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.

PRO OMASWA SPEAKING AT THE WORLD HEALTH SUMMITACHEST Executive Director Prof. Francis Omaswa has urged external partners to support research that responds to the needs of the local population.

This, said Prof Omaswa, would be through working with the mandated national organisations and civil society, whose mission is aligned to the development goals of the particular countries.

“All countries have development plans, with a research component in it and they have research coordinating bodies in the country. If we work with mandated national research organizations and inspired civil society organizations which speak for the people, the funding would be directed to more strategic areas,” said Prof. Omaswa

“Knowledge generation should be about the people – responding to the needs of the people. If the research generators are in sync with the people, the politicians just become a rubber stamp, if they want to be elected. The real issue here is that whatever research we are doing, what connection does it have with the quality of life to the people,” stressed Prof. Omaswa
He made the remarks during a panel discussion “Multi-Stakeholder Collaboration in Global Health Research” at the World Health Summit 2020.

Pro.f Omaswa was the chair of the Health Workforce sessionThe African Center for Global Health and Social Transformation (ACHEST) participated at the 2nd Uganda UK Health Alliance symposium held virtually on October 22, 2020.
The symposium is a platform for governments, institutions, and individuals to share expertise and opportunities on building capacity in global health to address existing demands and emerging public health challenges. It was held under the theme “Towards Universal Health Coverage: Building Global Health Capacity for a better decade.

Discussions focused on the progress towards UHC 2030 in the context of the ongoing COVID 19 Pandemic.
The ACHEST Executive Director, Prof. Francis Omaswa chaired a session on the health workforce challenges and collective action that should be taken by countries. He recalled that the last conversation with members of this group was about recruitment agencies.
He noted that during the pandemic, the difficulties faced by the health workers include fatigue, lack of Personal Protective Equipment (PPE), and allowances “which take long to come or don’t come at all.”

ACHEST’s Director of Non-Communicable Diseases and Healthy Ageing Dr David Okello has called for the need for public education and awareness on ageing as a natural process.

While making a virtual presentation on “Ageing Societies; Implications for Uganda” to the Rotary Club of Kampala on October 29, 2020, Dr Okello noted that it was important to promote the behaviour of better ageing, in order to address possible challenges that could affect the future senior citizens.

“Ageing is a natural process and part of life, with clear pathways from the womb to the tomb. What we do earlier affects us later in life. The relatively young population in Uganda should be encouraged to start now to plan for later years in life,” remarked Dr Okello.
Old age is defined by the United Nations as a person who is over 60 years of age. Global projections show that the world is ageing. Almost 700 million people are now over 60, and in 2050, there will more persons over 60 than children in the world.

Dr Okello noted that population ageing constitutes one of the most significant demographic transformations of the21st century.
In Uganda, life expectancy in 2020 is estimated at 64 years. The cohort of the current predominantly young people is predicted to grow and become older persons with rapid population ageing.

It is a huge milestone for Uganda’s health sector.

The country has launched the National Community Engagement Strategy (CES) for COVID-19 response.

The strategy seeks to ensure that all people in Uganda are aware, empowered, and activelyPrime Minister Dr. Ruhakana Rugunda speaks as Prof. Omaswa and Dr. Moriku looks on participating in the prevention and control of the outbreak of COVID-19 as both a duty and a right; using existing structures, systems, and resources.
It is premised on the principle that good health begins with individuals, their households, and communities.

The strategy will be rolled with immediate effect, starting with the COVID-19 hotspots in Kampala City and the border districts. It comes as the country is dealing with Phase IV of the pandemic. More than 10,691 cumulative cases and 90 deaths had been registered as of October 20, 2020.

If well implemented, the initiative would automatically have a ripple effect even long after COVID-19 -- by strengthening Uganda’s health system, achieving the Sustainable Development Goals(SDGs) and Universal Health Coverage (UHC); while at the same time institutionalizing the Intersectoral Collaboration and the Whole of Society approach.

Launch of the Community Engagement Strategy The strategy, endorsed by Uganda’s President Yoweri Museveni, was officially launched on October 20, 2020, by Prime Minister Rt. Hon. Dr. Ruhakana Rugunda.
Also in attendance were: Deputy Prime Minister Moses Ali, State Minister for Primary Health Care Dr. Joyce Kaducu Moriku, State Minister for Primary Education Rosemary Sseninde, State Minister for Defense Rtd. Col Charles Okello-Engola, Kampala City Council Authority Executive Director Dorothy Kisaka, among other officials.

In his address, Dr. Rugunda gave a chronology of high-level engagements between the National Task Force on Covid-19 and the Head of State that led to the formation of the strategy. Notably, the Technical Intersectoral Committee (TISC) was formed to enforce implementation efforts, and a Community Engagement sub-committee chaired by ACHEST’s Executive Director Prof. Francis Omaswa was formed to draft the Community Engagement Strategy (CES) and implementation arrangements. The diverse sub-committee comprises of key players from different government agencies. Civil society representatives from ACHEST and Red Cross Uganda are also on board.

Some of the officials and ministers who attended the CES launch pose for a group photo“We are formally calling upon and handing over ownership and responsibility to individual Ugandans, to control this pandemic. We are giving power to the people to defeat COVID19 by ensuring that the virus will not spread among them; that they are each other’s keeper”, said Dr. Rugunda.
He expressed optimism that the full implementation of the Strategy will institutionalize integrated People-Centered Primary Health Care (IPCPHC) as defined in the Alma Ata Declaration of 1978.
“Through this approach, Uganda’s health system will be much better, even after the pandemic,” he stressed.

The Prime Minister particularly applauded the Ngora District Local Government IPCPHC model as a good example of what happens when communities take charge of their lives. The project that is currently being implemented by ACHEST has seen improvements in the indices in hygiene, immunization, antenatal care among others.
“Early lessons in Ngora show how quickly lives get better when communities are in charge. The centrality people play is important. Do not wait for the Ministry of Health wherever you are. Be bold. Follow the SOPs for COVID19 prevention,” said Dr. Rugunda

Prof. Omaswa described CES is a major milestone in the history of health development in Uganda. It has been a long journey coming from 1987 when the Raphael Owor Commission, appointed by the then Health Minister Dr. Rugunda recommended community mobilization as the center of the health system in Uganda.
Prof. Omaswa stated that this was also an opportunity to implement to scale the existing multi-sectoral community health plans articulated in the National Health Policy and Strategic Plan launched over 20 years ago. “The return on investment will be much higher if people take charge of their lives.”

The State Minister for Primary Health Care Dr. Joyce Moriku Kaducu highlighted the importance of the country building on past experiences in fighting epidemics like Ebola and HIV. She committed full support from the Ministry of Health.

The Chairperson of the Technical Intersectoral Committee on COVID-19 Major Gen. GeoffreyMajor Gen. Geoffrey Muheesi Dr. Moriku Prime Minister Ruhakana Rugunda and Prof. Francis Omaswa Muheesi said the lead enforcers of the strategy will be the Village Health Teams (VHTs). They will maintain health registers and work with schools, cultural and religious leaders, and CSOs. Full-time community health workers will be paid a monthly allowance of 100,000 Uganda Shillings. VHTs will also be provided with necessary tools to do their work such as face masks, soap, sanitizers, thermometer, uniforms, smartphone, umbrella, gumboots, and relevant medical supplies.

Compiled by Carol Natukunda, Communications Specialist, ACHEST

The outgoing Ambassador of Japan Kazauki Kameda paid a courtesy visit to the AfricanACHEST ED Prof F. Omaswa shows his Hideyo Noguchi Africa award to the Japanese Ambassador his Excellency Kazuaki Kameda Center for Global Health and Social Transformation (ACHEST), to bid farewell as he ends his four-year tenure in Uganda.
In a brief address to the ACHEST staff members on October 15, 2020, the Ambassador said one of the highlights during his stay in Uganda was meeting the ACHEST Executive Director Prof. Francis Omaswa, who is the 2019 Laureate for the Hideyo Noguchi Africa Prize by The Government of Japan.
The Prize aims to honor individuals or organizations with outstanding achievements in the fields of medical research and medical services to combat infectious and other diseases in Africa, thus contributing to the health and welfare of the African people and of all humankind.
Ambassador Kameda also stressed that the Japan Government was committed to improving healthcare in Uganda and efforts to achieve Universal Health Coverage. Through the Japan International Cooperation Agency (JICA), Japan has supported infrastructure development and health service improvement at all the 14 regional referral hospitals in Uganda.
On his part, Prof. Omaswa thanked the Government of Japan for the support and collaboration over the years, including giving ACHEST the opportunity to undertake research on maternal mortality in Fort Portal, Mbarara, and Hoima hospitals. The research conducted in November 2019 shows the magnitude of the problem and where support is needed for quality health services.
ACHEST staff pose for a photo with Japanese Ambassador his Exellency Kazuaki KamedaOn a personal note, Prof Omaswa fondly reminisced that the ambassador had been particularly helpful in his preparations and travel arrangements to receive the Hideyo Noguchi Award in Tokyo, in August 2019.
“As an NGO, we have had a close relationship with Japan and Ambassador Kameda and we are grateful that he has been here to facilitate the relationship. That is why we say THANK YOU,” remarked Prof. Omaswa
Compiled by Carol Natukunda, Communications Specialist, ACHEST

Project team and district leaders at Ngora district headquartersThe African Centre for Global Health and Social Transformation (ACHEST) in partnership with the Ministry of Health (MoH) and Ngora District Local Government (NDLG) are piloting a project to implement Intersectoral Collaboration (ISC) for Integrated People-Centered Primary Health Care (IPCPHC), using Whole of Society approach. This pilot project operationalizes to scale the government of Uganda ISC and IPCHC Strategy in which the Village Health Team (VHT) is established alongside the elected Parish and Village Local Council 1 leaders who are responsible for the overall governance of the village. Cultural and Religious leaders and Civil Society are also engaged.

The project is premised on the principle that good health starts with, and is created byThe Village Health Team receive bicyles and other tools to use during the course of the project individuals, their families and the communities; and that individuals have the primary responsibility for maintaining their own health. The VHTs maintain health registers with records of the health status of each individual in the households; and promote and record good health practices, hygiene and health conditions of household members. They also identify, refer and follow-up patients in homes, ensure that immunization, maternal health and other population health needs are addressed.

The six months pilot project from August 2020 to January 2021 is being implemented in five villages of Adul, Obur, Oluroi, Ajeluk, and Okunguro including the Mukura Urban Council; all in Mukura Sub County, Ngora District.

Expected outcomes:
By the end of the project, it is expected that:
1. The communities will be able to own all issues and take charge of the quality of their lives and hold higher level duty bearers accountable.
2. With the increasing spread of COVID-19 infections in the country, this intervention will enable communities to be fully engaged in the response and control measures.
3. Better informed policymakers and budget holders adopt a favorable policy environment and improve resource allocation for ISC and health.
4. Health and other SDG indicators improved.

Image of the webinar flyerAssessing the digital needs and capabilities of students and educators would be one of the ways to ensure that E-Learning takes shape in Africa’s health professions training schools amidst the pandemic, Dr. Elsie Kiguli-Malwadde, Vice President of AFREhealth suggests.

While delivering a presentation on the challenges of COVID-19 and its impact on health professional training, Dr Kiguli-Malwadde, who is the ACHEST Director of Health Workforce Education and Development, highlighted the digital inequalities that both students and faculties are facing during the COVID-19 imposed a lockdown on education.

The webinar, organized by AFREhealth webinar was held on August 7, 2020, under the theme “Preparing for the New Normal for Health Professional Training in Africa Amidst COVID-19"

Dr. Kiguli-Malwadde gave an overview of pre-existing challenges for Africa’s health workforce, which have been escalated further by COVID-19 and the resulting lockdowns that have been instituted by different countries.

“ This has disrupted the training of future professionals. There have been school closures, loss of learning time and it is a challenge for even schools that are open to programme their activities. Those in clinical disciplines face a greater challenge with training in clinical settings,” she said.

A recent World Health Organisation study in 42 countries concerning educational institutions generally found that schools were open in only 9 countries, while 14 had schools completely closed and 19 partially closed.

Dr Kiguli-Malwadde observed that although a number of schools were trying to adjust to the use of new technologies, the challenges were enormous.

“In cases where ICTis being used for learning, there are challenges with internet connectivity and where there is connectivity, even getting the data is a problem. Some don't even have laptops, or access to computers especially when schools closed and students had to go back home. Many do not have access to devices,” said Dr. Kiguli-Malwadde.
She also told the webinar that in a random survey done by AFREhealth on E-Learning, only 4 out of 17 universities surveyed had zoom licences, while only 3 had learning management systems. Asked how they were managing, only 7 of them were using online platforms such as zoom, Go-meeting, MS Google teams, Whatsapp and Skype.

The Executive Director of the African Center for Global Health and Social Transformation (ACHEST), Prof. Francis Omaswa has challenged nurses to be involved in promoting and implementing integrated people-centered Primary Health Care (PHC).
This, Prof. Omaswa stressed, would make them leaders and at the same time enable the country to achieve Sustainable Development Goals (SDGs).
“I want to advance one opportunity that we can assign to nurses to take leadership in transforming the health of the people of Uganda. In integrated people-centered Primary Health Care, there is a tremendous opportunity for nurses to become the leaders and to me it is the quickest way to achieve SDGs I really would like to champion this. Nurses have skills as Home Visitors, and as Community Nurses which make them well placed to lead in PHC. If we do that, we will be on our way to build a strong and excellent contribution to strengthening health systems,” said Prof. Omaswa
He noted that Uganda had structures in place to ensure everyone is reached by the health system.
“We just need to use them. We have policies and structures in the district health systems in Uganda. They have very clear roles for nurses and we just need to prepare people to play those roles and be practical with home grown solutions,” said Prof. Omaswa
He made the remarks while speaking at the National Health Care Conference for Nurses and Midwives held virtually on August 22, 2020. The conference was held under the theme, “2020 The Year of the Nurse and Midwife,” as designated by the World Health Organization to celebrate and increase visibility of the work of nurses and midwives.

Integrated people-centered Primary Health Care approach will help African countries to achieve Universal Health Coverage (UHC), said Prof. Francis Omaswa, the Executive Director at the African Center for Global Health and Social Transformation (ACHEST).

“We need to institutionalize health systems which reach households. UHC is about leaving no one behind. But if you want to translate it into practical terms, it is about how the health system can reach all people in the country,” said Prof. Omaswa.

He made the remarks while delivering a keynote address at The 10th Eastern Africa Reproductive Health Network (EARHN) Coordination meeting, organized virtually by the Partners in Population and Development Africa Regional Office (PPD- ARO) on August 12, 2020.
The keynote address was titled, “Sustaining the moment for managing and implementation of reproductive health/family planning, maternal and child health programmes amidst the COVID-19 pandemic.

In his presentation, Prof. Omaswa used Uganda as an example of a country with excellent structures for the health system which goes down to the village level.

“Every village for 2,000 people is expected to have a team of nine people to compose a Village Health Team. One of them should be a Community Health Worker working fulltime who maintain a village health register in which every person in the household is recorded. The health situation of every person is monitored: who is the head of the household, is the mother going for antenatal care, are the children receiving immunization, are the homes hygienic and so on,” explained Prof. Omaswa.

“I would like to advocate for a people centered Primary Health Care which is owned by the people themselves… Your health is your business. It is not the business of the government,” he stressed.

Prof. Francis Omaswa giving his keynote address“The governance structures are in place. They are well designed. But we do not do what we want to do.”

This quote by the ACHEST Executive Director Prof. Francis Omaswa, set the tone for discussion at the 2020 Reproductive, Maternal Newborn Child and Adolescent Health (RMNCAH) Youth E-summit.

The third annual summit was held on August 8, under the theme “Leveraging local government structures to address persistent SRHR challenges and harness opportunities of a young population for national development.”

While delivering the keynote address, Prof. Omaswa stated that the current system was not adequately serving the vast majority of Africa’s youth who have dropped out of school and have no skills.

“We need to do something about the youth and our solution should be tailored for two groups of the youth -- the highly educated, high flying youth in urban areas; and the out of school, unskilled and demoralised youth in rural areas. The latter are just living on their own. They don't see themselves as part of the society. We have a big youth crisis in the country,” said Prof. Omaswa.

He explained that the decentralisation process in Uganda which started in 1997 seeks to take services to the local governments-- or nearer to the people, while the central government focuses on policy formulation, standards setting, resource mobilisation and human resources.
“Implementation of all services were decentralised to the local governments and we need to engage them,” he said.

Prof. Omaswa also gave a detailed elaboration on the governance structures at all levels - from the National Level or Cabinet level, to the District, Sub-county and Community Level.
“This structure is well designed and excellent. It's a question of making things happen. It can reach every home, LC1 and parish chief. If we operationalise this, we will be able to achieve our goals. Let’s work to achieve the targets so that no one is left behind. In Uganda, we have structures which can achieve SDGs and Universal Health Coverage,” stressed Prof. Omaswa

Dr. Elsie Kiguli-MalwaddeThe ACHEST Director of Health Workforce Education and Development, Dr. Elsie Kiguli-Malwadde, has been appointed Vice President of The African Forum for Research and Education In Health ( AFREHealth).

AFREhealth is an independent body that emerged from the Medical Education Partnership Initiative (MEPI) and Nursing Education Partnership Initiative (NEPI) with an aim of nurturing an interdisciplinary health professions organisation that is impactful in addressing Africa’s health challenges.

A new AFREhealth Executive Committee was announced at the Governing Council meeting held via an online zoom meeting on August 4, 2020.

ACHEST’s Dr. Kiguli-Malwadde will deputise the Associate Professor Abigil Kazembe from Malawi, who has been appointed President.

Other members of the Executive Committee are the Secretary, Ms Judy Khanyola (Rwanda); Treasurer, Prof. Milliard Derbew (Ethiopia); Immediate Past President, Prof. Marietjie de Villers (South Africa); and additional members Prof Fatima Suleman (South Africa) and Prof. Nelson Sewankambo (Uganda).

In a statement, Prof. Marietjie de Villiers said the newly constituted Executive Committee takes office with immediate effect.
“Our profound gratitude goes to the out-going office bearers for their dedicated and selfless service to AFREhealth during the past two (2) years. We thank and congratulate the new office bearers for stepping forward to serve AFREhealth in this new role. The AFREhealth community will accord the new Executive Committee our maximum support for taking AFREhealth into an exciting future. Long live AFREhealth!” the statement reads.

Commenting on her appointment, Dr. Kiguli-Malwadde said, “ I am greatly honoured and humbled that the Governing Council has considered me fit for this appointment. I enjoy working with the AFREhealth community, it is based on the African spirit of working together to make life better in Africa.”

For more information about AFREhealth, visit:https://www.afrehealth.org/

IMAGE OF THE FLYER FOR THE INDUCTION COURSE VIRTUALLY HELD ON JULY 10 2020As a young medical student, Prof. Sarah Kiguli says she knew what she wanted to specialise in. She had helped a woman give birth and felt a sense of fulfillment.

The first day as a newly qualified doctor, she was assigned to the Mulago Hospital’s Paediatric Acute Care Unit, where she saw children convulsing or children who could barely support themselves. She was deeply moved, and instantly knew this is where she wanted to be for the rest of her career. After internship, she served as a medical officer for two years and then pursued graduate training in Paediatrics and Child Health.

She has never looked back. “It has been years but I have never left Makerere College of Health Sciences and Mulago Hospital,” she says, “Later, I also did a Masters in Health Professions Education, my second passion”

Today, Prof. Kiguli urges young health professionals to know what their passion is - something that sparks one’s inner desire for the career before choosing their areas of specialisation.

“I sing in my heart and smile when I treat a child and see them begin to sit and eat. Do graduate training in an area which you love, and where there is need,” says Prof. Kiguli

Her story was one of the powerful experiences that medical interns who participated at the recent induction course got to benefit from, as they transition from being students to navigating work life challenges.

The award winning training programme, which has received global recognition at the USAID HRH2030 Health Workforce Resilience Awards, is organised by ACHEST in partnership with Health Professionals Education Initiative (HEPI), Makerere University College of Health Sciences and Ministry of Health.

IMAGE OF THE BOOK“Health is made at home and only repaired in hospitals when it breaks down. Be clean, eat well and do not share accommodation with animals,”
Any Ugandan who was old enough in the 2000s is likely to remember this slogan.
It was contained in the Ministry of Health radio advert to advocate for people-led primary health care as a foundation of health systems.
The catchy phrase “Health is made at home” was invented by the then Director General of Health Services, Prof. Francis Omaswa, who is currently the Executive Director at the Africa Center for Global Health and Social Transformation(ACHEST).
It has been widely quoted by health experts and enthusiasts to emphasise the role of an integrated and people-centered approach to health care that starts with individuals, families and communities.
Fast forward to 2020, “health is made at home” will no longer just be a quotation, but also a title of a recently published book on global health!
The Health is made at home; Hospitals are for repairs book has been published and launched on June 29th 2020 by global health writer, Lord Nigel Crisp and is now available at www.healthismadeathome.uk.

In his remarks during the virtual book launch on , Lord Crisp acknowledged that the title of the book was inspired by Prof. Omaswa.
“The title of the book was invented by my friend Prof. Francis Omaswa over 20 years ago,” he said.