Francis Omaswa answers questions on what is needed for World Malaria Day.

Kampala, 22 April 2021 – Over the past two decades, the world has made great progress in Prof Francis Omaswa Executive Director-ACHEST reducing malaria cases and deaths, but the pace has stalled in many high malaria burden African countries. Global malaria cases dropped by 29% between 2000 and 2019, but only by 2% between 2015 and 2019 when deaths fell by 15% compared with 60% between 2000 and 2019. Professor Francis Omaswa, Executive Director of the African Centre for Global Health and Social Transformation, explains what needs to be done to get malaria control and prevention back on track.

Why do we need to rethink malaria prevention?                                               There are two major reasons why we need to rethink malaria in Africa. First, is the fact that performance indicators have stagnated and are getting worse in some areas. Second, is that health systems are transitioning from top-down leadership to community ownership with generation and application of local solutions by the affected communities. We are off the track towards malaria elimination due to governance issues. Less money is going into malaria prevention programmes. The burden of malaria is not seen as a priority by political leaders and even the population themselves. There is a slackening of effort despite data indicating that we are stagnating.

The new direction for malaria control is to stop the top-down response and embark on an integrated, people-centred primary health care systems. This is the foundation of health systems of the future not only for malaria control but to achieve Universal Health Coverage and achieve the Sustainable Development Goals.

CONFERENCE FLYEROn March 19, 2021, THET UK partnered with the African Center for Global Health and Social Transformation (ACHEST) and Esther Alliance to host the second conference on COVID-19 Partnerships.
The conference was held under the theme: “COVID-19 Partnerships in the International Year of Health and Care Workers: Protect. Invest. Together.” This is in line with the World Health Organization year-long campaign to recognize health workers for their dedication and resilience in fighting the COVID-19 Pandemic.
Participants had the opportunity to reflect on what has been achieved by the Health Partnership community since the first conference in April 2021; and looked into the future, recognising the immense pressure that is now falling on health workers in every country. With the worrying increases in infections and the slow pace of vaccination campaigns in sub-Saharan Africa observed since the start of 2021 the conference discussed afresh at how the Health Partnership community is pulling together, especially now, when solidarity is more important than ever.
In his opening remarks, THET Director Ben Simms said: “We are here to celebrate but we also here to express our urgency and our anger. 2021 is not the same as 2020. We will never look at the world in the same way. We have been reminded about inequality, racism, about the underfunding of health services; and the effects of the pandemic continue to be felt. We need to argue that every health worker has the right to be properly equipped and supported. That every health worker, as every citizen, has the right to be vaccinated. We meet with humility.”
The virtual conference had 412 people from 44 countries across the globe participating. It also had 16 sessions and 48 speakers on wellness and compassion, advocacy, health systems strengthening, and COVID-19 response among others.
Advocacy in an era of COVID-19
This session explored the role individual health workers can play in advocating for change, including the challenge of overcoming 'anti-science' positions in communities and nations. ACHEST Executive Director Prof. Francis Omaswa was a panelist on this session. He expressed concern about the increased disinformation spread both through social media such as Whatsapp; as well as some politicians who give dissenting views.
He said: “We are challenged right now with handling information; misinformation, correct information. And when some of our leaders are not supporting health workers in getting the correct information out there, so that the public is together with health workers, based on the actual information, then the life of health workers becomes very complicated. We are challenged with issues of alternative factors versus real/actual facts. In this type of scenario, the health workers are in a dilemma. They themselves have to find out what the facts are. And then on top of that, they have to manage a community/public that is battling issues of what is true and not true.”
Prof. Omaswa referred to an example of the head of state in Africa who took a line that COVID-19 doesn’t exist in his country. “How do we deal with situations like that at global level, national level and down to community level? What about other heads of state? What has been their role? I am looking at health workers and other professionals such as lawyers. How do we speak truth to power so that it is possible for health workers to be able to do their job based on real facts not alternative facts and innuendo.,” asked Prof. Omaswa.

The recognition plaqueACHEST Consultant, Dr. Peter Eriki, received national recognition for his outstanding contribution to the fight against Tuberculosis.
Dr. Eriki, a TB and chest specialist, was the first Ugandan manager of the National TB Program (NTBP). He also served as a Regional Adviser for TB and Leprosy based in Congo Brazzaville; then as a World Health Organization (WHO) Country Representative in Angola, Kenya, and Nigeria.
Before his current consulting role at ACHEST, Dr. Eriki worked as Director Health Systems and Deputy Executive Director. He also served as a President of the Uganda National Association of Community and Occupational Health (UNACOH)
Dr. Eriki received the award from the Health Minister Dr. Jane Ruth Aceng during the national celebrations to mark World TB Day on March 24, 2021 in Moroto. Commenting on this achievement, Dr. Eriki says it is very humbling to be recognized when one is still alive”
According to the WHO-Afro, (https://www.afro.who.int/regional-director/speeches-messages/world-tb-day-2021 ), there were an estimated 2.5 million TB cases in the African Region in 2019, accounting for 25% of the global burden. More than 500,000 African lives are lost to this disease every year. This is inexcusable when TB screening and treatment is available for free in all countries.
The theme of World TB Day 2021 - ‘The Clock is Ticking’ –conveys the sense that the world is running out of time to act on the commitments to end TB made by global leaders. This is especially critical in the context of the COVID-19 pandemic that has put End TB progress at risk.
Dr. Eriki had this to say on prevention: “TB is an airborne infection, spread through coughing, laughing, singing, talking, etc. It's curable. The best prevention method is finding all the sick infectious people and putting them on treatment and encouraging them to complete treatment until cured."

The independent Africa Health Agenda International Conference (AHAIC) Commission has unveiled the State of Universal Health Coverage (UHC) in Africa Report.

 KENYA PRESIDENT UHURU KENYATTAThe report’s executive summary was released on the first day of AHAIC 2021 conference – a biennial convening of health ministers, private sector leaders, civil society and representatives from multilateral organizations taking place virtually from 8-10 March 2021.

The report highlights the progress made by African countries towards realizing Health for All and details the challenges and opportunities faced by countries in achieving UHC.
Compiled between November 2020 and March 2021, the State of UHC in Africa report takes stock of Africa’s progress in fulfilling commitments made by African leaders over the years, such as the Abuja Declaration (2001), the Africa Health Strategy (2007-2015, 2016-2030) and the Addis Ababa Call to Action on UHC (2019). It acknowledges the impact of colonial legacies, poor governance, and economic challenges on the continent’s health policies and outcomes. It details the performance of African countries on key UHC indicators, including effective coverage with needed health services, financial risk protection and health outcomes.

DR. TEDROS SPEAKING DURING THE VIRTUAL CONFERENCEAccording to the report, Africa’s health systems are poorly attuned to meet the health care needs of the poor, the disabled and other vulnerable groups, with coverage of essential health care services in Africa being decidedly low: only 48 per cent of the population receives the health care services they need. This means that approximately 615 million people in Africa may not receive the healthcare services that they need.

Quality of health care services provided in African countries is also low and is considered the poorest performing indicator of UHC – when quality of health care services is considered, service coverage scores across African countries are even lower. The report also reveals that coverage of essential services needed by women and girls in Africa is low, with data indicating that between 2015 to 2019, only 49 per cent of African women had their demand for contraceptives satisfied.

ACHEST STAFF TAKE A PICTURE WITH RESEARCH ASSISTANTSThe African Center for Global Health and Social Transformation (ACHEST|) is one of the partners that is implementing a new project on clinical skills update and mentorship in reproductive, maternal, new-born, child, and adolescent health in Uganda.
The project is under the Ministry of Health and is supported by the World Bank. The project which kicked off in February 2021 is expected to run until December 2021.
ACHEST will be carrying out its assigned tasks in selected districts in Eastern Uganda, while other partnering agencies will cover the rest of the regions.
The objectives of the project are to improve utilization of essential health services with a focus on reproductive, maternal, newborn, child and adolescent health services in target Districts; (b) scale-up birth and death registration services, and (c) to provide an immediate and effective response to an eligible crisis or emergency.

The Uganda Demographic Health Survey 2016 shows that far too many women continue to die pointlessly due to pregnancy and childbirth-related causes. The maternal mortality ratio stands at 336/100,000 live births while the neonatal mortality rate was 27 deaths per 1,000 live births.
“Our wives, sisters, and mothers are still dying. They are dying because of excessive bleeding, infection, obstetric labour, abortion, hypertension, and other direct and indirect causes,” said Dr Romano Byaruhanga while giving an overview of the maternal health and perinatal situation in Uganda. He expressed hope that the project would help identify the missing gaps in maternal health care services.
He made the remarks during the March 1-4th 2021 training of research assistants that was organized by ACHEST ahead of the fieldwork. The research assistants were trained in different data collection tools including the use of information and communication technology.
Other facilitators were Dr. Dan Kajungu, the Executive Director of the Makerere University Centre for Health and Population Research, and ACHEST’s Dr. Elsie Kiguli-Malwadde the Director of Health workforce Education and Development, Robert Odedo, the Head of Consulting and Dr. Peter Eriki, the Director of Health Systems.

DR. ELSIE KIGULI-MALWADDE 1ACHEST in partnership with the Ministry of Health and Health Professions Education Initiative held the 3rd interns’ induction course on February 26, 2021.
The course was hosted online due to the COVID-19 pandemic. About 70 newly qualified doctors, nurses, midwives and pharmacists participated. These graduates are currently doing internship from different hospitals across Uganda.
The objective of the course is to enable the young health professionals to be conversant with the Ugandan health system and the Ministry of Health Vision and Mission; to understand the basics of government procedures and rules and quality assurance in the health care system. It also ensures that medical interns are prepared to work in the Ugandan health system and understand the referral system, job market, career progression and postgraduate training; and how to take good care of themselves.
The course was moderated by the ACHEST Director of Health Workforce Education and Development, Dr. Elsie Kiguli-Malwadde, who described internship as the transition period between being a student and a fully-fledged professional.
“Internship is a fulfilling experience because you take on responsibilities that you couldn’t take on as students. But it is also busy and sometimes challenging and if we are not careful it can be stressful. Sometimes, it leads to burnout and can lead to mental health problems leading to poor patient care,” observed Dr. Kiguli-Malwadde.
Notably, this induction course has helped the young professionals who have gone through it to adjust and find internship exciting. Previous sessions were hosted in March and July 2020 with over 100 participants respectively.
The Deputy Director of Mulago hospital Dr. Rosemary Byanyima guided interns on how toDr. Rosemary Banyima manage the expectations of the hospital, Ministry of Health, the public, and their parents. She emphasized the need for professionalism, by giving a detailed description of the dos-and-donts while at work.
“When you come as an intern you have expectations but the hospital also has expectations as we are preparing you for the job market. There are many stakeholders in this. Apart from the clinical skills you have, you have to be very professional. We don’t expect you to hold any other job because an internship is a full-time job and an extra job would affect your performance. We expect you to manage time for your ward rounds. Don’t be on the phone for too long. Be courteous and empathetic to patients. These are people who are unwell and we have to put ourselves in their shoes and treat them the way we would want to be treated,” said Dr. Byanyima
The second speaker, Prof. Sarah Kiguli a senior pediatrician at Mulago National Referral Hospital had an interactive segment with the interns as she spoke about career opportunities and facilitating factors. Interns freely shared their experiences. Some of the common challenges that came out strongly were being nervous, worried, and excited on the very first day of internship due to the fear of the unknown; and being overwhelmed and exhausted due to the high patient numbers.

Flyer showing the panel of the Health is Made At Home Webinar“You are a Professor of Latrines… Shut up!”
Prof. Miriam Were had studied the pattern of hospital admissions and noticed that 80 % of cases were not just preventable, but were infectious diseases acquired mostly through the oral-faceal route. To prevent these needless admissions, she was advocating for building latrines as a key element to promote hygiene in the communities in Kenya. Yet, for this well-intended advice, Prof. Were was derogatively labeled the “professor of latrines.”
It wasn’t the first time she was ridiculed. Earlier, during her academic journey, she had chosen to undertake research on people’s participation in community health. However, her supervisors were not impressed.
They told her that is not an academic topic and she must look for an academic topic. She refused and thought they were going to throw her out. Her effort was to make sure that the problems were manageable.
She adds: “The thing is, there has been a lot of resistance, but COVID-19 has dawned on us all and community health is now respected.”
Prof. Were, Co-Founder of UZIMA Foundation-Africa, narrated this sad experience during a webinar on Health is Made at Home, Hospitals are for repairs – Mutual learning between Africa and Europe. The webinar held on December 15, 2020, was hosted by the African Center for Global Health and Social Transformation(ACHEST) in partnership with the African Forum for Research and Education in Health (AFREhealth) and Lord Crisp Nigel the author of the book “Health is made at home, hospitals are for repairs.”

ACHEST’s Director of Health Workforce Education and Development Dr. Elsie Kiguli-MalwaddeDR. ELSIE KIGULI-MALWADDE has been appointed to the WHO working group that is developing global competency standards on refugee and migrant health.

The strategic working group will provide technical support and inputs for WHO Health and Migration Programme PHM and the Health Workforce HWF departments in the development of global competency standards for refugees and migrant health.
It will also support high level advocacy and provide advice to enhance the buy-in by other academic institutions/ universities to use the global competency standards.

Dr. Kiguli-Malwadde, who is also the AFREhealth Vice President, was appointed alongside 9 other experts from top academic institutions/WHO Collaborating Centres that are leading in global or regional health and migration/displacement.

Commenting on her appointment, Dr. Kiguli-Malwadde said, “It is a privilege for me to serve on this committee, these global standards are key to transformation of health professions education. It is important to guide the training and influence the practice for the underserved groups such as refugees and migrants.”

Other experts on the working group include Associate Prof. J O Vearey, the Director African Centre for Migration & Society, University of the Witwatersrand in Johannesburg; Professor Cynthia Whitehead, the Director of Department of Family and Community Medicine (WHO Collaborating Centre) University of Toronto; Prof. Paul Spiegel, the Director Johns Hopkins Center for Humanitarian Health; Dr. Aula Abarra Honorary Clinical Lecturer Department of Infectious Disease, Faculty of Medicine, Imperial College, and London School of Hygiene and Tropical Medicine; and Fouad M. Fouad an Assistant Professor of Epidemiology and Population Health at the American University of Beirut, Lebanon.

The Executive Director of the African Center for Global Health and Social Transformation (ACHEST), Prof. Francis Omaswa has been appointed to the Independent Commission to review the status of Universal Health Coverage (UHC) in Africa. Prof Francis Omaswa 
The commission, established by AMREF Health Africa, will review the continent’s progress towards achievement of Universal Health Coverage (UHC) targets by 2030.

In addition to reviewing the continent’s progress, the commission dubbed “Africa Health Agenda International Conference (AHAIC) Commission on the State of UHC in Africa,” will provide recommendations on leadership, accountability, technology/innovation and health security, to help guide the continent towards achieving UHC targets.

Prof. Omaswa has been appointed alongside 10 other commissioners from a range of disciplines and sectors across Africa.

They include Co-chair Solange Hakiba (Rwanda) who is experienced in working with various donor agencies, including USAID, DFID, the Global Fund to fight AIDS, Tuberculosis and Malaria and Bill & Melinda Gates Foundation; and Co-Chair Prof Edwine Barasa (Kenya), who serves as the Director of the KEMRI-Wellcome Trust Research Programme in Nairobi, Kenya; the Head of the Programme’s Health Economics Unit and Professor of health economics at the University of Oxford.

Webinar flyerUganda’s Community Engagement Strategy (CES) for COVID-19 response will empower individuals and their households to fight the pandemic as well as address other social challenges.
“The strategy is not limited to COVID-19 alone. It addresses everything from food production, nutrition, to hygiene and so on,” said Dr. David Okello the Director of Health Systems at the African Center for Global Health and Social Transformation (ACHEST) and member of the Community Engagement sub-committee that developed CES.
Dr. Okello made the remarks while delivering a keynote address on CES, at a webinar hosted by the Palliative Care Association of Uganda on November 27, 2020.
CES was launched by the Uganda government on October 20, 2020, with the objective of ensuring that all people in Uganda are aware, empowered, and are participating in the prevention and control of the COVID-19 outbreak as both a duty and a right, using existing structures, systems and resources as much as possible. It is based on the premise that good health starts with and is created by individuals, their families, and the communities; and is supported, where necessary, by the skills, knowledge of professionals. Individuals have the primary responsibility for maintaining their own health and that of their communities.

If well implemented, Dr. Okello, explained that CES would strengthen the existing Community Health System for Integrated People-Centered Primary Health Care (IPCHC) and ensure that infections are minimized in the community. It will enable prompt identification, testing, treatment and rehabilitation as needed in communities.

“Let’s remain focused. The people of Uganda have the power to control the COVID-19 pandemic,” said Prime Minister Rt. Hon. Dr. Ruhakana Rugunda.Prime Minister Dr. Ruhakana Rugunda
Dr. Rugunda made the remarks on November 25, 2020, while addressing a press conference on the implementation of the Community Engagement Strategy(CES) for the COVID19 response.
“The strategy recognizes that the pandemic is here,” said Dr. Rugunda, and cautioned strongly against complacency among the population. “We are concerned at the rate of infection and deaths and we are also concerned about the level of complacency. COVID-19 is not in the past tense. It is very much with us,” added Dr. Rugunda
Uganda is now in Phase IV of the pandemic with widespread community transmission reported across the country. As of November 20, 2020, a total of 18,496 cumulative cases and 186 deaths had been confirmed by the Ministry of Health.
The decision to develop and implement CES was endorsed by President Yoweri Museveni during meetings with the National Taskforce for COVID-19 control at State House Entebbe on August, 28 and September 2, 2020, respectively. The development and coordination of the CES were led by a Sub-Committee chaired by Prof. Francis Omaswa, who is also the Executive Director of the African Center for Global Health and Social Transformation. The subcommittee is under the Technical intersectoral Committee of the National Taskforce.

The African Center for Global Health and Social Transformation (ACHEST) Director of HealthDr Elsie Kiguli-Malwadde Workforce and Development Dr. Elsie Kiguli Malwadde moderated a webinar on the state of accreditation of health professions training institutions in Africa. Dr. Kiguli-Malwadde is also the Vice President of the African Forum for Research, Education, and Health (AFREhealth)
The webinar held on November 11, 2020, was organized by AFREhealth under the theme Health Work Force Accreditation and Regulation in Africa.
Other speakers were Dr. Kgosi Letlape, the President of Health Professions Council of South Africa; William Pinsky, the President, and CEO, ECFMG; and Professor David Gordon the President of the World Federation for Medical Education (WFME).
The webinar discussed the need to strengthen the quality and performance of the health workforce in Africa during and after COVID-19; and well-functioning regulatory mechanisms, such as registration, licensing/certification bodies, and accreditation processes for training institutions.
Dr. Kiguli-Malwadde while opening the webinar stated that accreditation is not an end in itself, it is like taking a biopsy, it helps to come up with a diagnosis that assists the institutions to become better by examining their relevance, quality, and equity policies and implementation while regulation is like positive policing. All these are aimed at standardizing and maintaining and improving quality.

ntv talkshowOn October 30, 2020, the Health Systems Advocacy Partnership (HSAP) country partners held a live TV discussion on health systems strengthening.

This was to reflect on the last five years (2016-2020), that the HSA has been in existence.

The project has been implemented by Amref Flying Doctors/Amref Health Africa, the African Centre for Global Health and Social Transformation (ACHEST), Health Action International (HAI) represented in Uganda by the Coalition for Health Promotion and Social Development (HEPS-Uganda), Wemos and the Dutch Ministry for Foreign Trade and Development Cooperation.

The project has contributed to the realization of sexual and reproductive health and rights (SRHR) of people in sub-Saharan Africa through building the capacity of civil society actors and health stewards with knowledge, technical skills and tools that are needed to develop and implement evidence-based advocacy strategies.
A two-hour talk show was hosted on NTV Uganda on 30th October 2020 and streamed live on social media, attracting over 200 viewers. The partners shared experiences and lessons learnt through the five years of HSAP. They also shared opportunities for improved human resources for health, Health financing, access to health commodities and improved service delivery.

For over four years, the Health Systems Advocacy Partnership (HSAP) has been dedicated to improving the sexual and reproductive health and rights (SRHR) of people in sub-Saharan Africa (SSA). Now, as the Partnership draws to a close, partners have had the opportunity to reflect on the progress made and, most importantly, the sustainability of the HSAP’s work on health systems strengthening.
On October 22, 2020, the Partners – ACHEST, AMREF, HAI, and WEMOS held a virtual end-of-program conference under the theme After HSA: Ensuring the Sustainability of Health Systems Strengthening
More than 80 representatives from civil HSA in-country partners, local CSOs, local ministries of health, media in focus countries, and the Dutch Ministry of Foreign affairs participated in the meeting.

A series of breakout sessions provided space for the HSA Partners and other stakeholders to share some of the key lessons from across a range of topics and ideas on how to maintain the drive towards health systems strengthening post-2020.

Africa’s legislators should be involved in establishing strong community engagement structures to ensure that individuals actively participate in solving their own problems.
This would spontaneously lead to the achievement of Universal Health Coverage and Sustainable Development Goals.
The call to action was made by the Executive Director for the African Center for Global Health and Social Transformation(ACHEST), Prof. Francis Omaswa while giving a keynote address on universal access to reproductive health services amidst the COVID-19 pandemic. This was at the annual meeting of the Network of African Parliamentary Committees of Health (NEAPACOH) held virtually on October 28 – 29, 2020. The meeting was hosted by Partners in Population and Development and the African Institute for Development Policy.
Prof. Omaswa began his presentation with his famous quotation, “ Health is made at home. Be clean and eat well and do not share accommodation with animals,” which used to air on the radio in the early 2000s when he was Director-General of Services at the Ministry of Health.