Health
Uganda Newborn Programme Shifts the Paradigm of Newborn Care
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.
A Voice for Excellence, Equity and African Sovereignty
When Dr. Michael Makanga walked onto the stage at the 8th Galien Forum Africa in Dakar on 31 October 2025 to receive the Special Career Achievement Galien Prize, presented by President Bassirou Diomaye Faye under the theme Health sovereignty: an imperative for Africa, the moment carried weight beyond any medal or citation. “It is a celebration of a lifelong commitment,” he said, “but also a reminder of a responsibility I have never been willing to compromise: to inspire others to raise their voices for excellence, science, and equity.”
For more than two decades, Dr. Makanga has been a quiet architect of Africa’s health sovereignty. His work has unfolded far from cameras: in laboratories constrained by resources, in policy rooms where African priorities demanded a stronger voice, and in mentoring sessions with young scientists seeking reassurance that their ideas mattered.
Born and trained in Uganda, Dr. Makanga earned a Bachelor of Medicine and Surgery from Makerere University before pursuing a master’s degree and PhD at the Liverpool School of Tropical Medicine. His career spans nearly 30 years, encompassing tropical medicine, clinical trials in Africa and Europe, and senior international management roles. Since joining EDCTP in 2004, he has guided its growth as a unique Africa–Europe partnership, strengthening African capacity for high-quality, ethical clinical research while accelerating solutions for poverty-related diseases. Today, he leads the Global Health EDCTP3 Joint Undertaking under the EU’s Horizon Europe programme.
President Faye captured the essence of Dr. Makanga’s achievement: “Scientific excellence is not negotiable; it is earned. It underpins our credibility and our sovereignty.” For Dr. Makanga, the statement is a call to action. “I hope this recognition reminds us that Africa’s scientists and innovators can lead global health research with excellence and purpose. We owe it to the next generation to build the systems and confidence that make this possible,” he said.
Dr. Makanga’s peers describe him as a “builder”: someone who strengthens research systems, mentors emerging scientists, and fosters equitable partnerships long before “local ownership” became a policy buzzword. In his own words, the award honors his “career’s contribution to advancing Africa’s health sovereignty” while reinforcing his commitment to ensure younger scientists do not have to fight for legitimacy as previous generations did.
The 2025 Prix Galien Africa celebrated Dr. Makanga alongside innovators reshaping African science. La Ruche Health, a Côte d’Ivoire-based digital health platform, won for connecting users to certified providers through an AI-powered system. Senegalese computer scientist Adji Bousso Dieng received a special prize for applying artificial intelligence to the natural sciences, including spotting emerging viral variants using her “Vendi Score” tool. The awards were organised with the support of the Presidency of Senegal, the Gates Foundation, the West African Health Organization, and the Rockefeller Foundation, with a jury co-chaired by Dr. John Nkengasong and Professor Souleymane Mboup.
Yet the award’s true weight lies not in ceremony, but in its symbolism. Dr. Makanga’s career exemplifies how African scientists can lead, shape policy, and influence global health priorities when empowered and supported.
Makerere University colleagues attest to this impact. Dr. Victoria Nankabirwa, a clinical researcher and epidemiologist, reflects: “EDCTP support allowed me to build multidisciplinary teams, enhance laboratory and trial infrastructure, and generate evidence relevant for policy and practice. It strengthened my scientific independence and expanded the long-term sustainability of my research, particularly on childhood vaccines.”
She adds, “Dr. Makanga’s vision and commitment have strengthened institutions, built capacity, and fostered equitable partnerships, enabling African investigators to lead complex studies that address the continent’s priorities. His recognition shows what is possible when scientists are empowered, trusted, and supported.”
Dr. Alex Kayongo, an immunologist at Makerere University, describes EDCTP support as “catalytic,” enabling advanced training and a platform to study microbiome–immune interactions in HIV-associated COPD. His work is shaping mechanistic insights and strengthening Uganda’s capacity for complex respiratory immunology research. “Global health funding is increasingly competitive, making EDCTP’s role even more vital,” he says. “Africa needs sustainable support for complex, lab-intensive research. Continued investment in infrastructure, leadership, and fair partnerships is essential if African institutions are to drive innovation and secure true scientific sovereignty.”
Dr. David Musoke, an associate professor of disease control, credits his EDCTP fellowship with deepening his malaria research and advancing his career. His studies combined housing improvements, environmental management, and behavioural measures to complement traditional malaria prevention, shaping practical, community-informed interventions. “Dr. Makanga’s contribution to African science has been tremendous, and his continued stewardship gives us confidence that evidence generated on the continent will increasingly shape policy and practice,” he observes.
Dr. Makanga’s impact is visible not only in individual careers but across institutions and nations. Through EDCTP, he has championed African-led trials, strengthened laboratory capacity, and fostered cross-country collaboration. Colleagues emphasize that his leadership has created a generation of African scientists who are confident, collaborative, and globally competitive.
“My experience with EDCTP-funded programmes has shown the transformative impact of African-led research,” Dr. Nankabirwa reflects. “Dr. Makanga’s vision and commitment have strengthened institutions, built capacity, and fostered equitable partnerships, enabling African investigators to lead complex studies that address the continent’s priorities. His recognition shows what is possible when scientists are empowered, trusted, and supported, inspiring the next generation of research leaders.”
Dr. Makanga’s recognition is a tribute to perseverance, vision, and mentorship: a scientist who kept going when resources were scarce, a leader who refused partnerships that treated Africans as subjects, and a mentor who reminded young researchers that they belong at the centre of global science.
As he stood among Africa’s leading innovators in Dakar, the message was unmistakable: Africa can lead, Africa must lead, and it will lead, through science, excellence, and equity.
Makerere University is proud to celebrate Dr. Michael Makanga, one of its distinguished alumni, on receiving the Special Career Achievement Prize of the Prix Galien Africa 2025. This honor recognises his exceptional leadership in medical research and his role in advancing African-led science. Through his work, Dr. Makanga continues to strengthen institutions, mentor emerging researchers, and amplify Africa’s voice on the global health stage.
Kalangala, an idyllic archipelago often romanticised for its sunsets, today witnessed a historic leap in healthcare. Makerere University Vice Chancellor, Prof. Barnabas Nawangwe, launched the Infectious Diseases Institute (IDI) Kalangala Clinical Research Centre—the island’s first modern research facility.
“This is more than a building; it’s a lifeline,” said Prof. Nawangwe. “IDI is not only Uganda’s leading health partner, managing over 20% of HIV cases, but research is first on its agenda. If people are not healthy, they can’t work—it’s useless to invest in anything else.”
Kalangala ranks third in HIV prevalence nationwide at 13.1%, with fishing communities hardest hit. Until now, residents endured perilous boat rides to the mainland for advanced care. “Accessing healthcare has always meant a journey across waves—long, costly, and sometimes dangerous,” said District Chairperson Jajab Ssemakula. “You have not only invested in Kalangala; you have brought Makerere University to Kalangala.”
Supported by the Gates Foundation, the centre is part of a multinational HIV prevention study conducted across 31 sites in Kenya, South Africa, and Uganda. Its first mission: testing whether a monthly pill can protect adolescent girls and young women from HIV—a breakthrough that could transform vulnerable communities.
“This centre means access without barriers,” said Dr. Andrew Kambugu, IDI Executive Director. “Kalangala residents no longer need to travel long distances for clinical trials or advanced care.”
Prof. Samuel Luboga, IDI Board Chairperson, reassured residents of IDI’s long-term commitment:
“We are not a fleeting partner. This sentinel research centre aligns with our vision of freeing Africa from the burden of infectious diseases. The assurance I give Kalangala is—we are here to stay.”
Henry Ssebunya, Deputy Resident District Commissioner, praised IDI’s innovation and consistency:
“IDI has treated and cared for people living with HIV, deployed medical drones to deliver life-saving medicines, and now built a research centre. This is a new chapter for Kalangala.”
From a sleeping sickness camp in 1906 to a cutting-edge research hub in 2025, Kalangala’s story is one of resilience, innovation, and hope.
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