Health
We Are Pushing Nature to the Edge—But Solutions Are Within Reach: Global Conversations on Sustainable Health
By Davidson Ndyabahika and Johanna Blomgren
We’ve all done it—tossed leftovers, ignored wilted greens, or shrugged at a half-eaten meal. Food waste is a quiet guilt we all share, a reflex in a world of abundance and scarcity. But what if this small act connects to a larger global issue? On February 26, 2025, experts from Uganda, Sweden, and beyond gathered in a virtual seminar, asking, “How can we nourish ourselves without harming the planet?” Hosted by the Centre of Excellence for Sustainable Health (CESH), the discussion revealed a harsh truth—our food habits are draining the Earth.
The discussion on sustainable food systems marked the beginning of the annual four-part global conversation on sustainable health, organized through a collaboration between Sweden’s Karolinska Institutet and Uganda’s Makerere University under the auspices of CESH.
In Kampala, the paradox is stark. Every day, 750 tons of food waste fill the city’s landfills, enough to feed thousands. Rotten mangoes spill from crates in Nakasero Market, and half-eaten Rolex wraps pile behind street stalls. Uganda’s Food Rights Alliance shows 37.8% of this waste comes from plates and markets. Across East Africa, organic waste, like spoiled vegetables and discarded tubers, makes up 79% of urban trash—a grim reflection of broken systems. Beyond this is a city stuck with piles and piles of organic trash, which has previously been fatal with a slide in one of Kampala’s major landfills. Meanwhile, 26% of Uganda’s children remain stunted.
At the heart of this week’s global conversation was the WWF’s Living Planet Report 2024, a sobering revelation of a 73% decline in global wildlife populations since 1970. Freshwater ecosystems have hemorrhaged 85% of biodiversity, Latin America’s species richness has plummeted by 95%, and Africa—home to smallholder farmers who feed millions—has lost 76%. “Nature is disappearing at an alarming rate,” warned Harold Turinawe, WWF Uganda’s Forest Markets Transformation Manager, his voice weighted with urgency.
“We are pushing Earth’s systems to irreversible tipping points, and despite the increase in food production and land use and the destruction of habitats, the world is still hungry; we have over 735 million people going to bed hungry every other night. The contradiction is striking,” Turinawe added.
The report highlights the Amazon’s lush canopies that are felled for cattle ranches. The interplay of man’s unsustainable utilization of Mother Nature, leading to the food paradox, feast, famine, and ecological ruin, underscores the urgency of addressing global goals in a coordinated manner.
The report’s indictment of industrial food systems is clear: agriculture claims 40% of habitable land, 70% of freshwater, and drives 25% of greenhouse emissions. Yet, 735 million people still starve nightly. “Our obsession with monocultures and processed foods isn’t just destroying habitats—it’s failing humanity,” said Dr. Rawlance Ndejjo, the seminar’s moderator and a public health lecturer at Makerere University.
Florence Tushemerirwe, a Ugandan public health nutrition expert based at Makerere University’s School of Public Health, pointed out the irony: 26% of children are stunted, while obesity rises among adults in Uganda. “We grow nutrient-rich crops but export them, leaving people dependent on cheap, processed imports. In fact, many people do not appreciate their nutrient value,” she said. Uganda’s iodine-depleted soils now rely on fortified foods—a temporary fix for a growing crisis.
All through the seminar, the message was clear: we are wasting abundance while ecosystems crumble and people go hungry. “Our salt is iodized because our soils no longer provide it. Biodiversity loss isn’t abstract—it’s stealing nutrients from our plates. But if we don’t maintain our nature’s health, or our environmental health, or our natural resources health, it means that whatever food we grow, we actually do not carry the nutrients we need to maintain a diverse diet,” said Tushemerirwe.
The panel dissected global food trade’s role. WWF’s Turinawe lamented, “90% of deforestation is for agriculture. In Uganda, the once-vibrant wetland ecosystems of Lwera at the shores of Lake Victoria now face severe degradation due to large-scale rice growers; in the Amazon, its cattle ranches.”
Dr. Rachel Marie Mazac of Stockholm Resilience Centre stressed Europe’s complicity: “Sweden’s ‘virtual biodiversity loss’—importing deforestation via beef and soy—shows how our diets export destruction.”
“From a Swedish perspective, we are highly dependent on imports, particularly raw materials, which contribute significantly to biodiversity loss in other regions. It’s difficult to pinpoint the exact impact, especially with biodiversity, but there’s a concept of “virtual impact,” says Dr. Mazac.
Food consumed in Sweden, though produced elsewhere, contributes to biodiversity loss in those areas. The issue links to trade, food production, and distribution. It’s not just about production or waste but also equitable distribution.
Dr. Ndejjo added starkly, “You could be eating a burger from a cow grazed on razed Amazon forest. Guilt isn’t enough—we need systemic change.”
Amid the grim statistics, the panelists outlined a roadmap for redemption: nature-positive agriculture, subsidy policy reform, improved localized diets, global accountability, and honest discussions on the GMO dilemma.
Turinawe emphasized the need for agroecology in extension services—integrating trees, crops, and livestock to rebuild soil health and biodiversity. He stressed while critiquing Uganda’s Parish Development Extension Model for prioritizing enterprises for profit over sustainability. “We are saying get one million to a farmer. What are they producing? They are engaging in commodities that are predetermined. Nobody’s talking about Mother Nature. Who takes care of the soil? Who takes care of the water needs? Who takes care of the diversification we are talking about? But diversification in the diet begins with diversification on the farm. So my first issue is strengthening the agricultural extension services,” says Turinawe.
Adding that things like soil health management, land tenure system farmer-to-farmer network for peer learning, and fair farmer subsidies should be key to planning and agricultural extension.
“In Uganda, where I come from, and currently in Kampala, if you head north towards Zirobwe in Luweero District, you’ll find people we call Bibanja owners—essentially squatters who don’t own the land they occupy. These individuals cannot engage in sustainable agriculture as we’re discussing; their focus is survival. What we need are programs that give farmers secure land rights, which can motivate them to invest in soil health and environmental conservation—investments that take time. Improving soil is not a short-term effort; it requires long-term actions like planting trees, integrating practices, and using farmyard manure. None of this is realistic for someone who fears being displaced tomorrow. We need to approach this challenge collectively.”
Subsidies must reward sustainable practices, not industrial giants.
“Why not tax breaks for farmers using organic manure?” Turinawe challenged. “I would love to hear that a farmer that is engaged in sustainable cocoa production and coffee production gets a tax holiday rather than having a blanket of investors getting a holiday. Put subsidies and investment incentives in the right direction. We shall spur production, and of course, this will also bring in corporate partnerships, and we can make our supply chains safer, better, more green, and more sustainable,” Turinawe added.
Dr. Mazac noted that “nature-positive production can feed the world by optimizing crops, livestock, and wild fisheries, and supporting aquaculture that works with wetlands, not against them.” For Mazac, policy is key: She is also an advocate of subsidies and taxes that benefit farmers. Those that ensure incentives that improve soil health and maintain water quality as well as tackle climate change in order to make sustainability profitable.
“We must rethink trade to avoid widening the gap between food-producing areas and markets and instead support local farmers. Subsidies and taxes should empower these communities to nourish their populations before focusing on exports. While exports generate income, they also have significant impacts. A possible solution is changing production systems, but we must also shift dietary and consumption habits, making this a collective effort, not just an individual responsibility.”
Tushemerirwe is hungry for reviving indigenous crops and regulating predatory marketing. “Awareness is power. We must teach communities to value their traditional foods over processed substitutes.”
“There is good food grown in rural areas and available in markets, but people don’t recognize its value due to lack of guidance. We need food-based data guidelines to raise awareness. The Uganda Ministry of Health has a draft for this, along with draft policies to regulate unhealthy food marketing, especially to children. Junk food is advertised everywhere: hospitals, schools, and even street billboards, with fast food chains clustered together. We must regulate this and educate people on the nutritional benefits of eating what they grow over imported alternatives,” she stated.
Dr. Ndejjo believes these draft guidelines to regulate unhealthy food marketing should be finalized into policies and urges policymakers and implementers to prioritize the urgent need for these documents.
The conversation also weighed in on the genetic engineering in agriculture for increased crop yields, popular for GMOs, a dilemma that panelists called for their democratization rather than demonizing them. While Dr. Mazac cautioned against corporate-controlled seeds, Turinawe acknowledged their potential: “If democratized, drought-resistant crops could save farms in a warming world.”
Dr. Mazac noted that while in Europe and the European Union, they are not allowed to grow or sell foods that have been genetically modified, the essence of them should not be overlooked, since they are a technology that seeks to solve the future food crisis.
“GMOs aren’t inherently evil. Drought-resistant crops could save farms—but corporate patents trap farmers,” she said.
Turinawe added, “Our approach to GMO’s is a measure one bordering more on ethics and responsible use of GMOs; we see GMOs as a tool to promote resilience, especially since everything has changed—the food we once relied on can no longer grow in the same way. If GMOs help improve crop resilience, that’s a valuable tool. However, there are concerns that companies like Monsanto could use the GMO technology as a tool of exclusion, e.g., the fear of monopolizing future seed markets. This is where caution is needed.”
A Call for Radical Collaboration
The seminar’s resounding theme was unity: multi-sectoral collaboration is non-negotiable. From street food vendors to policymakers in the boardrooms, every actor must align. “Food systems aren’t siloed,” Dr. Mazac asserted. “They’re woven into climate, economy, and culture.”
“I think we need to sit and agree and engage quite regularly and find solutions for us to be able to produce food but sustainably,” concluded Tushemerirwe.
The Path Ahead
CESH’s global conversations on sustainable health are a microcosm of a global awakening, especially in tracking progress to meet our goals for 2030 and beyond: This seminar on food systems emphasizes the interconnectedness of food security and biodiversity. With the next UN Climate Summit (COP29) on the horizon, the panel’s message is clear—transformative change is possible, but only through courage, equity, and an unyielding reverence for nature.
To find more about this global conversation on sustainable health and more, visit CESH.health
Davidson Ndyabahika and Johanna Blomgren are the co-organisers of the global conversation on sustainable health
Nearly half of Uganda’s prison population has latent tuberculosis (TB), according to the latest Uganda National Prevalence Survey on Tuberculosis, HIV, and COVID-19. The survey, released on May 15, 2025, found that active TB cases in prisons stand at 1,900 per 100,000—eight times higher than in the general population.
The survey was conducted by Makerere University School of Public Health (MakSPH) in conjunction with the Uganda Prisons Services (UPS) and the Ministry of Health—with funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and technical support from the U.S. Centers for Disease Control and prevention (CDC)—and purposed to have a more profound understanding of TB to help inform public health programs for this high-risk population.
Dr. Simon Kasasa, a Senior Lecturer at MakSPH and Principal Investigator of this study, stressed that “staying for a longer duration, three years and above, posed a greater risk to TB infection in prison.” He also noted TB infection was much higher among male prisoners (48%) compared to female prisoners (38%) and among those of older age, 65 years and above. Meanwhile, the report noted concerns about excessive numbers in prisons as a key risk factor for TB transmission.
UPS consists of 257 prisons spread over 16 administrative regions with an average prisoner population of 56,400 (95% male), accommodation capacity of 16,612 (340%), and 9,904 staff (29% female).
HIV prevalence among prisoners was also alarmingly high at 11%, twice that of the general population. Notably, female persons in prison (PIP) had the highest HIV rates at 21%, compared to 11% for male PIP and just 2% among prison staff. However, the data also showed a significant drop in overall HIV prevalence within prisons, falling from 15% in 2013 to 11% in 2023, with the most dramatic decline among staff, from 12% to 2%.
Dr. George Tumusinze, a Program Manager and Research Associate, pointed out that although 92% of people with HIV in prisons know their status and 99% are receiving antiretroviral therapy (ART), only 70% have successfully reduced the virus in their bodies, highlighting important issues with how well the treatment is working.
Mr. Samuel Akena, the Deputy Commissioner General of Prisons, echoed these concerns by stating that the survey represents a significant milestone for the Prisons, not only in terms of data collection but also in Uganda’s journey towards achieving equity, justice, and the right to health for all. “This survey is historic. It represents one of the most comprehensive efforts to understand the health status of people in prisons in Uganda.” He emphasized the necessity of a collective and bold response, urging that “the time for piecemeal responses is over.”
Dr. Charles Olaro, Director General of Health Services at the Ministry of Health, emphasized the urgency of the situation, stating, “As we gather today to reflect on the findings of this important survey, we must recognize the urgent need for action in our fight against tuberculosis (TB) in Uganda. Despite our efforts, we are still grappling with the burden of this disease, and our progress toward eliminating it by 2030 has not been as swift as we had hoped.” He pointed out that the survey serves as a critical baseline that will shape future responses and guide resource allocation.
HIV prevalence among prison staff members was the lowest, at just 2%, reflecting a significant achievement in workplace health. Dr. Daniel Byamukama, Head of HIV Prevention at the Uganda AIDS Commission, praised prison authorities for their efforts, noting the remarkable progress over the past decade. In the first survey in 2013, only 34% of HIV-positive staff on treatment had achieved viral load suppression. Today, that figure has reached an impressive 100%, underscoring the impact of sustained prevention and care efforts.
While the prison HIV program has shown effectiveness—evidenced by a drop in prevalence from 15% to 11% among the prisoners over the past decade—Mr. Akena stressed the importance of prioritizing gender-responsive strategies in health interventions.
“Diseases do not recognize bars or borders. They thrive in environments where conditions are poor and resources are scarce. Women in prison face disproportionately higher risks, yet often remain invisible in program planning. This is not acceptable. If we are serious about health equity, we must prioritize gender-responsive strategies — within prison health systems and beyond,” Mr. Akena.
CDC Uganda Director Dr. Adetinuke (Mary) Boyd reinforced the significance of the survey in addressing public health risks. “In Uganda, CDC partners are helping to ensure inmates stay healthy during custody. This work facilitates safe reintegration into their communities, mitigates disease transmission to the general population, and reduces public health risks like untreated TB,” she stated. Dr. Boyd highlighted the role of PEPFAR in tackling critical global health threats, asserting that the survey offers helpful data for enhancing health collaboration within this vulnerable population.
The U.S. CDC has been supporting Uganda Prisons Services to provide comprehensive HIV/AIDS, STI, and TB prevention, care, and treatment services for the last 15 years (2010–2025), totaling over $18,046,263 in investment—including $550,000 to this study alone, through the Makerere University School of Public Health. The program supports capacity building, scale-up, and health system strengthening efforts in HIV/TB testing, care, and support for prisoners and prison staff, plus surrounding communities.
With 80% of prison wards overcrowded and 95% lacking adequate natural ventilation, the conditions in which these individuals live exacerbate the spread of infectious diseases, public health specialists have warned. This survey underlines the urgent need for systemic changes within the prison health system, as well as a commitment to uphold the rights and health of all individuals, regardless of their circumstances.
As Uganda grapples with these alarming statistics, the call to action is clear. Stakeholders must come together to implement effective health interventions, improve screening and treatment protocols, and ensure that the rights of incarcerated individuals are respected. The health of the general population is inextricably linked to the health of those within prison walls, and addressing these challenges is not just a moral imperative but a public health necessity.
Professor Rhoda Wanyenze, one of the investigators and Dean of the School of Public Health, asserts that the Survey findings are a wake-up call for stakeholders to prioritize health equity and justice for society’s most vulnerable members.
Prof. Wanyenze advocated for improved TB screening methods and institutionalization of regular mass TB screening using the WHO-recommended advanced diagnostic tools like digital chest X-rays with Computer-Aided Detection (CAD), as well as molecular diagnostics like GeneXpert and TB LAM, noting that traditional symptom-based screening missed nearly half of TB cases. “The use of molecular diagnostics like GeneXpert significantly improved case detection in our study,” she added, emphasizing the importance of timely diagnosis and treatment.
Uganda Prisons Service, in partnership with the Ministry of Health, has so far installed 14 GeneXpert machines in medium- to high-volume prison health facilities.
While some, including Members of Parliament, have raised concerns about the potential infringement on individual rights through mandatory TB testing in prisons, Dr. James Kisambu, the Commissioner for Prison Health Services, noted that it is now apparent, with these findings, for everyone to appreciate that in such confined settings, the risk of transmission is extraordinarily high. TB testing in these settings is not just a medical practice but also a crucial public health precaution that protects both prisoners and the wider community.
“Prisons are high-risk, high-transmission environments where one undetected case can rapidly escalate into an outbreak. In such settings, the right to refuse testing must be weighed against the right of others to be protected from infection. Mandatory TB screening, when done with dignity and linked to prompt treatment, is not a violation of rights — it is an essential public health measure to protect both people in prison and the communities they return to,” said Dr. James Kisambu.
The researchers from MakSPH were; Dr. Simon Kasasa, Associate Professor Esther Buregyeya, Dr. George Tumusinze, Dr. Simon Walusimbi, Dr. Dick Kasozi, Dr. Ronald Senyonga, John Baptist Bwanika, Prossy Nabaterega and Professor Rhoda Wanyenze.
Additionally, the study team from the Uganda Prisons Service comprised of Dr. Leonard Marungu, Charles Butagasa, Dr. James Kisambu and Dr. Johnson Byabashaiza, the Commissioner General of Prisons.
Finally, Dr. Deus Lukoye, Dr. Julius Ssempiira, Charles Kavuma, Rise Nakityo, Samuel Sendagala, Grace Nantege, Lisa Mills, Dr. Lisa Nelson, Kenneth Mwambi from U.S. CDC Uganda/Atlanta and PEPFAR USG agencies, and George William Kasule, Didas Tugumisirize, Dr. Simon Muchuro, Professor Moses Joloba, Dr. Turyahabwe Stavia from the Uganda Ministry of Health National TB and Leprosy Program (NTLP) completed the team.
On April 23, 2025, Makerere University School of Public Health (MakSPH) convened district leaders, health managers, and project partners to disseminate the outcomes of a major leadership and management strengthening initiative in Wakiso District, Central Uganda. The one-year project, part of the Global Health Partnerships programme funded by NHS England, was implemented in collaboration with Nottingham Trent University, Nottingham University Hospitals NHS Trust, Wakiso District Local Government, and Uganda’s Ministry of Health.
Launched in 2024, the project titled Strengthening Leadership and Management Among Local Government Health Managers in Wakiso District, aimed to co-design and pilot a leadership and management training tailored to the realities of Uganda’s decentralised health system. The intervention, led by Makerere University’s Dr. David Musoke and Nottingham Trent University’s Prof. Linda Gibson, through the over 15-year-old NTU-Mak Partnership impacting lives in Wakiso, began with a field visit to over 60 public health facilities in the district, a needs assessment within these facilities to identify key priority gaps, and a baseline survey with the health in-charges to establish the initial status of key indicators.
“We have been very fortunate to work with a supportive local government in Wakiso, from the top leadership down. While many projects struggle to engage district teams, our longstanding relationship with Wakiso made collaboration seamless. Although this was our first initiative specifically focused on leadership and management, we hope it will serve as a stepping stone for even more impactful work in the future,” Dr. David Musoke, a Senior Lecturer at Makerere University and the Uganda Project Lead, said during the dissemination workshop, highlighting the key success factors for the leadership and management project.
Initial results from the needs assessment and baseline on leadership and management competencies conducted among Wakiso District health facility supervisors early last year by the project team and shared during the three-day workshop in June 2024, held in Kampala, which kickstarted the six-month structured fellowship programme for 53 health managers in Wakiso, had found critical capacity gaps. Using a tool evaluating 17 leadership and 33 management competencies, only 40% of the managers met the 80% benchmark for leadership, scoring highest in cognitive skills, while just 33% met the required management standard, performing best in self-management and lowest in quality management.
Then, the health facility managers with postgraduate training, longer service, and strong team dynamics, showed overall better performance. While working relationships with subordinates and the district leadership were largely positive, performance was hampered by systemic challenges such as limited resources, low motivation, and weak teamwork. Overall, the study also pointed to a misalignment of expectations between the District Local Government and the Health Ministry, underscoring the need to strengthen coordination to improve services.
The result of this mismatch was to the effect that, as of this time last year, Wakiso District ranked among the bottom 10 on the national health league table, which is an annual Ministry of Health assessment of district performance across key service delivery and patient satisfaction indicators. This was despite Wakiso being Uganda’s most populous district, with over 3.4 million residents today, as it continued to struggle to deliver essential health services to the public. The 2022/2023 Annual Health Sector Performance Report also flagged persistent challenges, including frequent transfers of facility in-charges, overstretched management structures, and weak internal communication and coordination.
It was this stark reality that informed the leadership and management intervention in Wakiso. Officiating the dissemination of the project outcomes, Dr. Sarah Byakika, Commissioner for Planning, Financing, and Policy at the Ministry of Health and a member of the National Oversight Mechanism for the programme, commended the remarkable progress made in just six months, citing visible improvements across the district as a direct result of the intervention.
“I have been involved with this programme right from its inception, and I’m proud that Uganda became one of its major beneficiaries,” Dr. Byakika said with gratitude, commending the strong collaboration between the Ministry of Health, Makerere University, Nottingham Trent University, Nottingham University Hospitals, Wakiso District and the development partners for supporting the initiative. She emphasised the value of this partnership in strengthening leadership and management competencies among Wakiso District health managers to address critical performance gaps in health service delivery.
“Wakiso is Uganda’s largest and most populous district, yet it has long underperformed on key health indices. Despite its semi-urban nature, it faces enormous health service delivery challenges, partly due to the overwhelming burden on its District Health Officer, who oversees more than 60 public and over 340 private health facilities. Many of these private facilities open and close frequently, complicating service oversight,” Dr. Byakika observed with concern.
Her sentiments were echoed by the District Health Officer, Dr. Emmanuel Mukisa, in a message delivered by Wakiso District Biostatistician, Mr. Frank Kakande. He noted that the project had contributed to a noticeable shift in the district’s health system performance, with visible improvements in leadership, communication, and accountability among facility in-charges beginning to translate into better overall health service delivery outcomes.
“You cannot talk about management without addressing performance: they go hand in hand. As someone who sits at the centre of district health data, I can confidently say that performance has improved. During the most recent national local government performance assessment, where I participated in the evaluation, Wakiso District’s health department ranked 18th out of 146 districts. That health ranking is a major achievement. We have consistently performed poorly in the past, but this time, we made significant progress,” Mr. Kakande told the attentive audience, speaking with an air of relief and satisfaction.
The Wakiso District Biostatistician credited part of this progress within the district, from the poor performance last year, to the leadership training and mentorship delivered through the project, citing visible improvements across key health indicators. He stressed the need to sustain this momentum through continued mentorship, internal capacity strengthening, and consistent application of the skills acquired by health managers, particularly in tackling persistent management challenges such as absenteeism, delegation, and accountability.
“Last week, I held a performance review at Kakiri Health Centre III, and the improvements were clear. These management skills are making a difference. You can see the change across indicators. But what matters now is sustainability. The support provided through supervision and mentorship was essential. But it’s up to us to keep the fire burning. We have learned a lot: communication skills, problem-solving, time management, and decision-making. Managers are now communicating better. Even issues like absenteeism are being addressed through proper reporting and action,” Mr. Kakande said.
Earlier, Dr. Musoke, presenting the overall project overview and success, explained that based on initial findings from the baseline and needs assessment, the team co-designed and delivered a structured six-month capacity-building programme targeting 60 health facility in-charges in Wakiso District. The programme blended in-person and virtual sessions, combining practical training with one-on-one mentorship, and included an exchange component between Uganda and the UK to promote international exposure and peer learning. This allowed the health managers to apply new skills to strengthen health outcomes in Wakiso.
“This project rightly focused on addressing gaps in leadership and management. I advocated for including this component in the programme, because our national health review missions consistently show that poor performance often stems from weak leadership and management,” Dr. Byakika affirmed, adding that: “I am pleased to see that nearly all public facilities in Wakiso participated. While the project had a short implementation window, the evaluation already shows encouraging results. Health managers feel more empowered, motivated, and aware of their roles. That’s a significant step.”
For her part, Dr. Sheba Gitta, Uganda Country Director for Global Health Partnerships, formerly Tropical Health and Education Trust, applauded the leadership and management capacity-building initiative in Wakiso as a timely, locally driven intervention. She underscored the value of two-way learning between Uganda and the UK health systems through the programme, noting that Global Health Partnerships works closely with the Ministry of Health to ensure all funded initiatives align with Uganda’s national development priorities.
“What excites me most is that this was not a pre-packaged programme imported from the UK. The training was co-created by partners, based on local realities and needs. That approach reflects strong collaboration between Makerere University School of Public Health and Nottingham Trent University. I thank Prof. Linda Gibson for her continued commitment and Dr. David Musoke for his proactive leadership in bringing this programme to life. Your consistency and quality of work continue to stand out,” Dr. Gitta shared.
While commending the progress made, she cautioned against “pilotism”, as a tendency for promising projects to end prematurely, calling for the model to be scaled up nationally. To support sustainability, she stressed the importance of documenting the training process, outcomes, and costs to inform ministry-level decision-making and long-term adoption.
Dr. Gitta joined Prof. Linda Gibson, the UK Lead for the Project, to encourage the trained managers to become champions of leadership within their facilities and districts, ensuring that the impact of the programme endures beyond its current cycle. She also thanked NHS England and the UK Government for their trust and investment in Uganda’s health system.
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