Health
Holding the System Together During COVID-19: Steven Kabwama’s Research on Care Continuity
In March 2020, Uganda slowed to a near standstill. Roads emptied. Clinics fell quiet. Fear moved faster than information. Many perceived COVID-19 as a virus to avoid. Others saw it as a barrier that stood between a mother and antenatal care, a child and routine immunization, and a patient and life-saving HIV medication. What followed was not only a public health emergency but also a test of whether health systems could keep doing the ordinary work of care while responding to the extraordinary.
In early December 2025, a question first asked with urgency during a global crisis resurfaced in a quieter, more reflective moment. On December 2, a single bound copy of Steven Kabwama’s doctoral thesis was fastened to a wooden board dubbed ‘The Wall of Fame‘ at Karolinska Institutet. The ritual, known as spikning, is modest in appearance but weighty in meaning: a thesis is made public, opened to scrutiny, and years of private intellectual labour are released into the world. For Kabwama, it marked the moment when research forged in the pressure of a global emergency became part of the public record, no longer his alone but open to collective examination.
The tradition stretches back centuries, often traced to Martin Luther’s public posting of his theses in the 15th century. But in Stockholm, on a winter afternoon, history gave way to something more immediate. Kabwama stood briefly by the wooden board with a hammer and fixed his work in place. The moment was less about ceremony than readiness. The research was complete. The questions were now open.
Three days later, on Friday, December 5, 2025, Kabwama publicly defended the thesis in a hybrid ceremony at Wretlindsalen in Solna, joined, both in person and online, by colleagues from Uganda, Sweden, and beyond. By then, the work, which examines how health systems sustain essential services during crises, had already begun to circulate, quietly shaping conversations about preparedness, continuity, and care.
What that bound document contained, however, had been forged years earlier, inside outbreaks, lockdowns, data sets, and long nights spent asking how health systems hold together when everything else is falling apart.
Steven Ndugwa Kabwama remembers the beginning not as a single crisis, but as a series of decisions, some made urgently, others too late. As an epidemiologist by training, Kabwama, who had spent years responding to outbreaks through Uganda’s Field Epidemiology Fellowship Program, clearly understood that outbreaks had patterns; they arrived, demanded attention, and eventually receded.
COVID-19 was different.
“It became clear very early on,” he recalls, “that the urgency of the response was going to affect everything else: malaria, immunization, maternal health, HIV. And yet, very little had been written about how systems are supposed to hold both at the same time.”
That realization would shape the next chapter of his life and, eventually, his PhD.
From Outbreak Response to System Questions
Kabwama’s academic journey did not begin in epidemiology. In 2006, he enrolled for a Bachelor’s degree in Food Science and Technology at Makerere University, a programme traditionally geared toward food processing, quality assurance, and industrial production. It is a discipline that prepares graduates for careers in manufacturing plants, laboratories, and supply chains, work that often unfolds far from clinics, outbreaks, and emergency response rooms.
Yet even then, his interests leaned beyond production lines and quality controls. He was drawn to how systems affect people’s health long before illness appears and how nutrition, safety, access, and policy intersect. That early grounding in systems thinking would later resurface in unexpected ways.
He went on to earn a Master of Science in Public Health from the University of Southern Denmark in 2013, supported by a Danish State Scholarship. It was there that population-level analysis sharpened his interest in data, surveillance, and health equity. But it was the Advanced Field Epidemiology Fellowship, jointly run by Makerere University School of Public Health (MakSPH), Uganda’s Ministry of Health, and the U.S. Centers for Disease Control and Prevention, that placed him directly inside emergencies, where evidence, decisions, and lives converge.
As a Fellow, his work stood out. He later received the Outstanding Fellow Award from the Uganda Public Health Fellowship Program (Field Epidemiology Track, Cohort 2015), recognition of his contributions to outbreak response, national non-communicable disease analyses, and policy work, including Uganda’s Alcohol Control Policy. “You respond, you stabilize, you move on,” he says. “But I kept asking myself—what happens to everything else while we’re responding?”
The arrival of COVID-19 made it impossible to delay these questions.
A Crisis Within the Crisis
As countries rushed to contain the virus, restrictions came swiftly: lockdowns, curfews, and travel bans. From a disease-control perspective, the logic was familiar and defensible. In outbreak management, 21 days is a standard epidemiological window, often used to break chains of transmission in infectious diseases. But during COVID-19 in Uganda, the phrase “therefore…another 21 days of lockdown” took on a different meaning altogether: The repeated phrase in presidential addresses stretched from a technical containment tool into a lived reality that reshaped access to care, livelihoods, and movement. From a health-system perspective, the consequences were profound.
Kabwama joined a multi-country research effort spanning Uganda, Nigeria, the Democratic Republic of Congo, Senegal, and Ghana, examining how countries attempted to maintain essential health services while responding to COVID-19. This work was spearheaded by Dr. Rhoda Wanyenze, a Professor of Disease Control, Researcher, Public Health Expert, and Dean of the School of Public Health at Makerere University. She was then a member of the COVID-19 Scientific Advisory Committee to the Ministry of Health.
Kabwama volunteered to lead the objective of documenting these experiences, an area he quickly realized was underexplored.
“Criticism is always easier in hindsight,” he reflects. “But generally, the considerations about how restrictions would affect access to essential health services were made after the fact.”
His doctoral research, later defended at Karolinska Institutet, set out to answer a deceptively simple question: How can health systems minimize disruptions to essential services during public health emergencies while emerging stronger afterward?
What the Data Revealed
Kabwama examined how health service use changed before and during the pandemic by using a mix of interrupted time-series analysis, document reviews, key informant interviews, and focus group discussions.
The findings were sobering.
Facility deliveries and outpatient visits dropped sharply during lockdown periods. Routine childhood immunizations declined, and DPT3 doses fell by more than 4 percent, with similar reductions across polio vaccines. Movement restrictions, fear of infection, and overwhelmed facilities combined to keep patients away.
But the story did not end there.
Where systems were adapted by integrating services, leveraging community health workers, removing user fees, modifying logistics, and establishing coordination mechanisms for continuity of care, the declines softened. In some cases, the adaptations strengthened systems beyond their pre-pandemic state.
“These were not perfect solutions,” Kabwama notes. “But they showed us what flexibility, leadership, and trust can do under pressure.”
The Human Cost—and the Human Shield
Behind every data point were health workers navigating impossible conditions. Many worked without adequate protective gear. Others faced delayed allowances, long hours, and constant risk.
Kabwama asserts that health workers risk their lives in their work. “If we expect services to continue, then protecting their physical and mental well-being is not optional.”
His research consistently returned to one conclusion: that service continuity depends on people. Policies can guide. Infrastructure can support. But without motivated, protected health workers and trusted community intermediaries, systems falter.
Uganda’s community health workers, he observed, became a backbone of resilience. They traced contacts, delivered information, encouraged women to attend antenatal care, and helped sustain immunization demand when facilities felt distant or dangerous.
“In our context,” he says, “they were critical. That’s a lesson worth holding onto.”
Learning Across Borders
Conducting his PhD through a collaborative programme between Karolinska Institutet and Makerere University School of Public Health exposed Kabwama to how different systems responded under pressure.
At Karolinska’s Department of Global Public Health, students from around the world shared experiences shaped by culture, trust, and governance. One story stayed with him: Sri Lanka’s military, highly trusted by the public, played a key role in vaccine rollout.
“It taught me that resilience looks different everywhere,” he says. “What matters is understanding what each system already has and how trust operates within it.”
His supervision team, spanning Sweden and Uganda, including Prof. Tobias Alfvén, Prof. Rhoda K. Wanyenze, Dr. John Ssenkusu, Prof. Helena Lindgren, and Dr. Neda Razaz, reflected that same cross-system thinking.
Wanyenze describes Kabwama as “focused, committed, and remarkably productive.” She notes that he led two major workstreams across the five participating countries, helping generate critical evidence on health systems resilience and trust during infectious disease emergencies. “He made an enormous contribution to the research,” she says, “and he continues to do excellent work in this area.”
The Quiet Challenge of Doing Research in a Pandemic
Methodologically, the pandemic forced adaptation. Interviews moved to phones and Zoom. Access was negotiated carefully. Yet Kabwama sees the technology not as a limitation but as a strength.
“We captured experiences while they were still fresh,” he explains. “Before details were forgotten, before narratives were smoothed over.”
That immediacy gave his work an unusual clarity, documenting decisions as they unfolded, not as they were later remembered.
But beyond COVID-19, Kabwama’s thesis does not treat it as an anomaly. Rather, it presents COVID-19 as a stress test, exposing pre-existing weaknesses and potential strengths.
His central argument is that the ability to maintain essential health services during emergencies depends on baseline capacity.
“Now is the time,” he says, “to invest in health workers, in infrastructure, in guidelines for service continuity. This should be done now, not when the next crisis arises.
That conviction extends to learning itself. After-Action Reviews are conducted, lessons are noted, but too often, they fade.
“We need to be deliberate about learning,” he insists. “About documenting what worked and making sure those gains are not lost once the emergency ends.”
Work That Continues
Today, Kabwama is a Research Associate at Makerere University School of Public Health, a Monitoring, Evaluation and Learning Specialist with the Uganda Public Health Fellowship Program, and a member of WHO initiatives on trust and pandemic preparedness. He leads mortality surveillance in Uganda’s island districts, supports national NCD analyses, and continues to advise on emergency preparedness across Africa.
He remains, by his description, an optimist.
“There are people who think we are worse off now than before COVID-19,” he says. “In some ways, that’s true. But there are also many ways in which we are better prepared.”
Vaccines, data systems, community engagement, and global awareness have all shifted. The challenge is ensuring that momentum does not fade.
Dr. Steven Ndugwa Kabwama joins fellows in the MakSPH PhD forum who concluded their doctoral journeys in 2025. And the work of his research and scholarship does not promise certainty but offers something more useful: evidence that systems can bend without breaking—if they are prepared to learn, invest, and protect the people who hold them together.
The Democratic Republic of Congo (DRC) and Uganda recently reported an outbreak of Ebola Virus Disease (EVD), which is a serious and often deadly disease caused by a person being infected by the Ebola virus.
The virus spreads through direct contact with body fluids such as blood, saliva, faeces, vomit, urine, sweat or genital fluids from a person who is infected with EVD.
The symptoms of EVD usually develop after 8 – 10 days from contact with an infected person and may include fatigue, high fever, headache, sore throat, muscle and joint pains, vomiting and diarrhea and in severe cases, bleeding.
What should we do as the Makerere University community?
The Chief, Makerere Health Services, Prof. J.K. Byamugisha advises as follows:
- Avoid unnecessary contact such as shaking hands, hugging etc.
- Place alcohol disinfectants or hand washing equipment at all entry points within the University and ensure everyone is using them.
- Students should sit in single-person chairs while in class, avoiding contact with their neighbours.
- Do not sit too close to one another especially in frequently crowded places such as classrooms, library or any other waiting area.
- While at the University Hospital, wash hands a the gate, use alcohol disinfectant at the reception.
- All patients should have a maximum of one caretaker – others can check on them by calling.
- Avoid bringing luggage to the University Hospital.
- Target to do as instructed by the health worker.
- For further information and guidance on Ebola, please call Dr. Charles Basigara on Tel: 0702 966652 and Sr. Eunice Namubiru on Tel: 0779 950978 (Contact persons for the University Health Services)
Additionally, always look out for and ensure full compliance with Ministry of Health (MoH) Infection Prevention and Control measures such as the one below.
Please find attached detailed communications from Prof. Byamugisha and
the Permanent Secretary Ministry of Health.
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