle into national GBV prevention and response strategies. SafeBangle can be a valuable tool for policymakers as cases of violence that would have gone unreported will be brought to light and the would-be victims will be able to get immediate help from trusted relatives and friends.
- Provide economic opportunities and vocational training for women and girls to enhance their financial independence and reduce vulnerability to violence. There is therefore a need to introduce education and training programs that empower women and girls, by providing them with skills, resources, and opportunities to start their own ventures and to participate fully in community affairs.
- Strengthen and enforce existing laws and policies related to GBV, including laws against domestic violence, child marriage, and sexual assault without discrimination be it for law enforcers, leaders, and employers where such cases were suffocated. Ensure that perpetrators are held accountable through swift and fair legal processes that have no room for corruption.
- Establish and promote effective, accessible, and confidential reporting mechanisms for GBV incidents that provide confidence and can be trusted by survivors to enhance reporting of such incidences of GBV. Community Engagement and Involvement: Involve community leaders, religious leaders, and elders in discussions about GBV to promote gender equality, change social norms, and reinforce the message that violence against women and girls is unacceptable.
- Launch extensive public awareness campaigns to challenge harmful gender norms, report cases of GBV, raise awareness about the consequences of GBV, and promote positive behaviors and attitudes towards women and girls.
- Implement comprehensive sexuality education in schools and communities, educating young people about healthy relationships, consent, and reproductive rights to be able to make informed decisions about their own lives and well-being.
- Engage men and boys as allies in the fight against GBV, encouraging them to challenge harmful masculinity norms and behaviors. This will help minimize GBV because mostly they are the perpetrators. Strengthening Support for Survivors: Provide ongoing support and follow-up services for survivors of GBV mostly counselling services to aid their recovery and facilitate their reintegration into society.
- Provide ongoing support and follow-up services for survivors of GBV, mostly counseling services to aid their recovery and facilitate their reintegration into society.
- Provide avenues to seek free or subsidized services by survivors of GBV medical services and legal processes by survivors of GBV to enhance reporting of GBV cases, access to medical care, counseling, legal support, and other essential services.
- Encourage and support more research and innovations like SafeBangle to curb incidents of GBV.
- A comprehensive and inclusive approach is required. The efforts should involve government institutions, civil society organizations, community leaders, and individuals working together to address the root causes and provide support to survivors.
- Involve media in GBV prevention activities and for enhancing campaigns against GBV mostly on radio and TV.
MORE ABOUT THE STUDY
The core project team, included researchers at Makerere University School of Public Health (MakSPH), Medical College of Wisconsin (MCW) led by Prof. Julia Dickson-Gomez, SafeBangle Technologies, and Somero Uganda, a community-focused NGO, began the project by designing their research protocol and taking a CITI Program course on human subjects social/behavioral research. Team members also met with the Ministry of Gender, Labour, and Social Development (MGLSG) in support of the gender-based violence policy process, Ministry of Health and local government. They also established relationships with the Kampala Capital City Authority (KCCA) and Nakawa and Kawempe probation offices to support legal processes for the GBV survivors. SafeBangle Team also received an award from Defenders Protection Initiative.
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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