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.
Makerere University’s School of Public Health (MakSPH) showcased research, training and international partnerships supported through European Union funding during the EU Uganda Research and Study Fair 2026 held at Makerere University.
The fair brought together students, researchers, academics, government representatives and development partners to explore opportunities in education, research, innovation and international collaboration, while celebrating 50 years of partnership between Uganda and the European Union.
Through its exhibition, MakSPH highlighted research and capacity building initiatives addressing public health challenges including infectious diseases, non communicable diseases, health systems, climate change and pandemic preparedness.
18 EU funded projects supported at MakSPH
Prof. Rhoda Wanyenze, Dean of Students, School of Public Health, said the School has benefited from 18 EU funded projects over the past five years, supporting research and training across several areas of public health.
She said the projects have contributed to the training of PhD researchers and the development of research addressing infectious diseases and prevention, non communicable diseases, health systems, climate change and health.
Prof. Wanyenze also highlighted a new five year programme which started in 2021 that is aiming at strengthening capacity for research on pandemic preparedness and response, including outbreaks such as Ebola.
Another programme being undertaken with the Ministry of Health and Karolinska Institute focuses on improving maternal health while also addressing adolescent pregnancy and the health of mothers and children.
She described partnerships as critical to advancing science and innovation, noting that collaboration allows researchers in Africa and Europe to share knowledge and strengthen the impact of research on communities.
Research partnerships strengthen innovation
Prof. Robert Wamala, Director of the Directorate of Research, Innovation and Partnerships at Makerere University, said the exhibition provided an opportunity to showcase EU funded projects across the University.
He noted that the School of Public Health alone has more than 18 such projects, while other colleges also have several EU supported initiatives.
One of the projects showcased was PREPARE TID, a partnership aimed at developing rapid diagnostic technologies for emerging and re emerging infectious diseases.
Prof. Julius Okuni, Associate Professor of Veterinary Pathobiology and Molecular Diagnostics at Makerere University, said the project brings together universities, industries and other organisations from Africa and Europe.
The project is working to develop technologies that can quickly identify pathogens responsible for outbreaks such as Ebola, Rift Valley fever and Crimean Congo haemorrhagic fever.
According to Prof. Okuni, Makerere is involved in field and laboratory work to test and refine the technologies before they can be delivered to end users.
Fair provides platform for research visibility
For researchers at MakSPH, the fair also provided an opportunity to increase the visibility of ongoing research and create new connections with researchers, policymakers and potential funders.
Dr. Raymond Tweheyo, Honorary Lecturer and Senior Research Fellow in the Department of Health Policy, Planning and Management, said such exhibitions allow researchers to share their work and identify others working on related challenges.
He cited the CONNECT for Health project, which focuses on transforming non-communicable disease care in Uganda through collaboration with partners across several countries.
Dr. Tweheyo said exhibitions can help researchers connect with policymakers, civil society organisations and other partners who can contribute to translating research into practical solutions.
Assoc. Prof. Angelina Kakooza Mwesigye, Associate Professor and Child Neurologist at Makerere University College of Health Sciences, also emphasised the importance of exposing young people to international research opportunities.
She said the long standing Uganda Europe partnership provides opportunities for the next generation of researchers to learn, build networks and prepare for future research collaborations.
The School of Public Health’s participation highlighted the role of international partnerships in strengthening research capacity, supporting innovation and developing evidence based responses to Uganda’s public health challenges.
Uganda has strengthened its ability to respond rapidly to Ebola and Marburg outbreaks once cases are confirmed, but delays in frontline detection, health worker exposure, emergency financing bottlenecks and incomplete implementation of lessons from previous outbreaks continue to undermine preparedness, a study has found.
The findings were presented today, October 6, 2026, during a country validation workshop convened by the Meeting Targets and Maintaining Epidemic Control (EPiC) project, to examine lessons from Uganda’s response to filovirus disease outbreaks. The study was undertaken by Makerere University School of Public Health and FHI 360.
Presented by Dr. Steven Kabwama, the synthesis examined Uganda’s experience with recurrent Ebola virus disease (EVD) and Marburg virus disease (MVD) outbreaks between 2000 and 2026, drawing particularly on After-Action Reviews from the 2017 Marburg outbreak and the 2019, 2022 and 2025 Ebola outbreaks. The work seeks to consolidate recurring strengths, weaknesses, innovations and lessons that had previously been documented separately.
Uganda has recorded 12 filovirus outbreaks over the 26-year period, including nine Ebola and three Marburg outbreaks, according to the research team. Among the four outbreaks examined closely were the 2017 Marburg outbreak in Kween and Kapchorwa, the cross-border Ebola outbreak in Kasese in 2019, the multi-district Sudan Ebola virus outbreak in 2022, and the 2025 outbreak whose index case was a health worker.
Strong systems after confirmation
Across the outbreaks reviewed, the synthesis found that Uganda has developed significant capacity to mobilise after laboratory confirmation. National and district task forces and technical response structures are activated quickly, supported by strong laboratory capacity, established coordination mechanisms and increasingly sophisticated surveillance systems.
The country has also built laboratory capacity around the Uganda Virus Research Institute, mobile laboratories, genomic sequencing, sample referral systems and the Results Dispatch System. Digital surveillance tools, Village Health Teams, survivor champions and established national and district coordination structures have further strengthened response capacity.
Detection remains a weak point
However, the findings point to a critical problem before confirmation: recognising a possible outbreak early enough.
For outbreaks originating within Uganda, the synthesis found that the period between a patient’s first presentation and confirmation ranged from nine to 27 days. This the study found is linked to low clinical suspicion and weaknesses in screening. Other recurring challenges included delayed access to emergency financing, infections among health workers, disruptions to essential health services, community mistrust and stigma, and limited follow-through on recommendations from previous After-Action Reviews.
Opening the workshop, the Dean, Prof. Rhoda Wanyenze, said understanding these delays requires going beyond identifying broad weaknesses to examining where response systems fail in practice.
“We can identify a broad challenge such as delayed detection from the literature, but your experience on the ground can help us understand the specific factors that create that challenge,” Prof. Wanyenze said while addressing district health officials from across the country.
“When we begin looking for solutions, we need to be able to target the actual problems rather than simply identifying broad challenges.”
The workshop brought together partners and colleagues from districts, including people directly involved in outbreak response, to validate the synthesis against frontline experience. Prof. Wanyenze noted that published literature, scientific papers and response reports cannot capture every operational reality, making practitioner experience essential to understanding where delays occur and what interventions have worked. Remarks validation workshop
Turning outbreak experience into continuous readiness
Among the priority actions proposed are stronger screening and alert systems for earlier detection; ring-fenced emergency financing and more reliable responder payment systems; routine infection prevention and control training; stronger occupational protection for health workers; continued investment in laboratories and genomic sequencing; and preparedness extending beyond districts traditionally considered outbreak hotspots. The study also recommends stronger community engagement and a formal mechanism to track and finance implementation of recommendations from After-Action Reviews.
Dr. Andrew Acero, Director of the EPiC project at FHI 360’s Uganda Office said the central challenge is ensuring that experience accumulated during successive outbreaks translates into lasting institutional capacity.
“The real value lies in ensuring that what we learn changes what we do. Our findings should inform policy, shape guidelines and training, strengthen systems and ultimately improve practice.”
He noted that preparedness cannot begin only after an emergency has been declared, but must be built through sustained relationships, systems and capacity before outbreaks occur. Remarks validation workshop
The EPiC project is led by FHI 360 with core partners including Right to Care, Palladium and Population Services International.
Uganda’s latest national HIV survey reveals lower viral suppression among adolescents and young adults living with HIV than among older adults, even as the country records substantial improvements in controlling the virus. The findings come from Uganda Population-Based HIV Impact Assessment (UPHIA 2025), a national household survey examining HIV prevalence and whether people living with the virus know their status, receive treatment, and achieve viral suppression.
Releasing the preliminary UPHIA 2025 findings at the Uganda Media Centre on 1 October 2026, Minister of Health Hon. Dr. Chris Baryomunsi called for earlier prevention and testing, particularly among adolescent girls and young women, alongside support for treatment adherence. “We must reach out to the young people, ensure that they have information, they test, take treatment, and adhere to the treatment guidance,” he urged.
Hon. Baryomunsi recalled how fear had discouraged testing during his university years: “I remember when we were at university, we went for testing at the university hospital. We sat there for three hours. Some of us left without even testing because it was scary.” Today, he explained, “even if you test HIV positive, you can be initiated on treatment, and you live normally like the rest of those who don’t have HIV.”
UPHIA 2025 was locally led under the Ministry of Health’s overall leadership, with Makerere University School of Public Health serving as the prime implementer, a role ICAP at Columbia University held in the previous two surveys. The Uganda Bureau of Statistics led sampling, while the Uganda Virus Research Institute and National Health Laboratory and Diagnostic Services led laboratory operations. Regional referral hospitals and local governments supported implementation, and the U.S. government provided US$10 million through PEPFAR, along with technical assistance from the U.S. CDC.
UPHIA collected data from July to September 2025 among people aged 15 and above, including those outside routine treatment services. Of 6,283 eligible households, 94.4% completed interviews. Researchers interviewed 13,801 people and tested 13,477 for HIV.
Testing followed Uganda’s national algorithm, with laboratory confirmation of positive samples, viral-load measurement, and checks for antiretroviral medicines to establish treatment use. Researchers weighted the estimates to account for the sampling design. Participants received counselling and results, and those who tested positive were referred for treatment.
Hon. Baryomunsi thanked participants and their families for welcoming survey staff and contributing their time, information and samples, without which the national evidence would not have been available.
National progress and the youth gap
The survey estimated HIV prevalence, which means the proportion of people living with HIV, at 5.9% among those aged 15 and above, corresponding to about 1.496 million people in this age group nationwide. Prevalence was 7.3% among women and 4.1% among men, ranging from 1.3% in Karamoja to 8% in the South Western region.
Among people aged 15 and above living with HIV, 86% had achieved viral suppression, meaning a low amount of HIV in the blood, measured in UPHIA as fewer than 1,000 copies per millilitre. Suppression stood at 69.3% among adolescents and young adults aged 15–24 living with HIV, compared with 89.9% among those aged 50 and above. These estimates cover people living with HIV regardless of whether they know their status or receive treatment.
HIV prevalence among people aged 15–24 was 1.5%, including 2% among young women and 1% among young men. Among young women, prevalence was 1.3% at ages 15–19 and 2.8% at ages 20–24. These differences support attention to earlier prevention and testing, although they do not establish when infections occurred.
The highest prevalence estimates occurred among middle-aged adults: 15.7% among women aged 40–44 and 11.7% among men aged 45–49. Lower suppression among young people therefore requires attention alongside the higher HIV prevalence among middle-aged adults. Comparing the same age group across both surveys, viral suppression among people aged 15–64 increased from 74.9% in 2020–21 to 86.1% in 2025, while HIV prevalence remained at 5.9%.
Diagnosis and the path to 2030
The treatment results identify diagnosis as the main national gap. Among people aged 15 and above living with HIV, 85.3% knew their status. Of those aware, 99.1% were receiving treatment; among those receiving treatment, 96.5% had achieved suppression.
The 95-95-95 targets aimed for 95% of people living with HIV to know their status, 95% of those diagnosed to receive treatment, and 95% of those receiving treatment to achieve viral suppression by 2025. Among people aged 15 and above, Uganda exceeded the treatment and suppression targets, while diagnosis remained below target. UNAIDS’s Global AIDS Strategy 2026–2031 retains these targets towards ending AIDS as a public health threat by 2030.
According to WHO, viral suppression protects health and helps prevent HIV transmission. Uncontrolled HIV weakens the immune system, increasing the risk of serious illness. With continued treatment as prescribed, sexual transmission risk is negligible when HIV remains suppressed but detectable, and zero when undetectable. The Uganda AIDS Commission estimated over 34,000 new HIV infections in 2025, underscoring the importance of early diagnosis, timely treatment, and sustained suppression alongside other prevention measures.
The demographic stakes are substantial. People aged 15–24 constituted 21.2% of Uganda’s population in the 2024 census. The country’s Fourth National Development Plan, covering 2025–2030, prioritises a healthy, knowledgeable, skilled and productive population and reducing HIV through primary health care. Protecting young people’s health, therefore, supports their participation in education, work, and national development; UPHIA helps identify where services need greater attention.
Turning evidence into action
The study’s conclusions identify three priorities: sustain treatment outcomes, find people unaware of their status, and improve suppression among younger people. Permanent Secretary Dr. Diana Atwine connected the findings to the Ministry’s planning.
“We do believe that these results are a true reflection of what is happening in our country as far as the HIV status is concerned, and we do believe that it will give us a very clear direction and the roadmap that we are going to take in the next five years to target and to get our targets achieved.”
Acting on these priorities requires funding for services and research. Hon. Baryomunsi outlined plans to target resources where needs are greatest, strengthen district services and align partner support with government priorities. Responding to journalists’ questions, he noted the government’s intention to increase domestic funding for the HIV response, including research.
“The HIV/AIDS response, including research and surveys such as this one, has largely been funded by partners in the past. The government of Uganda is committed to allocating more resources from our domestic budget to support the response and research,” he noted.
For the first time in the UPHIA series, the survey assessed selected noncommunicable disease indicators among people aged 15 and above: 15.5% had elevated blood pressure, 24.8% were overweight or obese, and 0.9% had raised random blood glucose. These screening findings align with the Ministry’s integration agenda and Hon. Baryomunsi’s call to bring HIV and chronic care services together to address people’s wider health needs.
Speaking at the release of the preliminary results, U.S. Embassy Chargé d’Affaires Mikael (Mika) Cleverley described UPHIA 2025 as the first Population-Based HIV Impact Assessment worldwide fully led and implemented by the country itself.
“The study was led by Ugandan scientists, Ugandan managers, Ugandan public servants, Ugandan field teams, from design to data collection to analysis. And this is what two decades of focused strategic U.S. foreign investments in the public health sector was meant to produce, is to reinforce Ugandan leadership and Ugandan-led efforts.”
At the survey launch on 29 May 2025, MakSPH Dean Prof. Rhoda Wanyenze highlighted the partnership’s contribution: “The partnership between Makerere University and CDC has not only helped build national capacity in surveillance and epidemiology, but has also strengthened our ability to lead high-quality, large-scale national surveys.”
The Dean added: “After two decades of joint work, we are proud that UPHIA is now a fully Ugandan-led effort. This is critical to the sustainability of the skills and knowledge generation to inform our local response.”
UPHIA 2025 shows how far Uganda’s HIV response has advanced and where gaps remain. As the country works towards ending AIDS as a public health threat by 2030, reaching young people with testing, treatment, and continued care will be essential to extending those gains.
Read the full UPHIA 2025 summary results here:
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