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What works, what doesn’t work? Researchers uncover the effect of supporting districts to operationalise digital payments for vaccination campaign workers

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By Joseph Odoi

A motivated and satisfied health workforce is critical for the success of mass vaccination campaigns against diseases like polio. High-quality vaccination campaigns can interrupt disease transmission, especially during and after periods of disrupted health services, such as those caused by the COVID-19 pandemic.

In sub-Saharan Africa, most vaccination campaign healthcare workers (VCHWs) have historically been paid in cash. Cash payments are often plagued by delays in funds disbursement, leakages, theft risks, and limited financial transparency. These challenges can negatively affect vaccination coverage and worker satisfaction.

To address these challenges, many countries are transitioning to digital payment systems, which are perceived as faster, more convenient, traceable, reliable, and easy to implement. Digital financial systems are already being rolled out in countries including Côte d’Ivoire, Ghana, Mali, Congo, and the Democratic Republic of the Congo. Uganda, with a projected population of nearly 41.6 million, had over 30 million registered mobile money customers using e-cash in 2019.

While early rollouts of digital payments have been largely successful, their full impact on vaccination campaign workers had not been systematically evaluated.

 From 2021 to 2024, Makerere University (Uganda) and the University of Dakar (Senegal), with support from the Gates Foundation and technical partners including the Solina Group, WHO AFRO, and the Ministries of Health and Finance in both embarked on an important journey of research  under the Digital Health Payment Initiatives and Research (DHPI-R) Project in  28 countries in Sub Saharan Africa

To explore the experiences and lessons of polio vaccination campaign healthcare workers (VCHWs), both male and female, during the 2022 oral poliovirus vaccination campaign in Uganda, researchers led by Prof. Peter Waiswa (principal investigator), together with Margaret McConnell, Juliet Aweko, Daniel Donald Mukuye, Charles Opio, Maggie Ssekitto Ashaba, Andrew Bakainaga, and Elizabeth Ekirapa-Kiracho, with support from the Gates Foundation, conducted a study titled “The Effect of Supporting Districts to Operationalise Digital Payments for Vaccination Campaign Workers: A Cluster Randomised Controlled Trial During the 2022 Polio Vaccination Campaign in Uganda.”

This study examined whether supporting districts to implement electronic cash (e-cash) payments, instead of cash, increased e-cash usage and improved vaccine campaign healthcare workers’ (VCHWs) motivation and satisfaction during an oral poliovirus vaccination campaign in 2022 in Uganda.

The  mixed method study  now  published in BMJ Global Health, September 2025  was conducted in 54 districts in Uganda that had set up the government e-cash payment platform by May 2022. It involved healthcare workers supporting the polio vaccination campaign, regardless of direct vaccine contact. This included nurses, clinicians (vaccinators), mobilisers, community health workers (village health team members), recorders, local council representatives, and supervisors. The unit of randomisation was the district, while the unit of enrolment and data collection was the individual worker.

Method and Setting

As part of this study , In November 2022, a total of 54 districts and 2,665 vaccination campaign healthcare workers (VCHWs) were enrolled in the study and randomly assigned to two groups. Intervention districts received training on using the government e-cash platform, including managing user roles, uploading beneficiary data, and generating payment reports.

The control districts received the standard support given to districts during mass vaccination campaigns from the MoH, MoFPED, WHO and other development partners. This support included group training on implementation of payments, provision of vaccination materials and financial aid.

The study collected data on how VCHWs were paid, their motivation, and their satisfaction with the payment method. Overall, 765 VCHWs in intervention districts and 589 in control districts received e-cash payments.

Findings

Mode of payment for the vaccination campaign healthcare workers

Overall, approximately half of the campaign workers, 50.8% (1354/2665) were paid digitally (e- cash), either using mobile money or via the bank (online supple mental table 2). Payment by e- cash was higher among females, 53.9% (656/1215) compared with males, 48.1% (698/1450) and was lowest among campaign workers aged 30–39 years, 48.7% (368/765). E- cash payment was higher in the intervention arm at 57.5% (765/1,330) in comparison to the control arm at 44.1% (589/1,335).

Satisfaction with payment received during the campaign

 Only 36.5% (705/1930) of the VCHWs were satisfied with the payment received during the campaign, with satisfaction being slightly higher in the intervention arm, 37.9% (353/931) compared with the control arm 35.2% (352/999) and among females 37.9% (351/925) compared with males 35.2% (354/1005). Satisfaction was lowest among the married workers, 35.7% (575/1611) compared with the other categories.

Timing and completeness of payments

Nearly, all VCHWs were paid after the campaign, 97.6% (1884/1930), with no significant difference between the intervention (98.1%, 913/931) and the control (97.2%, 971/999) arms

Delayed/non- payment was highest among those with no formal education, 34% (17/50) and among community mobilisers, 30.7% (392/1071). The majority (70.6%, 1362/1930) of the VCHWs stated that the payment received met or even exceeded their payment expectation.

Participants also stated that e-cash was convenient, transparent, time-saving, and cost-saving, as it reduced travel and waiting times and minimized informal deductions.

Despite these benefits and support to districts to operationalize digital payments , there was no significant difference in workers’ motivation or satisfaction between the intervention and control groups. The researchers attributed this  partly due to challenges associated with both cash and digital payment modes.

Challenges experienced in effecting payments at the district level

Also a number of challenges were uncovered in this study . Challenges with e-cash payments included unanticipated withdrawal charges, unreliable internet networks, and lengthy processes for validating mobile telephone numbers. For example, payments were delayed or not processed when VCHWs’ names did not match the registration details held by telecommunication companies, or when workers did not have phones registered in their names.

One key informant had this to say on challenges around e-cash payments

‘’ There was a general complaint of charges. Remember when they are dispersing funds, they stick to the budget exactly. They are not looking at the charges. And when you are also paying you have to allocate minus the charges. You get the point. So the people would be expecting let’s take an example of 150 000/= and then they get 149 something. So, they would ask, ‘Why are we getting less money?’ So we labored to explain to them that the bank is charging a certain fee to facilitate the e- cash. (KII_West_EPI FP) There were also challenges associated with an unreliable internet network that was necessary to facilitate log ins for approval of payments

On Challenges experienced in effecting payments at the district level ,Key informant interviews with district leaders involved in the payment process identified several bottlenecks  during the payment process of the campaign healthcare workers. One of the major e- cash payment challenges was a lengthy process of validating mobile telephone numbers. ensuring that the VCHW’s names matched the registered mobile account names attached to the telephone number provided by the VCHW for receipt of funds.

‘’Unsuccessful validation occurred when the VCHW’s names did not match the registration details held by the telecommunication companies. Payments for such individuals were delayed or not effected at all. Because some of them do not even have the phones, but they are very good at doing the work…Or if they have, then the phone is not registered in their names. We were supposed to bring that database of the community as well and feed them into the system. That became a problem’’. (KII_North_ADHO)

Suggestions to improve use of e-cash payment system

To increase the use of e- cash, the majority of key informants identified continued training of key staff as a critical intervention with subsequent follow- up to ensure payments are well implemented.

‘’We are not yet ready; our capacity hasn’t been built. We have a big knowledge gap regarding the e- cash system here in this district. (KII East CFO) We request for more training to be conversant [with the system], and to discuss the challenges together during that training, as we share the experiences. Where we have challenges, we sit together and see how they can be addressed’’.  (KII_Central_CFO)

The participants also expressed the need for feedback mechanisms to allow them to dialogue with the payers in case there was a delay in payment. Additionally, the participants also acknowledged that there was a need to gradually expand adoption of digital payments considering contextual barriers. A hybrid approach would be an alternative, especially in the remote and hard-to-reach districts.

Other suggested solutions include early preparation of campaign health worker databases to allow for the lengthy telephone validation processes, improvement of the internet infrastructure, consistent use of e- cash payments across programmes and inclusion of withdrawal charges when making payments.

Moving forward policy, the researchers recommend the need to support e- payment systems, in order to minimize challenges in the pay ment processes.

‘’Suggestions to improve the e- cash experience include training of personnel in charge of e- cash payments, timely creation of VCHWs databases, expanding e- cash payments across programmes for efficiency and inclusion of withdrawal charges for the digital payments. To ensure the institutionalisation of digital payment interventions across Uganda, several key enablers are essential. These include formal policy integration by the Ministry of Health and Ministry of Finance into operational guide lines and budget frameworks, as well as ongoing capacity strengthening at the district level to enhance digital planning, payroll management and troubleshooting. Reliable infrastructure such as mobile connectivity and access to digital financial services like mobile money must also be prioritised, especially in rural areas. Implementing routine monitoring and feedback systems will be vital for tracking payment timeliness, worker satisfaction and system performance, allowing for continuous improvement. Furthermore, fostering public–private partner ships with telecom providers and payment platforms is critical for cost- effective scaling. With strong political commitment, aligned funding and active community engagement, this model holds the potential for broader national and regional adoption, leading to more efficient and equitable health service delivery’’. The paper concludes on the way forward

To read the paper; click; https://gh.bmj.com/content/10/Suppl_4/e016666

About The DHPI-R project

The DHPI-R project was commissioned by the Bill and Melinda Gates Foundation (BMGF) to generate evidence on digital payments in Africa. Although inception, conceptualization of the proposal, and grant award were conducted earlier in 2021, the DHPIR project officially started implementing activities in November 2021, up to March 2025. DHPIR is hosted at the School of Public Health, College of Health Sciences at Makerere University and is implemented in Anglophone and Francophone hubs (countries) in Africa. The Anglophone hub is hosted at MAKSPH, while the Francophone Hub is hosted by the University of Dakar (UCAD) in Senegal.

DHP-IR was rooted in the End Polio Game Campaign, championed by WHO-Afro and partners in 28 countries in Sub Saharan Africa, where digital payments was a key strategy for timely and complete payments to campaign workers.

Mak Editor

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Makerere, Karolinska Reflect on 25 Years, Encourage University Research Equality

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Photo by Kseniya Hartvigsson.

STOCKHOLMMakerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships.

The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.” Scholars, policymakers, and university leaders gathered to discuss how institutions can build collaborations grounded in trust, shared ownership, and mutual respect.

Organized by the Centre of Excellence for Sustainable Health (CESH), a joint initiative between Makerere University and Karolinska Institutet, the forum reflected on how equitable partnerships drive progress toward the 2030 Sustainable Development Goals.

Hours before the event, Sweden’s Ambassador to Uganda, H.E. Maria Håkansson, posted on X (formerly Twitter):

“The partnership between Makerere University and Karolinska Institutet is both dynamic and exemplary in how many years of development cooperation can lay the foundation for mutually beneficial relations between institutions in Sweden and Uganda.”

Front Row (L-R): Prof. Helena Lindgren, Dr. Phyllis Awor, Prof. Rhoda Wanyenze, Sweden’s Ambassador to Uganda, H.E. Maria Håkansson, Prof. Annika Östman Wernerson, president of Karolinska Institutet, and Prof. Peter Waiswa during their visit to Makerere University on Nov. 11, 2024. Photo by Davidson Ndyabahika
Front Row (L-R): Prof. Helena Lindgren, Dr. Phyllis Awor, Prof. Rhoda Wanyenze, Sweden’s Ambassador to Uganda, H.E. Maria Håkansson, Prof. Annika Östman Wernerson, president of Karolinska Institutet, and Prof. Peter Waiswa during their visit to Makerere University on Nov. 11, 2024. Photo by Davidson Ndyabahika

Equity, Trust, and Warmth at the Core

Panelists navigated questions of power, agency, and mutual respect. Policymakers, researchers, and academics agreed that successful partnerships depend not only on fairness but also on warmth, the human connection that sustains collaboration and ensures initiatives respond meaningfully to local realities.

Dr. Andreas Göthenberg, executive director of the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), recalled that earlier models often reduced African researchers to “data farmers” in one-directional projects led from the North.

“We now support balanced research collaborations, not capacity building alone,” he said.

Over the past decade, he added, STINT has seen a surge of high-quality proposals from African researchers seeking genuine collaboration.

“When partners bring different expertise and learn from each other, that is when collaborations work well,” he said. “Institutions with fewer resources can now do very advanced things; that’s a real game changer.”

Göthenberg said Africa’s rapid advances in microfinancing, cloud computing, and even space research show that “technology development means institutions with fewer resources can still do very advanced things,” offering lessons for innovation systems in Europe.

Dr. Andreas Göthenberg, executive director of the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), speaking during the Global Conversations on Sustainable Health, in Stockholm. Photo by Kseniya Hartvigsson. Pics failing to upload on Mak News with errors of "resources"
Dr. Andreas Göthenberg, executive director of the Swedish Foundation for International Cooperation in Research and Higher Education (STINT), speaking during the Global Conversations on Sustainable Health, in Stockholm. Photo by Kseniya Hartvigsson

Why Equitable Partnerships Matter

Professors Rhoda Wanyenze and Stefan Swartling Peterson have argued that traditional models often concentrate leadership and funding in the Global North, thereby limiting the agency of Southern partners.

Their work from long-term collaborations in Ethiopia, Uganda, Lao PDR, and Vietnam shows that shifting leadership to where research occurs strengthens local capacity and aligns agendas with community needs.

They demonstrate that equity relies on mutual trust, transparency, and shared decision-making, principles that transform funding into a tool for empowerment rather than dependency. Joint PhD programs, reciprocal staff exchanges, and twinned supervision models have further enabled two-way knowledge flow and reduced brain drain.

“Partnerships grounded in reciprocity, inclusion, and respect are not only ethically sound but also more effective,” Wanyenze said. “They build local ownership, lasting capacity, and context-driven innovation.”

Front Row: Prof. Annika Östman Wernerson, president of Karolinska Institutet (L) and Makerere Vice Chancellor Prof. Barnabas Nawangwe (R) with officials during the hybrid forum. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
Front Row: Prof. Annika Östman Wernerson, president of Karolinska Institutet (L) and Makerere Vice Chancellor Prof. Barnabas Nawangwe (R) with officials during the hybrid forum.

Championing South-to-South Knowledge Exchange

Associate Professor Caroline Wamala-Larsson, director of the SPIDER program at Stockholm University, underscored that the Global South must set its research agendas.

“The agenda must be set by Southern institutions. Swedish institutions act as collaborators, not directors,” she said.

She cited projects in Uganda, Tanzania, Rwanda, Bolivia, and Mozambique where South-to-South learning has flourished.

Associate Professor Caroline Wamala-Larsson, director of the SPIDER program at Stockholm University, presents at the Global Panel on Equitable Partnerships. Photo by Kseniya Hartvigsson. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
Associate Professor Caroline Wamala-Larsson, director of the SPIDER program at Stockholm University, presents at the Global Panel on Equitable Partnerships. Photo by Kseniya Hartvigsson

“Bolivians traveled to Tanzania to share source codes from a research management system. Now, the University of Dar es Salaam wants to adopt it,” she said. “Solutions developed within the South often fit local contexts better than Northern models.”

Wamala-Larsson added that innovation and digital transformation have strengthened institutional systems. “We need new funders, private sector partners, and universities to participate equally.” Respect for each partner’s contribution is essential for sustainability,” she said.

Adapting to a Changing Global Landscape

Shifting global priorities and limited funding are reshaping how universities collaborate. Ms. Brenda Wagaba, partnerships officer at Makerere University, noted that while funding remains limited, the Government of Uganda, for instance, has taken steps to support local research through the Research and Innovation Fund. “The government started setting aside money for university research even before the recent cuts,” she said.

“Now, with those cuts, the need for sustained domestic investment is even greater.” She added that such initiatives strengthen the confidence of Southern partners to engage as equal contributors in global collaborations.

Dr. Rawlance Ndejjo, a Makerere University researcher, said local initiatives could help sustain momentum. “Local funding opportunities allow countries to find resources for research and partnerships. Such efforts can improve equity through bottom-up collaborations,” he said.

Dr. Rawlance Ndejjo, a Lecturer and Lecturer at Makerere University, receives a souvenir from Prof. Annika Östman Wernerson, president of Karolinska Institutet. Photo by Kseniya Hartvigsson. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
Dr. Rawlance Ndejjo, a Lecturer and Lecturer at Makerere University, receives a souvenir from Prof. Annika Östman Wernerson, president of Karolinska Institutet. Photo by Kseniya Hartvigsson

Göthenberg noted that new opportunities lie in multidisciplinary work. “Many of the challenges we face today demand broadly defined solutions,” he said. “Multidisciplinary projects lead to broader societal impact and stronger partnerships.”

He also pointed to Africa’s demographic advantage: “With its young population and rapid innovation, Africa is driving technological development in ways that can benefit both continents.”

Equitable Partnerships Deliver Results

Wagaba said engaging communities early is key to success. “When we engage communities early, we can bridge the gap between large-scale interventions and local acceptance. Whether it’s water, vaccines, or health infrastructure, success depends on understanding immediate community priorities,” she said.

She cautioned that top-down projects often fail to deliver lasting impact.

“You may build a vaccine plant or develop a vaccine, but if a community’s immediate need is safe water, your intervention will falter,” she said, adding that warmth, respect, and open communication are as critical as technical expertise.

Makerere Vice Chancellor Prof. Barnabas Nawangwe highlighted tangible results from Sweden’s long-term support.

Makerere Vice Chancellor Prof. Barnabas Nawangwe presenting during one of the engagements with the KI team to commemorate 25 years of partnership in Stockholm. Photo by Kseniya Hartvigsson. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
Makerere Vice Chancellor Prof. Barnabas Nawangwe presenting during one of the engagements with the KI team to commemorate 25 years of partnership in Stockholm. Photo by Kseniya Hartvigsson

“Under the SIDA program, 500 PhD students were trained, all of whom returned to Uganda,” he said. “The program made them feel at home while gaining knowledge abroad. Without mutual respect, equity will always face challenges.”

Prof. Annika Östman Wernerson, president of Karolinska Institutet, said sustainable partnerships depend on continuous engagement.

“Every collaboration begins with people meeting. Warmth and curiosity are crucial between individuals and institutions,” she said. “Equity is not static; it requires continuous work. Trust and transparency are critical.”

MakSPH Partnership Officer Ms. Brenda Wagaba Mugarura receives a souvenir from Prof. Annika Östman Wernerson, president of Karolinska Institutet, in Stockholm, Sweden. Photo by Kseniya Hartvigsson. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
MakSPH Partnership Officer Ms. Brenda Wagaba Mugarura receives a souvenir from Prof. Annika Östman Wernerson, president of Karolinska Institutet, in Stockholm, Sweden. Photo by Kseniya Hartvigsson.

A Global Model for Sustainable Partnerships

The 25-year collaboration between Makerere University and Karolinska Institutet demonstrates how long-term, equitable partnerships can strengthen research systems and inform policy.

As Nawangwe put it:

“Students return home, communities benefit, and research informs global health policy. This is a model of how equity and trust drive sustainable partnerships.”

Makerere University and Karolinska Institutet teams celebrate after Vice Chancellor Barnabas Nawangwe and President Annika Östman Wernerson signed the renewed MoU, extending the partnership to 2030. Photo by Kseniya Hartvigsson. Makerere University and Karolinska Institutet (KI-Mak) marked 25 years of collaboration on Oct. 15, 2025, with a hybrid forum on research equity, highlighting lessons for universities striving toward fair and sustainable global partnerships. The event, part of the Global Conversations on Sustainable Health, explored the theme, “Exploring Power Dynamics & Equity in Partnerships.”
Makerere University and Karolinska Institutet teams celebrate after Vice Chancellor Barnabas Nawangwe and President Annika Östman Wernerson signed the renewed MoU, extending the partnership to 2030. Photo by Kseniya Hartvigsson

The Makerere–Karolinska (KI-Mak) partnership shows how universities, funders, and governments can work together fairly and Like many others working in this field, the Center recognises that there is still much to learn and discuss about how partnerships can continue to evolve through openness, dialogue, and shared reflection.

As Makerere and Karolinska look to 2030, their renewed agreements promise more than ceremonial goodwill. The two universities will intensify exchanges between students and faculty, expand joint research, share academic output, and organise lectures, conferences, and workshops. They will also open new paths for training, scientific collaboration, and shared learning. After 25 years, the partnership has proven that long-term cooperation can endure and excel with mutual respect, steady investment, and a clear purpose.

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Davidson Ndyabahika

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TWAS recognises Dr. Angelina Mwesige Kakooza for her research

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Dr. Angelina Mwesige Kakooza, Associate Professor of Paediatrics in the Department of Paediatrics and Child Health receives her award.

Dr. Angelina Mwesige Kakooza, Associate Professor of Paediatrics in the Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences (MakCHS) received the 2025 TWAS-Fayzah M. Al-Kharafi Award in Medical Sciences. She was recognised for her research on neurodevelopmental disorders – particularly epilepsy, cerebral palsy, and nodding syndrome – and for advancing policy and research, mentorship, as well as local community interventions to enhance children’s health.

The award was given at the recent 17th General Conference of The World Academy of Sciences (TWAS) held in Rio de Janeiro, Brazil under the theme ‘Building a Sustainable Future: The Role of Science, Technology, and Innovation for Global Development.’ Organized in partnership with the Brazilian Academy of Sciences (BAS) and TWAS, the conference brought together leading scientists, policymakers, and institutional leaders from across the global South and beyond.

In her remarks after receiving the award, Dr. Kakooza said, “This award highlights the importance of neurodevelopmental disorders which are a great health problem worldwide, often diagnosed late and treated poorly,” said Kakooza. “It affirms my contribution to science in Africa, strengthens advocacy for gender equity in science and education and makes me a role model for others, increasing my influence in the scientific community.”

Associate Professor Angelina Mwesige Kakooza.
Associate Professor Angelina Mwesige Kakooza.

Dr. Angelina Kakooza Mwesige is a Ugandan scholar with over 25years teaching experience whose research focuses on neurodevelopmental disorders in children centred on their epidemiology, early screening, identification and community based interventions in Uganda. Her current areas of research cover studies on early detection and interventions for young infants at high risk of neurodevelopmental delay and disability in Nepal and Uganda; development of community engagement projects to empower adolescents living with epilepsy in Uganda reduce stigma in their communities; as well as development and testing of an interactive epilepsy smart phone application to improve resilience among them.

TWAS is a global merit-based science academy based in Trieste, Italy, and administered as a UNESCO Programme Unit. Read more here: https://twas.org/

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Zaam Ssali

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Refugee Health Journalism as Empowerment: Why Accuracy, Dignity & Context Matter

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Participants in the Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts at MakSPH on 3rd October 2025. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.

In July this year, I joined a study tour to Imvepi Refugee Settlement in Uganda’s West Nile region under the RISK-WASH Project, led by Dr. Richard Mugambe. Established in 2017 in what is now Terego District, Imvepi is one of several settlements created to host people fleeing conflict in neighbouring South Sudan. Now home to more than 60,000 refugees, it reflects Uganda’s progressive refugee policy, anchored in the 2006 Refugee Act, which promotes the integration of displaced families within host communities, allocates land for livelihoods, and ensures access to national services. It remains a model both commendable and instructive for the region.

With nearly two million refugees and asylum seekers, most of whom are women and children, Uganda stands among the world’s leading examples of inclusive, community-based refugee protection. The RISK-WASH Project, implemented by the Makerere University School of Public Health (MakSPH) in collaboration with IHE-Delft, BRAC, and icddr,b, with support from the Dutch Ministry of Foreign Affairs, organised the three-day visit. The project builds evidence for better Water, Sanitation, and Hygiene (WASH) decision-making in humanitarian settings, developing practical tools to assess how exposure to unsafe water, poor sanitation, and environmental hazards affects the health of both displaced and host populations.

The RISK-WASH Project team, together with officials from the Uganda Red Cross Society, meet the Imvepi Refugee Settlement Commandant during a field visit in July 2025. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.
The RISK-WASH Project team, together with officials from the Uganda Red Cross Society, meet the Imvepi Refugee Settlement Commandant during a field visit in July 2025.

In Imvepi, that evidence takes human form. Water points run dry under intense demand or drought; latrines overflow during rains; fragile health systems strain to contain preventable diseases that flourish in such conditions. One nurse may attend to hundreds of patients in a single day, treating malaria, respiratory infections, and diarrhoeal diseases directly linked to inadequate WASH infrastructure. The images linger long after one leaves, especially when reflecting on the media’s role in shaping refugee narratives. What struck me most was how such realities are often reduced to statistics or fleeting headlines that reveal little about the lives behind them. I left Imvepi convinced that we, in the media, must not only report but listen differently.

When we cover refugees, we often begin with numbers. Yet behind every statistic is a heartbeat and a history the news cycle rarely pauses to hear. Refugee health, perhaps the most human measure of displacement, is still too often framed as a crisis rather than a continuum of resilience, policy, and rights. The World Health Organisation’s World Reports on the Health of Refugees and Migrants reminds us that refugees frequently experience poorer health outcomes than host populations, not because they are inherently vulnerable, but because access to care is often obstructed by law, language, and logistics. Health, like truth, then, becomes interestingly dependent on who is allowed to speak and who is heard.

Floods in Adjumani refugee settlement left shelters destroyed and water sources contaminated, heightening the risk of disease outbreaks and exposing the fragile health conditions faced by displaced families. Photo taken in 2024 during a MakSPH study on refugee health and climate change. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.
Floods in Adjumani refugee settlement left shelters destroyed and water sources contaminated, heightening the risk of disease outbreaks and exposing the fragile health conditions faced by displaced families. Photo taken in 2024 during a MakSPH study on refugee health and climate change.

It was in this spirit that, on October 3, 2025, we convened the Media Training Workshop on Refugee Health and Migration Reporting at MakSPH. The one-day seminar brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts. Our goal was not to add another humanitarian angle to the news but to rethink how the media can report with depth, ethics, and empathy. Working with partners such as Africa Humanitarian Action, Emesco Development Foundation, and Farmamundi, we explored the subtle power the media wields to either dignify or diminish, to clarify or distort, the lived realities of refugees, particularly in the realm of health.

During my session, Refugee Health Reporting as Empowerment: Negotiating Accuracy, Dignity, and Context,” I invited participants to view journalism through the lens of Paulo Freire, the celebrated Brazilian transformative educator who wrote the Pedagogy of the Oppressed while in exile in 1970. Through his influential work, Freire argued that oppression persists when those in power control language and narrative, when others are spoken for rather than heard. Liberation begins, he said, when people “name their world.” That principle remains profoundly relevant to our craft as journalism and communications practitioners. Refugees must not remain objects of our storytelling; they are its subjects. Journalism, in its truest public function, becomes liberating only when it is dialogic, when we report with people, not merely about them.

I led a session titled “Refugee Health Reporting as Empowerment: Negotiating Accuracy, Dignity, and Context” on October 3, 2025, framing it around Paulo Freire’s pedagogical philosophy of liberation through dialogue and critical reflection. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.
I led a session titled “Refugee Health Reporting as Empowerment: Negotiating Accuracy, Dignity, and Context” on October 3, 2025, framing it around Paulo Freire’s pedagogical philosophy of liberation through dialogue and critical reflection.

This transformation begins with accuracy. In Uganda, refugees share the same health system as host communities, one already strained by staff shortages, drug stock-outs, and donor fatigue. Yet many stories stop at official statements or NGO press releases. Limited access, shrinking newsroom budgets, and bureaucratic gatekeeping tempt journalists to rely on polished humanitarian narratives. But when we do, we risk becoming megaphones for the powerful. Accuracy demands courage, the willingness to verify, to cross-check, and to step beyond curated camp tours. In refugee reporting, truth is not just a professional standard; it is an act of respect.

Still, truth without dignity can harm. Too often, images of refugees serve as shorthand for despair—dust, hunger, tents. Such imagery may evoke sympathy, but it often strips away humanity. From practice, I have seen journalists lower their lenses before asking names. I have also seen how a small shift in approach, say seeking consent, giving space, and listening before photographing, can restore dignity to both subject and story. Words matter too. Calling someone an “illegal immigrant” or describing an “influx” of refugees turns people into problems. Language should humanise, not flatten. To describe refugees as mothers, health workers, or students is to reassert their agency and affirm our shared humanity, something Freire would have deeply valued today.

Media trainer Mr. Wilson Akiiki Kaija facilitates a session on “Centring Humanity” during the Refugee Health and Migration Reporting Workshop at MakSPH, underscoring the media’s role in advancing accuracy, dignity, and context in refugee reporting. October 3, 2025. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.
Media trainer Mr. Wilson Akiiki Kaija facilitates a session on “Centring Humanity” during the Refugee Health and Migration Reporting Workshop at MakSPH, underscoring the media’s role in advancing accuracy, dignity, and context in refugee reporting. October 3, 2025.

And no story exists in isolation. Every health headline in a settlement echoes across systems of policy, climate, economics, and gender. A cholera outbreak in Kyangwali is not merely a medical event or isolated incident; it may be showing broken sanitation infrastructure and the politics of aid, which may result in a national disease outbreak. Context is the soul of credibility. Without it, even accurate stories can mislead. In Imvepi, I saw first-hand that refugees’ health challenges are inseparable from Uganda’s own development journey, from how budgets are made to how global partners value African hospitality. The more connections we draw, the closer we come to the truth.

By the close of the workshop, it was evident that empowerment in journalism is not a slogan but a discipline. It demands patience, humility, and persistence. It calls for the co-production of stories, revisiting them, verifying them, and allowing refugees to narrate their realities. It also calls on institutions to invest and fund field reporting, train correspondents in trauma-sensitive and peace journalism, and protect journalists pursuing uncomfortable truths. Without such support, even good intentions dissolve into soundbites.

I often return to Freire’s words of wisdom: To speak a true word is to transform the world. This means that words are not just passive descriptions but powerful tools for action and social change, especially when they are paired with critical reflection and a commitment to praxis (work and action). Refugee health journalism, at its best, is precisely that kind of speech: accurate, dignified, and deeply contextual. It is not merely charity reporting; it is solidarity reporting. For anyone, given the wrong circumstances, can become a refugee. And solidarity, unlike sympathy, does not look down; it stands beside. When we write from that conviction, our stories do more than inform. They humanise, connect, and remind us that telling the truth well is, in itself, an act of justice.

From right: Africa Humanitarian Action’s Mr. Yakobo Kaheesi and Emesco Development Foundation’s Mr. Patrick Ssentalo join facilitators and organisers Mr. Wilson Akiiki Kaija and Mr. Davidson Ndyabahika in awarding certificates to media participants after the successful training on Refugee Health and Migration Reporting on October 3, 2025. Media Training Workshop on Refugee Health and Migration Reporting that brought together twenty journalists from Kampala, Kyaka II, Adjumani, and other refugee-hosting districts, Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa on 3rd October 2025.
From right: Africa Humanitarian Action’s Mr. Yakobo Kaheesi and Emesco Development Foundation’s Mr. Patrick Ssentalo join facilitators and organisers Mr. Wilson Akiiki Kaija and Mr. Davidson Ndyabahika in awarding certificates to media participants after the successful training on Refugee Health and Migration Reporting on October 3, 2025.

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John Okeya

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