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Mak Transitions $100 Million Digital Health Systems Assets to Health Ministry

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Fifteen years after a sustained investment of over $100 million, Makerere University has transitioned Uganda’s digital health systems and assets to the Ministry of Health, marking a fundamental shift from externally supported interventions to full national ownership.

On 31 March 2026, a handover ceremony at Uganda’s Ministry of Health marked the closing of one chapter in Uganda’s digital health journey and the beginning of another, one in which systems built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program now sit firmly within government hands.

The national handover event brought together a cross-section of Uganda’s health leadership, academia, and development partners, led by the U.S. Ambassador to Uganda, H.E. William W. Popp; the Permanent Secretary, Dr. Diana Atwine; and the Director General of Health Services, Dr. Charles Olaro. They were joined by the CDC Country Director, Dr. Mary A. Boyd, senior government officials, implementing and development partners, technical teams, and the media. At the center of that moment was Makerere University School of Public Health, an institution that, over more than 70 years, has built its reputation as one of the region’s most enduring public health research and training hubs, working hand in hand with ministries of health, districts, referral hospitals, and partners to turn evidence into public systems that last.

Back in time, Uganda had made important gains in HIV control, but behind those gains were structural weaknesses that could not be ignored: fragmented data monitoring and evaluation systems, parallel reporting channels, weak digital integration, limited surveillance responsiveness, constrained oversight in decentralized structures, and uneven quality assurance across the HIV continuum of care. The problem was not simply that data existed in too many places but it was that the health system could not always use that data quickly enough, coherently enough, or at sufficient scale to guide action.

The MakSPH-METS program was designed as a response to that reality, build the backbone of a data-driven health system, supported through three successive grants totaling US$103.8 million by the United States Government through Centers for Disease Control and Prevention (CDC) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

The program, rather than working around government systems, worked inside them with a deliberate and system-wide focus to strengthen health information systems, expand surveillance, improve governance and accountability, institutionalize quality improvement, and build the workforce needed to run all of it.

That choice to work within the Ministry of Health structures and across decentralized systems made all the difference. It meant the investment was not in parallel projects, but in national architecture, and over time, that architecture began to take shape.

Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.

Reporting through DHIS2 (District Health Information System 2), the world’s largest open-source health management information system platform improved from 58 percent in 2020 to 98 percent in 2025. DHIS2 is a flexible, web-based tool used to collect, manage, and analyze both aggregate and individual-level data.

Also, tracked through the MakSPH-METS program, electronic medical record coverage rose to a high of 86 percent in 2024 from 50 percent in 2020, and reached 100 percent in high-volume sites. Additionally, a functional National Data Warehouse came into place. Across the country, 1,300 health facilities implemented HIV case-based surveillance, 1,084 facilities implemented HIV recency surveillance, and 300 sites established all-cause mortality surveillance. Six regional referral hospitals were implementing integrated surveillance for severe acute respiratory infections, influenza-like illness, acute febrile illness, and SARS, popular for Severe Acute Respiratory Syndrome, which is a viral respiratory illness caused by the SARS-associated coronavirus. At the governance level, 10 regional referral hospitals and 65 CDC-supported districts were trained and supported in planning and oversight, while regional referral hospital capacity scores improved from 58 percent in 2021 to 79 percent in 2024.

These are strong statistics. But the deeper story is that Uganda moved from fragmented systems to a more integrated, data-driven public health response. What had once been separate reporting streams, paper-heavy workflows, and delayed visibility became a system able to provide more timely access to data, better accuracy, stronger dashboards, and more confident decision-making. Health workers could access patient information faster. Today, district leaders are able to review performance data more accurately, national programmes can respond more strategically and data is no longer just collected, but used.

The transition also touched the practical side of care, including laboratory systems, patient records, commodity tracking, quality improvement, and outbreak intelligence.

Dr. Alice Namale, Executive Director of MakSPH-METS Program, was careful during the handover not to let the digital systems overshadow the broader institutional gains. MakSPH-METS, she noted, had “improved regional referral capacity and the district health team capacity to manage programs,” and those systems were now being leveraged by disease programs beyond HIV. She also captured the spirit of the team behind the work, saying the staff had adapted through a changing landscape. “For us, it was never business as usual. We had to continuously adapt as the landscape kept changing, and the team delivered with grace and professionalism,” Dr. Namale said.

Dr. Alice Namale, Executive Director of MakSPH-METS Program speaks during the handover ceremony on Tuesday. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Dr. Alice Namale, Executive Director of MakSPH-METS Program speaks during the handover ceremony on Tuesday.

Adding that; “We have strengthened systems and built capacity across the health sector, and these gains are now supporting not just HIV programs, but broader health services.”

That wider view matters that the systems handed over were not only about HIV reporting but they included platforms for electronic medical records, HIV case-based surveillance, stock monitoring, quality improvement, early infant diagnosis, viral load reporting, PEPFAR reporting, DREAMS tracking tool for tracking adolescents and young people data, outbreak and respiratory illness surveillance, ICT asset tracking, and e-learning platforms. In plain terms, these are the tools that allow clinicians to see results faster, managers to monitor performance more clearly, districts to respond to outbreaks sooner, and national leaders to plan with greater confidence.

The Ministry of Health now boasts of 16 such systems that have been fully developed and handed over, including UgandaEMR repositories, DREAMS Tracker, PREV Tracker, the HIV CBS dashboard, the Weekly Stock Status System, OpenHIM for health information exchange, EMR metrics, eIDSR, a platform for documenting patient level data on acute illnesses like pandemics, the QI database for visualising facility data on continuous improvement, EID and viral load dashboards, TB eCBSS, PIRS that supports PEPFAR indicator reporting beyond the DHIS2, and the SURGE Dashboard, a power BI based reporting platform.

This handover included 725 servers, more than 4,700 computing devices, solar systems for nearly 800 facilities, connectivity equipment for more than 1,300 sites, video conferencing systems, and network upgrades for regional referral hospitals. Those investments, valued at about US$9.3 million in ICT infrastructure alone, helped kick-start Uganda’s digitalization journey in practical terms: power, devices, connectivity, storage, and the ability to sustain real-time data exchange across facilities.

For the Ministry of Health, the significance of this transition is both strategic and immediate. Dr. Charles Olaro, Director General of Health Services, put it plainly that “Data is the lifeblood of decision-making,” and it provides “the raw materials for accountability.” In a sector where financing, human resources, commodities, and performance all depend on credible information, that was not a ceremonial line, but was a statement of what national ownership now requires.

Dr. Charles Olaro, Director General of Health Services delivers his remarks at the ceremony on Tuesday this week. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Dr. Charles Olaro, Director General of Health Services delivers his remarks at the ceremony on Tuesday this week.

“As a Ministry, we are focused on how this can support sustainable national ownership that is built to last, while strengthening resilient health systems. We look forward to leveraging these gains as part of our national digitalization roadmap, ensuring they continue to support and improve our systems moving forward,” said Dr. Olaro.

Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health, spoke with equal clarity about what comes next. She described the handover as both a celebration of “tangible milestones of growth” and a call to responsibility. Uganda, she said, is not going back to paper-heavy systems. “We are not going to start again. We are just moving ahead.” At the same time, she was firm that ownership must come with inventory, verification, deployment, maintenance, and continued investment in people.

Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health delivering her remarks. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health delivering her remarks.

Calling the digital systems and assets “this treasure,” she urged districts and hospitals to take care of it, and made a broader plea that Uganda government should not lose the skilled workforce developed through the partnership, especially the technical teams that established these systems under the program. “This is the cream of the cream,” she said, arguing that the country should find ways to retain this talent as digital systems expand.

Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health speaks to journalists at the Ministry of Health in company of the U.S. Ambassador to Uganda, William W. Popp and Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health speaks to journalists at the Ministry of Health in company of the U.S. Ambassador to Uganda, William W. Popp and Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS.

On his part, the U.S. Ambassador to Uganda, William W. Popp, framed the handover in similar terms, as a move from project implementation to self-reliance. He described it as “a new phase in national ownership and sustained self-reliance,” and linked it to the December 2025 U.S.-Uganda health memorandum of understanding, which set out a broader vision of government-led delivery, accountability, and stronger national systems. He stressed that foreign assistance, when delivered with discipline and accountability, should build lasting national capacity. In his words, the handover symbolizes a stronger Ugandan health system that benefits Uganda, the region, and the wider world.

U.S. Ambassador to Uganda, William W. Popp during the handover ceremony. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
U.S. Ambassador to Uganda, William W. Popp during the handover ceremony.

For Makerere University School of Public Health, the moment was deeply consistent with its long institutional identity. The School began in the 1950s as preventive medicine, grew into one of sub-Saharan Africa’s earliest public health institutions, and has remained closely linked to the Ministry of Health through teaching, service, research, and workforce development.

Emphasizing the Ministry’s continued reliance on national expertise and long-standing institutional partnerships, the Permanent Secretary underscored the critical role of the Makerere University School of Public Health in sustaining and advancing Uganda’s health systems:

“We are still going to work with you… because you are our important resource in the country. You have the skill, you have the experience—and above all, you are Ugandans,” Dr. Diana Atwine said emphatically.

Dr. Diana Atwine, the Permanent Secretary signs to receive the digital health systems and assets. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Dr. Diana Atwine, the Permanent Secretary signs to receive the digital health systems and assets.

Her remarks stresses not only MakSPH’s technical capacity, but also the trust it has built over years of collaboration with government positioning the School of Public Health as the Ministry of Health’s strategic partner in driving nationally owned, sustainable health system improvements.

MakSPH has worked across more than 25 countries in Africa in recent years, trained thousands of public health professionals, and sustained long-term partnerships with organizations including CDC, NIH, the Global Fund, Johns Hopkins, WHO, the UN agencies and others. Its own strategic direction emphasizes community engagement, policy influence, partnership, and translating research into practical public good.

That is why Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS, described the handover not as an ending, but as a transition. “As an academic institution, we are always exploring—looking for innovative, creative ways of doing things. We test them, and then work with key actors to take them over, scale them up, and sustain them,” she said. Later, she added, “This is not the end. This is the beginning of a new phase.”

Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS speaking at the handover of the systems and assets. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS speaking at the handover of the systems and assets.

For Wanyenze, that philosophy has always been intentional. “This is not our data, this is not our house, this is Ministry of Health,” she emphasized, an approach that places national ownership at the center from the very beginning. The School’s role, then, is not to hold systems, but to build them, prove them, and let them go when they are ready to stand.

And when that happens, she argues, it is not a loss but success. “When what we have contributed to is taken over, sustained, and continues to grow—that is success.”

Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.


Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS signs to transition the digital health systems and assets to the Ministry of Health on 31st March 2026. Transition of Uganda’s digital health systems and assets built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program with funding from the U.S. Government to the Ministry of Health (MoH), 31st March 2026, MoH Headquarters, Kampala Uganda, East Africa.
Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS signs to transition the digital health systems and assets to the Ministry of Health on 31st March 2026.

For years, much of Uganda’s health system operated with limited visibility, records stacked in paper files, data delayed, and decisions often made without a clear picture of what was happening on the ground. That is what makes this moment different.

After more than 15 years of investment and collaboration, Uganda is now taking over a digital health infrastructure built not just to collect data, but to actually use it, making information more timely, accessible, and practical for decision-making. The handover of the Monitoring and Evaluation Technical Support (MakSPH-METS) programme assets and systems marks more than a transfer of equipment or platforms; it reflects a shift toward a system that can better generate and use its own data.

In the end, the legacy of MakSPH-METS is not only the hardware, but something less visible and more important: a stronger ability to make informed decisions, knowing where the burden lies, where gaps remain, where stockouts occur, where patients are lost, and where progress is being made.



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Davidson Ndyabahika

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NIH/Fogarty Director Visits MakCHS, Underscores Impact of Research Training and Health Partnerships

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Officials pose for a group photo with Dr. Steven Schiff during his visit to CHS on 5th August 2026. Makerere University College of Health Sciences (MakCHS) hosts Director of the NIH Fogarty International Center (FIC), Dr. Steven Schiff, 5th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.

On 5th August 2026, Makerere University College of Health Sciences (MakCHS) hosted the Director of the NIH Fogarty International Center (FIC), Dr. Steven Schiff, for a visit highlighting the College’s research, training and institutional partnerships supported through the National Institutes of Health (NIH)/Fogarty International Center.

The visit included engagements at MakCHS and Mulago National Referral Hospital, bringing together College leadership, Directors of teaching hospitals affiliated with MakCHS, research investigators and trainees. In attendance were Dr. Joseph Kagaayi who represented the Dean of the Makerere University School of Public Health, Dr. Elias Kumbakumba, Dean of the School of Health Sciences at Mbarara University of Science and Technology (MUST) and Dr. Cissy Kityo Mutuluuza, Executive Director, Joint Clinical Research Centre (JCRC).

A key focus of the visit was the impact of D43 research training programmes supported by NIH/FIC. Principal Investigators presented examples of how the programmes have strengthened research capacity, developed new scientific expertise, supported postgraduate training and contributed to health research and policy in Uganda.

Welcoming Dr. Schiff, Professor Bruce Kirenga, Principal-MakCHS provided an overview of the College, its history, academic programmes, research priorities and extensive network of teaching and research sites. The College, Uganda’s premier centres for health professional education, currently brings together four schools: the School of Medicine, School of Biomedical Sciences, School of Health Sciences, School of Dentistry, alongside a range of research centres and specialised programmes.

Professor Kirenga highlighted the growing breadth of research at MakCHS, including infectious diseases, non-communicable diseases, translational medicine, population health, mental health, digital health, implementation science, biomedical sciences, genomics, bioinformatics and data science.

Prof. Bruce Kirenga (Standing) makes his remarks. Makerere University College of Health Sciences (MakCHS) hosts Director of the NIH Fogarty International Center (FIC), Dr. Steven Schiff, 5th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Bruce Kirenga (Standing) makes his remarks.
CURRENT D43 PROJECTS AT MAKCHS
No.Award TitlePrincipal Investigator
1Reducing the Impact of Rheumatic Heart Disease across the Life Span: The Impact ProgramProf. Nelson Sewankambo
2Enhancing Research capacity for Sickle Cell Disease and related NCDs across the Lifespan in Uganda. “Enrich Project”Prof. Sarah Kiguli
3Scaling Up advanced genomics and bioinformatics Research training in paediatric HIV/AIDS in Uganda – SURGEDr. Kyobe, Samuel
4Training in Malaria Epidemiology, Translational Research, and Implementation Science to Strengthen Malaria Policy and Control in UgandaProf. Moses Robert Kamya
5Strengthening behavioral and social science research capacity to address overlapping stigma, social and psychological challenges among people with HIV in UgandaProf. Moses Robert Kamya
6Training in non-communicable diseases epidemiological, data science and Implementation Science research to strengthen evidence-based interventions, policy and control in UgandaAssoc. Prof. Bruce James Kirenga
7Building Implementation Science Capacity at Makerere University to Strengthen the Response to the HIV/AIDS Epidemic in UgandaProf. Moses Robert Kamya
8Training in Malaria Epidemiology, Translational Research, and Implementation Science to Strengthen Malaria Policy and Control in UgandaProf. Moses Robert Kamya
9Harnessing Health Data Science capacity to strengthen evidence-based interventions, policy and response to the HIV/AIDS Epidemic in Uganda (H-DATA)Prof. David Patrick Kateete

From research training to real-world impact

Presentations from D43 Principal Investigators demonstrated how sustained NIH/FIC investment has supported researchers at different stages of their careers while contributing to evidence that can inform health programmes and policy.

In malaria research, trainees have been involved in studies examining the effectiveness of interventions such as insecticide-treated bed nets and the immunological consequences of reduced malaria transmission. Researchers are also investigating how malaria risk and immunity change when transmission is interrupted, generating evidence that can help inform strategies for sustaining the gains made through malaria control.

The implementation science portfolio provided another example of research translating into measurable health outcomes. One study examining enhanced counselling and peer support among young people living with HIV in south-western Uganda reported improvements in HIV-related outcomes, demonstrating the potential of locally-led research to strengthen service delivery.

Researchers in behavioural and social sciences have also been supported to investigate mental health and other health outcomes, illustrating the multidisciplinary nature of MakCHS research and the importance of combining biomedical, clinical and social science approaches.

Building capacity in specialised and emerging fields

The presentations also showcased the role of NIH/FIC-supported programmes in creating expertise in areas that were previously limited or unavailable within Uganda.

A programme focused on HIV research among pregnant women, children and adolescents has supported postgraduate and short-course training in areas including clinical trial design, pharmacokinetics, biostatistics, behavioural science, regulatory and ethical considerations, and implementation science.

Other programmes have contributed to the development of expertise in bioinformatics, genomics and data science, including the establishment and strengthening of postgraduate programmes. Researchers are increasingly applying artificial intelligence and machine learning to complex biomedical and HIV datasets, with the goal of generating evidence that can be translated into policy and practice.

Dr. Cissy Kityo Mutuluuza, Executive Director of the JCRC highlighted emerging work in gene and cell therapy under the NIH/FIC supported project Building Gene Therapy Capacity in Uganda implemented at JCRC. She explained that the programme includes efforts to establish sustainable research and training capacity for HIV cure research in Uganda. The programme brings together institutions in Uganda and international partners, with an emphasis on developing locally relevant expertise, infrastructure and research capability.

Dr. Cissy Kityo Mutuluuza (Standing) highlights JCRC's work. Makerere University College of Health Sciences (MakCHS) hosts Director of the NIH Fogarty International Center (FIC), Dr. Steven Schiff, 5th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. Cissy Kityo Mutuluuza (Standing) highlights JCRC’s work.

Strengthening institutions and developing future leaders

Beyond individual research projects, speakers emphasised the broader institutional impact of Fogarty-supported training.

Over the years, NIH/FIC-supported collaborations have contributed to the development of postgraduate programmes, research laboratories, specialised scientific disciplines and networks of researchers across Uganda. Trainees have progressed into academic and research leadership positions, with some becoming professors, programme leaders and advisors contributing to national health initiatives.

The programmes have also supported short courses, mentorship, international research placements and collaborations designed to enable Ugandan scientists to develop advanced skills and return to strengthen research and training at home.

Presenters stressed the importance of moving beyond individual training to building institutions capable of sustaining research programmes, mentoring future scientists, managing complex studies and translating findings into health interventions.

Research serving Uganda’s health system

The visit also underscored the close relationship between MakCHS research and Uganda’s health system. Researchers and faculty contribute to national programmes in areas including HIV, tuberculosis, malaria, vaccines, maternal and child health and other public health priorities.

Evidence generated through research has helped inform national guidelines, programmes and policy discussions, while College researchers and teaching hospitals continue to provide expertise during public health emergencies and disease outbreaks.

The speakers noted that partnerships such as those supported by NIH/FIC are most valuable when they create lasting local capacity — enabling Ugandan institutions and scientists to generate and use evidence to address the country’s health priorities.

A partnership built on shared learning

Dr. Steven Schiff makes his presentation. Makerere University College of Health Sciences (MakCHS) hosts Director of the NIH Fogarty International Center (FIC), Dr. Steven Schiff, 5th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. Steven Schiff makes his presentation.

In his engagement with the College, Dr. Schiff reflected on the longstanding relationship between NIH/Fogarty-supported programmes and Ugandan researchers. He acknowledged the depth of expertise and experience that has developed through years of collaboration and emphasised the value of partnerships that support scientific exchange and capacity building in both directions.

Dr. Schiff noted that the presentations demonstrated impact of the partnerships which extends well beyond the number of people trained. Investments in researchers have helped establish new academic programmes, strengthen laboratories and research infrastructure, expand multidisciplinary collaborations and create a growing generation of scientists able to lead research in Uganda and internationally.

The visit therefore provided an opportunity not only to showcase ongoing work, but also to reflect on the evolution of research capacity at MakCHS and its contribution to Uganda’s health priorities.

As MakCHS continues to expand its research portfolio into emerging areas such as artificial intelligence, genomics, precision medicine, translational science and advanced therapeutics, the College reaffirmed the importance of strategic partnerships in developing the people, systems and infrastructure needed to turn scientific discoveries into improved health outcomes.

Zaam Ssali
Zaam Ssali

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AFRHiCARE Shares Evidence and Co-Creates Solutions to Strengthen Uganda’s First-Referral Hospitals

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Stakeholders pose for a group photo during the AFRHiCARE Meeting held on 13th August 2026. Makerere University School of Public Health (MakSPH) Wellcome Trust through a 2023–2029 Discovery Award-funded Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative stakeholders from five first-referral hospitals in Uganda meeting to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care, 13th August 2026, Kabira Country Club, Kampala Uganda, East Africa.

The Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative on August 13, 2026 brought together stakeholders from five first-referral hospitals in Uganda to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care.

Funded by the Wellcome Trust through a 2023–2029 Discovery Award, AFRHiCARE is a partnership between Makerere University, the University of the Witwatersrand, the KEMRI-Wellcome Trust Research Programme and the University of Oxford. The initiative seeks to generate evidence to inform the future development of first-referral hospitals, with a focus on service delivery, health workforce dynamics, leadership, management, governance and technology.

In Uganda, the study is being implemented at Kawolo Hospital, St. Joseph’s Hospital Naggalama, Adjumani Hospital, Kiryandongo Hospital and Masindi Hospital. The hospitals play a critical role within the Primary Health Care (PHC) system, linking lower-level health facilities to higher-level referral services.

The stakeholder meeting provided an opportunity for the participating hospitals and other stakeholders to move beyond receiving research findings to interrogating the evidence, sharing experiences and identifying actions that can be implemented at hospital, district and national levels. This approach is central to AFRHiCARE, which uses stakeholder engagement to promote cross-learning and support hospitals to develop quality improvement actions.

Evidence from the health workforce

One of the key areas presented was the status of the health workforce across the five hospitals. The first-round assessment surveyed 609 frontline health workers. It examined staffing, job satisfaction and professional quality of life.

Some of the AFRHiCARE Stakeholders in a group discussion. Makerere University School of Public Health (MakSPH) Wellcome Trust through a 2023–2029 Discovery Award-funded Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative stakeholders from five first-referral hospitals in Uganda meeting to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care, 13th August 2026, Kabira Country Club, Kampala Uganda, East Africa.
Some of the AFRHiCARE Stakeholders in a group discussion.

The findings show a significant staffing gap. Against the 2023 staffing norm of 343 staff, all five hospitals were operating at less than half of the recommended level. Masindi Hospital had the largest gap, operating at 37.6% of the norm, while Adjumani, Kiryandongo, Kawolo and Naggalama were at 48.1%, 48.7%, 44.9% and 44.6%, respectively.

However, the findings suggest that staff retention is relatively good in the public hospitals. The main challenge appears to be recruitment and filling vacant positions rather than widespread staff turnover.

Health workers identified promotion, workload and salary as the lowest-rated aspects of their jobs across the five hospitals. Overall job satisfaction ranged from 59% in Masindi to 71% in Naggalama.

Despite these challenges, the findings reveal strong commitment among health workers. Compassion satisfaction was high, with many reporting pride in their work. At the same time, workload emerged as a major concern.

Strong relationships among colleagues were also identified as a key strength, suggesting that teamwork and peer support remain important sources of resilience within the hospitals.

Strengthening hospitals within the health system

Speaking during the dissemination, Dr. Raymond Tweheyo, Co-Principal Investigator and Research Manager for AFRHiCARE Uganda, noted that first-referral hospitals have often been neglected in critical areas, including staffing, financing, infrastructure, leadership, management and governance.

Dr. Raymond Tweheyo. Makerere University School of Public Health (MakSPH) Wellcome Trust through a 2023–2029 Discovery Award-funded Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative stakeholders from five first-referral hospitals in Uganda meeting to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care, 13th August 2026, Kabira Country Club, Kampala Uganda, East Africa.
Dr. Raymond Tweheyo.

He said these gaps affect hospitals’ ability to deliver services effectively and respond to the needs of the communities they serve.

Dr. Tweheyo re-echoed a message from the Principal Investigator, Professor Frederick Ssengooba, on the importance of situating the district hospital at the apex of the PHC network. This perspective recognises that challenges experienced at district hospitals may be linked to weaknesses elsewhere in the health system.

For example, weak referral systems, shortages of health workers and capacity challenges at lower-level facilities can increase pressure on first-referral hospitals. Addressing these problems therefore requires system-level solutions involving multiple actors.

The AFRHiCARE protocol similarly identifies persistent challenges around resource constraints, service delivery, workforce wellbeing, leadership and management, governance, technology and the ability of hospitals to meet changing community needs.

Dr. Raymond Tweheyo makes his presentation. Makerere University School of Public Health (MakSPH) Wellcome Trust through a 2023–2029 Discovery Award-funded Future of Africa’s First Referral Hospitals: Innovation and Care (AFRHiCARE) research initiative stakeholders from five first-referral hospitals in Uganda meeting to review research findings, reflect on persistent challenges and identify practical solutions to strengthen hospital performance and quality of care, 13th August 2026, Kabira Country Club, Kampala Uganda, East Africa.
Dr. Raymond Tweheyo makes his presentation.

From research to action

Participants discussed priorities including filling critical staffing gaps, improving transparency and equity around promotion, addressing excessive workloads, strengthening referral systems and reducing the pressure created when patients bypass lower-level facilities. The meeting also considered which challenges can be addressed by hospitals and which require action from district authorities and the Ministry of Health.

Betty Kyakuwa
Betty Kyakuwa

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Dr. Musoke Takes Over as Head of Disease Control & Environmental Health

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Officials witness as Dr. David Musoke and Dr. Esther Buregyeya shake hands at the handover ceremony on 11th August 2026. Makerere University School of Public Health (MakSPH) leadership transition, Department of Disease Control and Environmental Health, Dr. David Musoke takes over from Dr. Esther Buregyeya, 11th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.

The Makerere University School of Public Health (MakSPH) has formally transitioned leadership of the Department of Disease Control and Environmental Health, with Dr. David Musoke taking over from Dr. Esther Buregyeya, who served as Head of Department for more than nine years.

The handover marked both an appreciation of Dr. Buregyeya’s tenure and a renewed call for the Department to strengthen its position as a leading centre for Environmental Health, Occupational Health, Disease Control and Prevention.

Dr. Buregyeya, who took over the leadership of the Department in January 2017 and served until May 2026, described her tenure as a period of significant growth in teaching, research, community engagement and staff development. She emphasised that the achievements were a result of shared leadership and the collective efforts of Department members, School leadership and partners.

Dr. David Musoke (L) and Dr. Esther Buregyeya (R). Makerere University School of Public Health (MakSPH) leadership transition, Department of Disease Control and Environmental Health, Dr. David Musoke takes over from Dr. Esther Buregyeya, 11th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. David Musoke (L) and Dr. Esther Buregyeya (R).

Among the key milestones during her tenure was the strengthening of the Department’s academic portfolio. The Department completed the review of the Bachelor of Environmental Health Science curriculum and supported the development of the Master’s programme in Environmental and Occupational Health. It also contributed to the development of the PhD by coursework and expanded online learning materials and short-course offerings, including training in Water, Sanitation and Hygiene and Occupational Health and Safety.

The Department also made progress in strengthening its laboratory capacity. With support from the School leadership, equipment was procured for the Environmental Health laboratory, which is currently based at Kasangati. The Department has also benefited from equipment donated through partnerships.

Another significant achievement highlighted during the handover was the development of human capacity. Several staff and research associates have pursued doctoral training, strengthening the Department’s pool of researchers and future academic leaders. Dr. Buregyeya noted that building this capacity was essential to ensuring continuity and preparing the next generation of faculty.

Dean commends leadership and mentorship

The Dean of MakSPH, Prof. Rhoda Wanyenze, commended Dr. Buregyeya for her leadership and credited the Department with developing a strong culture of mentorship and nurturing young professionals.

Prof. Wanyenze noted that although Disease Control is one of the School’s original departments, its membership has remained relatively young, with many emerging professionals being mentored and supported to grow within the School. She particularly applauded the Department for attracting and retaining talented Environmental Health graduates and for creating opportunities for research associates to contribute to the School’s work.

Prof. Rhoda Wanyenze (Left) and Mr. Amos Dembe (Rear) witness as Dr. David Musoke presents an appreciation plaque to Dr. Esther Buregyeya. Makerere University School of Public Health (MakSPH) leadership transition, Department of Disease Control and Environmental Health, Dr. David Musoke takes over from Dr. Esther Buregyeya, 11th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Prof. Rhoda Wanyenze (Left) and Mr. Amos Dembe (Rear) witness as Dr. David Musoke presents an appreciation plaque to Dr. Esther Buregyeya.

She also welcomed the establishment of the Master’s programme in Environmental Health, describing Environmental Health as an important frontier for public health. She challenged the Department to consider developing a PhD pathway in Environmental Health and to build a coordinated research agenda examining the links between the environment, infectious diseases, non-communicable diseases and broader health systems.

Prof. Wanyenze further called for greater investment in Occupational Health, noting the importance of workplace health, mental health, physical health and occupational safety, particularly as Uganda’s informal sector continues to grow. She also urged the Department to strengthen entomology and related research in vector-borne diseases.

A new chapter under Associate Professor David Musoke

Receiving the responsibility, Associate Professor David Musoke described his appointment as both an honour and a homecoming. He completed his Bachelor’s degree in Environmental Health at Makerere and later worked in the Department of Health Policy, Planning and Management before returning to Disease Control, where he has spent much of his professional career.

Assoc. Prof. Musoke paid tribute to Dr. Buregyeya, whom he described as a mentor and an example of shared leadership. He noted that during her tenure, the Department had grown from having a single undergraduate programme to developing a Master’s programme, contributing to PhD training and expanding its research portfolio into new and emerging areas. He also recognised the growth of early-career researchers, many of whom have progressed through doctoral training and into academic roles.

He pledged to build on these achievements while working closely with Department members, the Dean and other School departments. He also acknowledged the confidence placed in him by colleagues during the selection process and committed to working collectively to advance the Department.

A call to define the Department’s future

While celebrating the Department’s achievements, Prof. Wanyenze challenged the new leadership to develop a clear strategic agenda that distinguishes and strengthens the Department’s areas of expertise.

Dr. David Musoke and Dr. Esther Buregyeya cut cake at the handover ceremony. Makerere University School of Public Health (MakSPH) leadership transition, Department of Disease Control and Environmental Health, Dr. David Musoke takes over from Dr. Esther Buregyeya, 11th August 2026, Mulago Hospital Complex, Kampala Uganda, East Africa.
Dr. David Musoke and Dr. Esther Buregyeya cut cake at the handover ceremony.

Prof. Wanyenze urged the Department to take forward the urban health agenda, particularly in light of Uganda’s rapid urbanisation and the emerging challenges associated with waste management, environmental health and the delivery of preventive health services in urban settings.

She further called for deliberate investment in people, infrastructure, research and partnerships. In particular, she encouraged the Department to use the new School infrastructure to develop a laboratory and to strategically support PhD training in areas where expertise is currently limited.

“You don’t have to carry this burden alone. There are people who can support the growth of the department,” Prof. Wanyenze said in encouraging the new leadership to build on the expertise already within the Department.

The handover concluded with the formal transfer of responsibility, followed by a presentation to Dr. Buregyeya in appreciation of her service and a cake-cutting ceremony bringing together the outgoing and incoming Heads of Department and members of the Department.

Betty Kyakuwa
Betty Kyakuwa

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