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Tuesday, April 25, 2017

From Russia With Love; Uganda Nuclear Power Plant

By Esther Nakkazi

On April 19th, the leading Uganda daily newspaper, The New Vision carried on its front page a story ‘Russia to build Nuclear plant for Uganda’. The story went ahead to state that talks about the project are in the final stages.

When I read the story I was did not react much but an expat in energy and infrastructure from Holland hung onto the story and was perplexed. He asked me about the Chernobyl disaster and I knew nothing about it but read about it.

The Chernobyl disaster occurred in April 1986 and is recorded as the most disastrous nuclear plant accident in history. It spilled over the whole of Europe and was costly in terms of cash and casualties. And its still consuming money and causing damage to humans and wildlife.

We could say that the Russians learnt a lot since then and they are the best country to teach us on how to avoid a similar scenario read ‘disaster’ but there are some issues that are so ‘Ugandan’ I do not know that Uganda can handle nuclear technology, which requires the highest level of safety.

If you travel on Ugandan roads and watch our construction industry with buildings collapsing half way and killing workers, you clearly understand that safety is not an issue in Uganda. For the Chernobyl disaster to happen there was an among other things an overlap in safety.

If Uganda has to go ahead with this project there some key questions; who will own the nuclear plant? Is it Uganda or Russia?. If it is Uganda do we have the money to sustain it for hundreds of years after the Russians leave. We must be aware that it continues to eat money even when it generating no money at all. 

The plant will generate radio active waste, which is harmful to people and the environment. Do we have the capacity to handle such waste which causes cancer if it is not well managed?

Where will the it be built? It has to be build near water because it operates with pressurised water, generates steam and needs water for cooling. So I suppose it will be on Lake Victoria or River Nile, all water bodies shared with other partner States. The politics of that will be interesting to watch?

Nuclear energy is good so don’t get me wrong. It is the cheapest form of energy and is carbon-dioxide free during production. You can also use its radiation to treat cancer.

But its also the highest level of technology and requires discipline and maximum level of safety, which at this point I am afraid to say Uganda does not have. So hopefully the Uganda Ministry of Energy officials who are okaying this project have the capacity to question some of these issues and others that I may not mention here before the project takes off.

Wednesday, April 19, 2017

Stellenbosch University Software Donation troubles Makerere

By Esther Nakkazi

Makerere University will upgrade or all togather overhaul its system responsible for storage of administration, finance and student data, officials said.

The International Tertiary System (ITS) that integrates finance, human resource and academic data was brought in to Makerere from Stellenbosch University about ten years ago. It was a donation costing about $700,000.

However, Makerere University officials say their staff in the academic Registrar’s department who have already been arrested, allegedly tampered with the system which, caused a delay in issuance of transcripts to students who graduated in February this year. But some sources say this is not the case.
The staff also allegedly altered students’s marks and listed some 58 students into the 67th graduation booklet. Makerere administration has been apologising to the affected students and promised quick action.

Now the University wants to upgrade the ITS, which is unique and was tailor-made for Stellenbosch university, and has also since become obsolete.

“We have been operating a system purchased from South Africa but it is now obsolete that is why some unscrupulous staff managed to beat it. So we shall either upgrade it in the medium term or buy a new system,” said Prof Barnabas Nawangwe, the deputy vice chancellor in charge of finance.

Prof Nawangwe explained that either decision would rely on the cost but only if they failed to agree on upgrading the ITS with a new version would they buy a new system.

When Makerere administration realised that there were anomalies on the 67th graduation list, they halted the issuance of transcripts which affected over 14,895 students.

Prof John Ssentamu Ddumba, Makerere University vice chancellor, instructed the IT team to clean up the system and ensure that it is not tampered with again.

In mid March, Mr. Alfred Masikye, the academic registrar wrote to all university stakeholders alerting them on a temporary shut down in processing transcripts which alarmed the recently graduated students who wanted their transcripts for either further studies or to apply for jobs.

According to Masikye’s communication the university management had discovered that names of 58 students had their marks altered and henceforth withdrew them pending further investigations.

Press reports show that as early as 2015, Makerere withheld about 14,000 students’ transcripts until they verified their results. Prior to that incident, in 2008 a meeting had noted that the ITS was insecure and ill functioning.

A source who did not want to be named told this reporter that since inception, the ITS has always had major flaws and was incompatible with Makerere University.

One of the reasons is that the ITS was never configured to Makerere’s requirements but implemented the way it was working at Stellenbosch University, the source said. “It was like do it here as you did it there. It was also a donation and the administrators could not refuse it.”

Stellenbosch University and Makerere University have major variables. As a software that was tailor-made to Stellenbosch, its failures or repairs meant calling someone from South Africa, which was costly, the source said.

She said the two universities with major differences could not be aligned to fit the ITS at Makerere. For instance while the ITS was using the calendar year in Stellenbosch, Makerere uses an academic year so data inout and storage was a challenge.

Makerere university, as its legacy, has always registered students using registration numbers but the ITS system uses a ten-digit student number. When this anomaly was realised the Makerere administration started issuing student numbers on top of the registration numbers to fit the system.

Users at the administration level complained and they requested that one of numbers be dropped but Makerere had to keep its legacy of registration number so both of them were maintained causing more chaos.

The other issue is that the ITS would allow students to register online only after paying at least 60 percent of the tuition fees. The way the ITS was modelled is that it would automate registration with that data input from finance and enable the student to register.

Since Stellenbosch University is a state-subsided most of its students would have no problem with that requirement but Makerere has been in running battles with students to pay their school fees on time. 

However, another source who also preferred anonymity says the students results management system responsible for input, storage and administration of student marks and production of transcripts was locally designed.

He said Makerere is just not saying the truth about the problem and not effectively managing issuing of transcripts to graduated students on time.

Makerere University officials, however said the two were aligned so the locally made system, which was tampered with by its staff was aligned to the ITS and students records would be imported into it. But the matter would soon be resolved.

Ends.  

Monday, April 3, 2017

Ebola Vaccine induced longest reported immune response

By Esther Nakkazi

An investigational “prime-boost” Ebola vaccine regimen, induced a durable immune response in 100% of healthy volunteers over one year, the longest duration follow-up reported researchers said.

The data was reported in The Journal of the American Medical Association (JAMA) on 14th March. The Phase 1 study is the longest duration follow-up reported for any heterologous prime-boost Ebola vaccine regimen.

This follows recent evidence of the persistence of Ebola virus in bodily fluids and the potential for sexual transmission among Ebola survivors, which reinforce the urgent need for a robust and durable vaccine for the disease.

“The world needs a vaccine to help prevent or mitigate future Ebola outbreaks, and ideally it should provide sustained protection for at-risk populations,” said Paul Stoffels, M.D., Chief Scientific Officer, Johnson & Johnson in a press release.

Janssen’s investigational Ebola vaccine regimen was developed in collaboration with the National Institutes of Health (NIH). The regimen is based on Janssen’s AdVac® technology and MVA-BN®technology from Bavarian Nordic A/S. Johnson & Johnson’s partners in the Ebola program also include Europe’s Innovative Medicines Initiative, the London School of Hygiene & Tropical Medicine, Inserm, and BARDA.

In the Phase 1 study, led by the Oxford Vaccine Group at the University of Oxford, UK, healthy volunteers were given one vaccine dose to prime their immune system and the alternative vaccine to boost their immune response.

The Phase 1 study enrolled healthy participants aged 18 to 50 years. Of 75 active vaccine recipients, 64 attended follow-up at day 360, the latest time point analyzed. No vaccine-associated serious adverse events were observed from day 240 to day 360. All of the active vaccine recipients maintained Ebola virus-specific antibody (immunoglobulin G) responses from the first post-vaccination analysis conducted through to day 360. 

Dr Matthew Snape, Chief Investigator of the study reported that this is the longest duration follow-up for any heterologous prime-boost Ebola vaccine regimen yet published. 

Phase 1, 2 and 3 studies are ongoing to confirm these findings.

A total of 10 clinical studies are being conducted on a parallel track across the U.S., Europe and Africa in support of potential eventual registration for the Ebola vaccine regimen. The first study of the vaccine regimen in a West African country affected by the recent Ebola outbreak began in Sierra Leone in October 2015.

In September 2016, Janssen completed a submission to the World Health Organization (WHO) for Emergency Use Assessment and Listing (EUAL) for the investigational preventive Ebola prime-boost vaccine regimen. 

Janssen in partnership with Bavarian Nordic rapidly scaled up production of the vaccine regimen and now has approximately 1,800,000 regimens available, with the capacity to produce several million regimens if needed.
ends

EU funding to combat illegal fishing on Lake Victoria

Fisheries Managers from Uganda, Kenya and Tanzania



















By Esther Nakkazi
The European Union (EU) will contribute 100,000 Euros to improve monitoring, control and surveillance of Lake Victoria to combat illegal, unreported and unregulated fishing. More funds are expected from partner states.

The EU funds to be available for eight months from April to November 2017, will be managed by the Lake Victoria Fisheries Organisation (LFVO) and given to SmartFish one of the largest regional Programmes for fisheries in Africa.

At a regional consultative meeting held in Entebbe (28-29th March), fisheries managers from three partner states that share Lake Victoria of Uganda, Kenya and Tanzania agreed on a joint action plan.

The fisheries managers agreed to carry out joint patrol activities, registration of fishers, enforcement and support to comply with licensing, marking licensed fishing boats as well as creating awareness and encouraging voluntary surrender of illegal fishing gears.

“Pooling of assets, information and knowledge between different countries enables countries to share surveillance and control of fishing,” said Fanjanirina Jérômine, IOC-SmartFish monitoring, control and surveillance (MCS) Assistant.

Patrick Kimani the Kenya regional representative IOC-SmartFish said there is need to sustain MCS activities being undertaken although inspite of these illegal fishing on Lake Victoria persists.

Paul Okware the acting assistant commissioner in charge of regulation and control at the Uganda Ministry of Agriculture, Animal industry and Fisheries said illegal users use strange illegal methods and gears, they have increased catching and trading in immature fish and in the meantime harmonising all agencies in enforcement for all partner states has become a nightmare.

Fisheries situation in Uganda:

Lake Victoria partner states now all have different standards especially after Uganda in November 2015, suspended all operations of Fisheries Officers, Beach Management Units (BMUs) and police pending reforms.

But prior to this there was harmony as fisheries management in Uganda, Kenya and Tanzania was on a single spine command. By 2004, co-management, BMUs and other institutions were formed.

In Uganda, with time these did not function well as parallel and uncoordinated enforcement systems and officers emerged who pushed the technical officers and BMUs to the side lines thus causing a gap for fisheries illegalities to escalate.

Uganda’s suspension was announced by the President Yoweri Museveni in November 2015 and he issued a directive requiring fisheries to form a Fish Protection Unit (FPU) led by an officer from the Presidents office and to that effect a Memorandum of Understanding (MoU) was prepared, in the long run the Fish Bill incorporating reforms will be passed.

BMUs were useful to improve and maintain sanitation to meet Fish Quality Assurance and safety requirements, maintain and update registers of BMU and vet fishers to be licensed, provide fisheries catch and marketing data, implement fisheries regulations and management measures at the landing sites as well as develop local fisheries management plans, said Okware.

Museveni also directed that special courts for fisheries be introduced. He abolished importation of fishing gears and announced imprisonment of 7 years for fisheries offenders.

According to Okware over 300 illegal gears were impounded in 2015/2016 and 0.3% vessels are licensed in Uganda waters but if all vessels were licensed and a formidable enforcement was in place, Uganda would collect Ushs 5 billion annually.

Godfrey Monor, the executive secretary LVFO said it was awkward that only 0.3 vessels are licensed by Uganda because it creates a situation of ‘free for all’ which is not healthy for an ecosystem.

But the meeting heard that licensing in Uganda is also used as a management tool, more like the less the licensing the more the fish stocks will grow.

Uganda has also introduced a mobile licensing system and TradeMark East Africa will soon train fisheries people on e-licensing system.

Kenya and Tanzania Monitoring, Control and Surveillance status report;

In the Kenya waters, according to the 2016 frame survey, gill-nets increased by 2% from 188,984 in 2014 to 192987 in 2016 of these about 40% are undersize or illegal; monofilaments increased from 58 in 2004 to 20,842 in 2016; beach seines increased by 24% from 724 in 2014 to 901 in 2016.

The number of fishers increased by 9% from 40133 in 2014 to 43,799 in 2016; boats increased by 7% from 13,402 in 2014 to 14365 in 2016. Over 300 illegal gears were impounded in 2015/2016 and they are in the process of boat registration to give specific identities to crafts then licensing to will commence.

This comes at the backdrop that Kenya since the inception of the devolved system of governance no meaningful MCS has been done as well there is little information exchange between counties and national governments.

Meanwhile, Tanzania has the highest MCS activities compared to Uganda and Kenya on Lake Victoria. For instance for the period January 2016 to March 2017, Tanzania patrols resulted into confiscation of 19,250 beach seines, 3,171 undersize gill-nets, 9,459 monofilaments, 44 dagaa nets, 84,140 kgs of immature fish and apprehension of 777 culprits.

In Tanzania, fishing vessel licensing is done by a competent authority in collaboration with BMUs. According to the frame survey report 2016, the total number of fishing crafts operating in Tanzanian waters were 31,773.

A total of 18,452 or 58.07% of the total Fishing Crafts are registered and licensed, the highest number on Lake Victoria.

Way forward for MCS on Lake Victoria;


The meeting heard that inspite of all activities including joint regional patrols by partners states on Lake Victoria there is increased illegal fishing as well as catching and trading in immature fish.

Susan Imende deputy Director at Ministry of Fisheries Development Kenya said fisheries managers have to think ‘outside the box’ as illegal users are ahead of them which is pushing down fish stocks and while joint regional patrols could be effective and are a normal procedure the arrested fishers say they are being harassed.

Samson Abura the LVFO Communication Director said this time it should be ‘ business unusual’ and suggested a data base for MCS operations and IUUs to be set up as well as a good plan to show partner governments what is being done.

However, Monor from LVFO was skeptical about sustainability and if suggested activities would create any change. “We have done many activities but get the same results. We shall first increase the appetite of illegal fisheries but what happens after November?,” he asked after the EU funds are used up.

“This is like a ‘knee jack reaction’ because the funds are available. Will it be sustainable and have effective outcomes?” wondered Monor.

ends

Tuesday, March 21, 2017

Government can cheaply realise girls pads pledge

By Esther Nakkazi

When he was campaigning for re-election of Uganda’s top job in 2015, candidate Yoweri Museveni promised free sanitary pads for all school girls under the Universal Primary and Secondary Education (UPE/USE) programs that were started by his party, the National Resistance Movement (NRM).

It was an election pledge he made while on his forth leg of the campaign trail in northern Uganda. “Girls should not have to run away from school because they are embarrassed. We will get them what to use,” said Museveni. But he has not made good on this campaign promise.

He was re-elected in 2016 and he named his wife Janet Kataaha Museveni on the new cabinet as the minister of education and sports who in her capacity is supposed to make this happen.

But now a year later, Mrs. Museveni stunned the nation while speaking to the parliament education committee when she honestly said there are no funds to provide free sanitary pads.

I think the incident would have largely passed as any parliament news item until Dr. Stella Nyanzi  put out a provocative post that rocketed around the internet.

Nyanzi said her own mother provided her with ‘Lilia’ pads to protect her dignity and hygiene meanwhile of Mrs. Museveni who asked parliamentarians to understand that there is no funding, she   dismissed as ‘no mother to the nation’.

“I should visit her without protection during my next menstruation period, sit in her spotless sofas and arise after staining her soul with my menstrual blood! That will be my peaceful demonstration in solidarity with Uganda’s poor adolescent girls,” Stella wrote.

Her demonstration continued with setting up a ‘gofundme’ and an online campaign for free pads. In the schools were she has been girls received free pads while singing and dancing to Stella’s self composed ‘pad lyrics’ which goes like “I have a pad.… I put it here.. I pepeya.”

The Ministry of education has since put out a circular not to allow Nyanzi and activists into government aided schools. Private schools are also monitored.

In my opinion, Nyanzi has given menstrual hygiene visibility. Many people may not like her choice of words but at least the message was sent home and hopefully government will full-fill its pledge.

It is true that candidates may make promises to the public to win over votes but in his case, Museveni was an incumbent and knew that forking out Ush16bn annually to provide free pads was unsustainable but a promise is a promise so let him manoeuvre.

Well, menstrual hygiene management was our topic of discussion at the 18th science café organised by the Health Journalists Network in Uganda (HEJNU) in partnership with Reach A Hand and supported by UNFPA Uganda.

In our discussion at the café we talked about the need to emphasise hygiene while talking about menstruation. I like what Nyanzi wrote; “My mother provided pads in order to protect my dignity and hygiene. I excelled at school although I was a menstruating girl.”

To emphasise it further, Dr Edson Muhwezi, the country Assistant Representative UNFPA said it should not only be the aspect of the pad but also the soap, availability of water and education.

A typical girl without access to modern pads lives in a rural setting, sleeps on the floor, for her it is a taboo to talk about pads in public, she uses a cloth which she washes and cannot even dry in direct sunlight. So it dries but not thoroughly and thus has moulds which cause candida and itching. That is unhygienic.

She is also afraid to go to school and will be absent. Studies have shown that early pregnancy and menstrual hygiene are leading causes of school dropout for girls. A study conducted by IRC and SNV in 2012 estimated that close to 4 million Ugandan girls live without proper sanitary care. As a result, 1 out of 10 girls skips school or drops out entirely due to a lack of menstrual hygiene.

Godfrey Walakira from the youth organisation, Straight Talk Foundation told journalists at the café that it was important to make boys and fathers part of the menstrual hygiene conversation. For isn’t it boys who tease the girls and also make it impossible for them to go to school? While fathers buy pads for their daughters.

Another idea Walakira proposed was to include pads as a mandatory on school items for all girls. After all they ask for all sorts of things; cement, brooms, razor blades, beds, basins.. This should be in the short term as Museveni manoeuvres to fullfill his pledge.

When girls have sanitary wear they are empowered psychologically and they gain self confidence said Sophia Grinvalds, the Founder and Director, AFRIpads (U) Ltd.

They also create equal opportunities for the girls. Let us do the maths. A school term has three months, for each month a girl experiences menstruation for one week. Without pads the girl will miss school for 3 weeks in a term totalling a month of the school term. How then do you expect her to compete with boys?

Even if the government does not offer expensive pads there are cheap alternatives like the Ugandan-made Makapads and AFRIpads which are also reusable and their deluxe kit of 4 pads which costs Ushs 16,000 can be used for a year and the test kit of two pads costs 6,500.

The Afripads are thus durable, cost effective, logistically easy to distribute, ultra absorbent and made of fabric so no burning or itching effect, eco-friendly since they do not require regular disposal and a perfect solution for menstrual hygiene, explained Grinvalds. Many girls are using these in refugee settlements.

So since there are cheaper alternatives which are sustainable surely government can full fill its pledge. It is a good gesture that translates to democracy too. Dr. Muhwezi said non profits shall continue to do their part because at the moment UNFPA has partnered with AFRIpads and Straight Talk Foundation to distribute free pads but it is a concerted effort.

With government as a player in menstrual hygiene, better, broader and faster outcomes for the girl child will be realised. Menstrual hygiene management will be a priority and institutionalised in Uganda. That is not so difficult come on!

Thursday, March 9, 2017

African Media Can Move Beyond Risk in Biotech Reporting

By Esther Nakkazi

An image of an injection into a juicy tomato 'tomato syringe' or a huge cabbage with an elephant body are the most common illustrations used by the media on biotechnology stories.

Its dramatic, catchy, appealing and all about ‘hey-stop-pay-attention’ but can also be the opposite.

So the cabbage can have an elephant gene, yes it can because basically biotechnology involves movement of genes of interest.

These illustrations depicting biotechnology were first published in 2000 and have persisted much to the frustration of scientists, science communicators and not-for-profit organisations like ISAAA or the International Service for the Acquisition of Agri-Biotech Application which continuously tracks such stories and images.

“It gives the impression that scientists are injecting things into crops which creates fear, anxiety, outage and mistrust,” said Dr. Margaret Karembu an environmental scientists from ISAAA who said they have even written to the media houses that continue to use these illustrations to no avail.

She was speaking to media practitioners at a COMESA/ACTESA communication training on biotechnology and biosafety held in Addis Ababa, Ethiopia from 7th to 9th March 2017.

I can best describe it as the media wanting to keep biotech dramatic pictures, illustrations and stories while scientists want facts only. The India suicide story of BT cotton still continues to make rounds alarming people in African and not much is done to explain that these happened due to borrowers failing to pay their debts and it was thoroughly investigated.

The groups on either side of the debate are not very helpful as each feed exaggerated messages to the media that is not well trained. But Dr. Karembu maintains that even those pulling these technologies downward or disagree should argue from an informed point of view.

For the African media, of course minus South Africa, which is ahead of the pack in biotechnology, this reporting might be inevitable. After all, uptake of the technology is at snail-speed. The media can only move in tandem with upcoming laws and research as well skeptics seem to override the contest with the limited public knowledge.

But Dr. Karembu is still unhappy that the African media still depicts biotech as a foreign technology, that those illustrations show monsters trying to dump things in Africa yet more and more African scientists have been trained on biotechnology.

With this pool of trained African scientists, however, a few try to preach the biotech gospel some get disappointed after spending long hours with reporters only to get foot notes in controversial stories.

Biotech stories have to compete and if not relegated to science pages or publications are used as fillers in daily media. Writing them as ‘she-said-he-said’ without much analysis and investigation does not make them popular either.

ISAAA has noted that the African media continues to hype the risk factor alarming publics and not explaining the technology enough. I must say going beyond portraying biotech as a myth, mystery, superstition will take a while for the African media just as interchanging the terms GMOs and biotechnology continues.

Dr. Getachew Belay a plant breeder from COMESA/ACTESA says the word ‘hazard’ makes him uncomfortable in African biotech stories but how risk is overplayed and perpetually communicated remains bizarre to him. All technologies have risks and benefits - the balancing of the two sides alludes the media.

Biotechnology may be used in various industries including pharmaceuticals, but it is particularly controversial in agriculture because it is what we eat. That not withstanding it is a highly regulated technology with rigorous safety assessment.

It does not help that biotech terminologies have no local language translations yet community radios keep mushrooming everywhere in Africa and the farmers tune. But ISAAA has scientists who have been trying to define and find local dialect meaning for biotech terms.

But this it is not as fast as how science is developing and whose work is it anyway? “ You need a strategic approach,” said Dr. Karembu who links these stories to the African victim mentality, which delays grabbing of opportunity and fails to separate politics from technical issues.

“Encourage more of dialogue than debate. Shed off that mentality so you are not victims of the technology,” she said but it easier said than done and especially with writing biotech.

Nixon Ngang’a a science editor at Citizen Television and biotech media trainer said he would still use the illustrations to catch the attention of a six year old and his grandmother. Isn’t that what communication is all about anyway - visual attraction.

But he is quick to defend using these images. ‘It is not malicious. We want to catch attention of the audience,” he said.

I must also say that the narrative is changing albeit gradually. The African media has come a long way in reporting biotech. It is improving as some journalists exclusively becoming science journalists like me but the biotech trainings remain are far in between and some scientists remain media shy.

But we shall get there as the pool of more African journalists and trained on biotech and better pictures and illustrations are made available.
ends

Thursday, February 23, 2017

From Village to Community Health Workers Uganda hopes to achieve health SDGs

By Esther Nakkazi

Uganda had an outbreak of Ebola Hemorrhagic Fever in 2000, there were deaths but it was also largely contained. At the time the Director General at the Ministry of Health was Prof Francis Omaswa.

Using this example at the first international symposium on community health workers ongoing in Kampala, Omaswa said what helped to not turn the outbreak into a catastrophic event like what happened in west Africa was among others village health workers.

Communities listened to village health workers who helped to disseminate information but the most important ingredient here was trust.

For 16 years now, Uganda has engaged Village Health Teams (VHTs) but it will this financial year 2016/ ending June 2017 switch to Community Health Extension Workers or the CHEW strategy.

The symposium is convened by Makerere University College of Health Sciences, School of Public Health, Uganda in partnership with Nottingham Trent University, UK and Ministry of Health, Uganda. Dr. David Musoke is the symposium chair and its theme is community health workers and  their contribution towards Sustainable Development Goals (SDGs).

Switch from VHT to CHEW strategy;

There is no doubt as to the positive contribution towards promotion of health, community mobilisation and helping to contain disease outbreaks made by VHTs in Uganda. But 16 years after their existence, 75% of the disease burden in Uganda, which is preventable persists and the top 10 killers are still the same.

So could it be that the VHTs strategy is wrong, was it a 'cut and paste' or it just needs an overhaul? Well, the government is now moving to the CHEW strategy. This does not mean that VHTs will disappear, no they won’t.

VHTs will remain with their role of community mobilisation and some will be absorbed into the CHEW system said Dr. Christopher Oleke at the health workers symposium.

Currently, Uganda has 180,000 VHTs working as volunteers but only 60,000 have been trained. With lack of monitoring, supervision and accountability these have been engaged in an unharmonised and uncoordinated structure.

One of the challenges with VHTs has been the supporting partners who have been messy as each trains their own VHT. Imagine this scenario; in one parish a partner trains a VHT to distribute bednets and check for malaria, another one is trained to preach nutritious feeding, one looks out for pregnancy problems, another is trained to encourage delivery in health centres etc.

So the interventions are not bad and by the way they have produced some visible results as in the case of Kanungu district in south Western Uganda where they have improved maternal and new born health outcomes but the governance and lack of leadership among supporting partners has created chaos rather than progress.

You cannot blame partners entirely, the voluntary role can carry only so much responsibilities. But some VHTs are working 7 days a week for long hours and are untrained.

So Uganda wants to fix it. The CHEW strategy will engage only 15,000 health workers. They have to be between 18-35 years and with a minimum education to qualify. They will be paid a salary by the government and get regular training. Their roles will be defined among them conducting baseline and other important surveys.

As Prof Francis Omaswa put it, ‘they should not be the big doctors in the villages’, anymore so they will be monitored, supervised and supported through a proper governance structure. “They should not be left in isolation,” he cautioned.

But most importantly, the CHEWs will 'reorient' the minds of Ugandans towards healthy living. How? According to Dr. Oleke many Ugandans think that having medicines in health facilities and doctors equals to good health.

The CHEWs will focus on the household as a totality promoting good hygiene, standard health practices like immunisation and most of all promote the use of less alcohol which is causing Ugandans numerous health issues said Dr. Oleke.

They will also play an important role of registering all pregnant women and new borns electronically who will be followed through the system - that way Uganda hopes to improve the mother and new- born well being.

The CHEW strategy will have a strong monitoring, supervisory, accountability and will be under a harmonised structure said Dr. Oleke.

Innovative financing for health workers;

But there are cautionary voices and suggestions before the roll out begins this financial year. Dr. Elizabeth Ekirapa from the School of Public Health warned this should not create a parallel administrative structure instead they should be integrated within the national health care system.

Ekirapa also said the CHEW strategy should be sustainable and be home grown or customised to Uganda. It copies a lot from Ghana and Ethiopia CHEWs.

Dr. Patrick Kadama from ACHEST was concerned about the financing structure, which if not well thought out might distort equity. It comes amidst Uganda trying to create a national social health care insurance scheme and other tax based systems.

Dr. Kadama also thinks the CHEW strategy implementers should ensure good returns on the investment thus a specific investment case should be done before roll out. They should also ensure that the CHEWs boost primary health care.

Concurring with everyone else he said the CHEWs should work in tandem and in sync within a defined national health care system - read - ‘not in isolation’ and the roll out should be gradual. Talk about the best of the best but let us wait for implementation. 

ends