I arrived in Uganda a bit over two weeks ago, and am having a lot of fun so far. The first week my colleague and host here, Catherine Mbabazi, had to travel to Fort Portal for her Aunt's burial. So I went with her and did a safari in Queen Elizabeth National Park where we saw lions, elephants, hippos, crocodiles, boks, wharthogs, monkeys, chimpanzees, and more. It was awesome and a nice start to my time here. I've also made many friends and Kampala has quite the nightlife scene (with many places totally outdoors so very COVID friendly).
Lions (above) and elephants (below) at Queen Elizabeth National Park
In terms of work, there are two main objectives to my time in Uganda. First, I am conducting a survey of district-level officials to try to understand variation in local health systems resilience during the COVID-19 response. Since spring 2020 I worked with Catherine and colleagues to analyze the impact of COVID-19 on the use of essential maternal, reproductive, and immunization services. Using the results from this analysis, we now want to try to see what factors at the local level may explain variation in district ability to maintain these services during the first year of the pandemic to inform future policy and responses to emergencies. In Uganda's decentralized context, districts are responsible for service delivery and implementing guidelines from the national level. So, basically, we want to measure what districts implemented from the Ministry of Health's "Guidelines on continuity of essential health services" and see if that explains any of the variation in outcomes (I.e. resilience). I am basing this off of Professor Tom Bossert's "decision space" framework and he was also nice enough to chat with me about applying his framework to this work (one of my favorite parts of being a PhD student is being able to talk about my ideas with very smart people).
For this project, I am working with Catherine who is a Senior Program Officer at the National Population Council (NPC) within the Ministry of Finance, Planning, and Economic Development (we met back at Harvard in 2018 when she was a Takemi Fellow!). We also have two professors from Makerere University involved and a colleague from UNFPA (formerly at the MoH). I will introduce the team in more detail in a subsequent blog post! For now, I have drafted the survey, sampling strategy, protocol, and work plan, and next steps include piloting the survey and figuring out whether we will physically travel to districts to conduct the survey or administer it digitally through a focal person within the district offices. Since it is a survey, we want to try to maximize our sample size, but given my limited budget, we may need to be innovative in order to get a good sample - we will see how it works out!
To inform our survey and get feedback,
we have also been meeting with several people. So far, we met with Dr. Charles Olaro who is the Director of Clinical Health Services at the MoH and was leading the COVID response in the country. We spoke with him about district variation in essential health service delivery during COVID and he told us that they are currently undergoing a review of the COVID response to see what worked well and what didn't - we hope our study will be useful in this effort.
We also met with Professor Freddie Ssengooba who is the Chair of the Department of Health Policy, Planning, and Management at Makerere University School of Public Health. He has a wealth of experience directly related to our study topic, and he graciously spent over three hours reviewing the draft survey with us and providing feedback.
Me, Catherine, and Prof Freddie discussing the survey draft (above); me outside MUSPH building in Kasangati (below)
The second goal of my time here is to learn more about Uganda's health system and governance context and build connections that will hopefully lead to more collaborations. For this, I am taking advantage of every opportunity to follow Catherine around while she does her work! At NPC, recently they have been traveling to cities to discuss integration of population factors into planning at the local level. I sat in on meetings with the Kampala City Council, and traveled to Mbarara city and Masaka city as well. I also joined a meeting at the National Planning Authority to discuss cross-sectoral issues in budgeting and planning. These presentations and discussions on planning and budgeting processes at national and local levels are super interesting to me. It is clear that there is a lot of room for more data, evidence, and modeling (my area of interest!) to inform planning at all levels.
Some more pictures below!
Me outside the National Planning Authority (above)
Me (above) and the team (below) outside KCCA
Catherine presenting on the demographic dividend at Mbarara city headquarters (above); a stop along the equator while driving to Mbarara City (below)
