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There is an increasing trend toward regionalization as higher education adapts to openness and globalization. In response, East African countries formed networks and partnerships that strengthened business, higher education, student and staff mobility, and research. This is because regionalization is embedded in East Africa's economy, politics, culture, and social norms. In addition, regionalization is influenced by internationalization and globalization. It promises development opportunities, although challenges are inevitable. This paper examines the contributions of regional student mobility to East Africa's development. We use neoliberal and world systems theories to illuminate the advantages and disadvantages of regionalizing higher education and explain how partner states can maximize opportunities and minimize challenges. Data was collected through convenience sampling of two hundred international students and two staff members in international students' offices. Data analysis revealed that the regionalization of East African higher education reflects historical power relations; it has benefits though founded on inequalities.

The 1998 UNESCO World Conference on Higher Education in Paris recommended that global higher education institutions should internationalize and reduce inequalities between developed and emerging countries. Since then, universities strive to incorporate an international dimension in their service. The aim was initially guided by the 20th century understanding of internationalization being just, fair, and an equitable process that promotes peace and mutual understanding. However, under the influence of the General Agreement on Trade in Services and competition, internationalization changed focus and became less inclusive. This paper explores inclusive international education in East Africa using narrative review methodology. Findings suggest that rather than promoting access and equity in higher education, internationalization, for example, excludes economically disadvantaged, disabled, and adult learners. Thus, in addition to internationalization at home, inclusive internationalization abroad strategies should be devised. Internationalization of higher education is more valuable if it translates into fair, just, and peaceful social systems.

Amid a rise of misinformation worldwide, this paper examines digital misinformation literacy as it relates to COVID-19 news in East Africa. The study is grounded in inoculation theory and contributes to the body of scholarship examining misinformation literacy beyond the Western world. Data came from a comparative, cross-national survey in Kenya, Uganda and Rwanda (N = 3,203), making this the largest known empirical investigation into digital misinformation literacy in the region within the context of a pandemic. Paper surveys were distributed throughout all three countries in 2021. The data revealed differences in actual and perceived misinformation literacy levels. Kenyans and Rwandans were better at detecting false COVID-19 statements in the media, whereas Ugandans were better at detecting true messages. Similarly, Kenyans' and Rwandans' perceived levels of digital misinformation literacy were higher than Ugandans'. Regarding perceived exposure to COVID-19 information, Kenyans felt they were exposed to fake COVID-19 news online more often than Ugandans, who felt more exposed than Rwandans. This research contributes to the growing literature on digital misinformation literacy, an area which isn't significantly studied in many world regions, especially in Africa. [ABSTRACT FROM AUTHOR]

Medical education in Africa is in desperate need of reforms, evident in widespread diseases, and an inability to mobilise and train the required medical workforce to deal with these health issues. However, the exponential rise in the use of mobile technologies due to the spread of the Internet and increased telecommunication networks offer an opportunity for the transformation of medical education and practice through the deployment of mobile devices as a medium for learning and conveying health care services to the remote and resource-constrained locations of Sub-Saharan Africa (SSA). This paper reviewed articles on the affordances of m-learning for distributed medical education in SSA published between 2010-2018. Results from 18 articles identified in the review revealed a slow-paced ascendancy of practice and research in the field; it further exposed competing priorities, infrastructural deficit, and chronic workforce shortages as the bane of m-learning implementation in the subregion. This paper makes recommendations that will enhance the growth of mobile-based distance medical education and practice in SSA.

This paper investigates the short and long-term pernicious impact of armed conflicts on education and educational agents (students, teachers and students' parents), using a multivocal review by means of the integration and qualitative analysis of 60 research reports (voices) found in two databases: Web of Science and PROQUEST in the period between 1995 -date of the first founding paper- until 2014. Through the analysis of source data (voices) and taking the "multivocal review" as a method, the voices have been combined in nine categories, namely: a) Refusal and impediments to a return to education; b) Educational infrastructure damaged or destroyed; c) Cuts in or withdrawal of spending on education; d) Loss of the educational and protective functions of the family; e) Loss of the academic community; f) Non-qualified teaching staff; g) Drastic loss of skills; h) Abandoning school (population movements, destruction of networks and social environment); i) Behavioural problems: traumas, pedagogical roles and self-victimization. These categories have highlighted the serious consequences arising from conflicts, infringing as they do the most basic human rights and in particular the right to a sound education during childhood.

Inclusive education is a key strategy in addressing the needs of children with autism and other developmental disabilities in sub-Saharan Africa, who rarely access specialist care or quality education. We aimed to systematically review qualitative research on stakeholder experiences, attitudes and perspectives on inclusive education for pupils with developmental disabilities in mainstream schools in sub-Saharan Africa. We searched five databases and selected relevant studies through a two-stage screening process. We synthesised the papers identified through template analysis of the Results and Discussion sections, guided by the" Consolidated Framework for Implementation Research." Thirty-two publications met the inclusion criteria. The studies were conducted in seven countries and explored the experiences of pupils with developmental disabilities, parents, peers without developmental disabilities and teachers. Multiple barriers (e.g. unclear policies, insufficient training and support for teachers) and opportunities (e.g. teachers' commitment to inclusion, collaboration between teachers, the work of non-governmental organisations (NGOs)) for implementing inclusive education for pupils with developmental disabilities in sub-Saharan Africa were identified, occurring across national and community contexts and school, classroom and individual teacher levels. To effectively implement inclusive education for pupils with developmental disabilities, teachers need access to appropriate training, resources and support. Governments can capitalise on motivated teachers and the relevant work of NGOs.

Purpose: This paper aims seeks to reflect on the transition of a school of architecture to incorporate sustainability principles as a core part of its undergraduate (Part I) programme. The paper offers a brief overview of the processes undertaken and outcomes of this to an integrated problem-based learning approach and with sustainability at its core changing both knowledge content and pedagogical approaches. Design/methodology/approach: Reflecting on the transition to a sustainability-based curriculum, this paper makes use of a mixed methods approach incorporating a review of literature on sustainability in architectural education, pedagogical approaches and epistemology, as well as educational issues in sub-Saharan Africa. The main study made use of an ethnographic approach, including document analysis, interviews, observations and one-on-one informal interactions with students, faculty and alumni. Findings: While the transition to a sustainability-based curriculum was achieved, with integrated studio courses at second- and third-year levels, this did not come without challenges. Divided opinions of formal education, linked to preconceived ideas of what constituted architectural education led to some resistance from students and professionals. Nevertheless, the programme serves as testament to what is achievable and provides some lessons to schools seeking to transition programmes in the future. Practical implications: The paper contributes to discourses on sustainability in architectural education, examining the transition taken by an architectural programme to incorporate sustainability as a core part of its curriculum. The outcomes of this process provide advice that could be useful to schools of architecture seeking to integrate sustainability into their programmes. Originality/value: As the first architecture programme in East Africa to integrate sustainability principles into its programme, this study provides an insight into the processes, experiences and outcomes of this transition. This reflective engagement highlights value of an enabling environment in any transitional process.

Background: Conceptualisations of what it means to use evidence in policymaking often appear divided between two extremes. On the one side are works presenting it as the implementation of research findings - particularly evaluations of intervention effect. In contrast stand theoretically informed works exploring the multiple meanings of evidence use, political complexities, and the constructed nature of research evidence itself. The first perspective has been criticised as over-simplistic, while the latter can make it difficult to answer questions of what might be good, or improved, uses of evidence in policymaking. Methods: To further debate, this paper develops a 'programmatic approach' to evidence use, drawing on theories of institutional decision making and empirical work on evidence use within 11 National Malaria Control Programmes in Africa. We apply the programmatic approach by investigating the key goals and tasks of programme officials, recognising that these will shape the routines and logics followed affecting evidence utilisation. We then map out the forms, sources, features, and applications of evidence that serve programme officials in their goals. Findings: In the case of malaria programmes, evidence use was understood in relation to tasks including: advocacy for funding, budget allocation, regulation development, national planning, and identification of information gaps - all of which might require different evidence sources, forms, and applications. Discussion and conclusions: Ultimately the programmatic approach aims to facilitate clearer understanding of what uses of evidence are appropriate to policymakers, while also allowing critical reflection on whether such uses are 'good' from both programme and broader social perspectives.

In this paper, we discuss a perennial question in the field of music teacher education: is school music education better served with generalist or specialist teachers? To answer this question, we discuss the educational policy reforms implemented in two African countries, Uganda and South Africa, and in Spain as well. We also discuss how teacher education is implemented in these countries--in the case of Spain, in the lights of the European Higher Education Area (EHEA)--in what refers music teacher education and its professional development. From this policy analysis at curriculum and teacher education levels, we raise implications for teacher preparation and subsequent professional development of music generalist and specialist teachers. In our conclusion, we deduce that students may be well served with either generalist or specialist music teachers as long as they are prepared to move content forward, to meet contemporary global student needs.

Today, more than half of the world population is under the age of 25 years and one in four is under age 18. The urgency of expanding access to Comprehensive Sexuality Education (CSE) notably for children and young people in Africa and Asia is greater than ever before. However, many challenges to the implementation and delivery of CSE in resource poor settings have been identified in the literature. CSE's effectiveness could be strongly improved if these challenges were better met. This paper aims to contribute to those much-needed improvements by sharing lessons learned from a decade of implementation of one particular CSE programme, "The World Starts With Me," among various populations in 11 low income countries in Africa and Asia. The aims, content, reach and effectiveness of the programme are described. Next, the challenges for implementation and delivery at student, teacher, school and context level are discussed with reference to the wider knowledge base in this area. Finally, suggestions are provided for ways forward including the increased sensitivity of programmes for normative and practical barriers to sexual health, further advancement towards gender transformativity, a far-reaching expansion of comprehensive forms of teacher training and coaching, and a serious stepping-up of multilevel "whole school" approaches.

In many low- and lower-middle-income countries, private schools are often considered to offer better quality of education than government schools. Yet, there is a lack of evidence to date on their role in reducing inequalities: namely, the extent to which private schooling improves learning among the most disadvantaged children. Our paper uses household survey data from Kenya, Tanzania, and Uganda to identify whether any observed impact of private schooling on core literacy and numeracy skills differs according to children's household wealth. We demonstrate wealth gaps in access to private schooling, and use inferential models to account for observable differences between those who do and do not enrol in private schools. In Kenya and Uganda, we find that private schooling appears to improve the chances of children learning relative to their peers in government schools, but the chances of the poorest children learning in private schools remains low and is at best equivalent to the richest learning in government schools. In Tanzania, private schooling does not seem to improve poorer children's learning, whereas it does for richer children. These findings raise a caution about the extent to which private provision can help narrow learning inequalities.

Research ethics education is critical to developing a culture of responsible conduct of research. Many countries in sub-Saharan Africa (SSA) have a high burden of infectious diseases like HIV and malaria; some, like Uganda, have recurring outbreaks. Coupled with the increase in non-communicable diseases, researchers have access to large populations to test new medications and vaccines. The need to develop multi-level capacity in research ethics in Uganda is still huge, being compounded by the high burden of disease and challenging public health issues. Only a few institutions in the SSA offer graduate training in research ethics, implying that the proposed ideal of each high-volume research ethics committee having at least one member with in-depth training in ethics is far from reality. Finding best practices for comparable situations and training requirements is challenging because there is currently no "gold standard" for teaching research ethics and little published information on curriculum and implementation strategies. The purpose of this paper is to describe a model of research ethics (RE) education as a track in an existing 2-year Master of Public Health (MPH) to provide training for developing specific applied learning skills to address contemporary and emerging needs for biomedical and public health research in a highly disease-burdened country. We describe our five-year experience in successful implementation of the MPH-RE program by the Mbarara University Research Ethics Education Program at Mbarara University of Science and Technology in southwestern Uganda. We used curriculum materials, applications to the program, post-training and external evaluations, and annual reports for this work. This model can be adapted and used elsewhere in developing countries with similar contexts. Establishing an interface between public health and research ethics requires integration of the two early in the delivery of the MPH-RE program to prevent a disconnect in knowledge between research methods provided by the MPH component of the MPH-RE program and for research in ethics that MPH-RE students are expected to perform for their dissertation. Promoting bioethics education, which is multi-disciplinary, in institutions where it is still "foreign" is challenging and necessitates supportive leadership at all institutional levels. [ABSTRACT FROM AUTHOR]

Purpose: The paper aims to critically evaluate the day-to-day processes of employee performance management and control (EPMC) in an African-based organization and sheds light on formal and informal management controls, social relations and worker responses. Design/methodology/approach: The paper draws on research undertaken within an Ugandan-based agricultural research organization. A case study approach was used to facilitate an understanding of everyday organizational practices and context. The paper uses ethnographic research and grounded theory, with methods including interviews and observation of work practices. Findings: The findings provide a nuanced understanding of how performance management and control plays out in practice and show that the unquestioning imposition of Western practices that ignore traditional norms is unlikely to result in desired outcomes. Research limitations/implications: Since the paper took on a cross-sectional study, a longitudinal study might reveal whether and how the values of managers and employees in Africa-based organizations change over time. Practical implications: The study's findings indicate the need for a more critical examination of EPMC that takes account of employee attitudes, behaviors and social relations at the intersection of both the formal and informal organization. Originality/value: Although cultural and institutional approaches have been used to evaluate human resource management (HRM) practices in Africa, organizational behavior approaches to performance and control at the micro-level had been underexplored. [ABSTRACT FROM AUTHOR]

Discussions on African responses to Covid‐19 have focused on the state and its international backers. Far less is known about a wider range of public authorities, including chiefs, humanitarians, criminal gangs, and armed groups. This paper investigates how the pandemic provided opportunities for claims to and contests over power in Uganda, the Democratic Republic of the Congo, and South Sudan. Ethnographic research is used to contend that local forms of public authority can be akin to miniature sovereigns, able to interpret dictates, policies, and advice as required. Alongside coping with existing complex protracted emergencies, many try to advance their own agendas and secure benefits. Those they seek to govern, though, do not passively accept the new normal, instead often challenging those in positions of influence. This paper assesses which of these actions and reactions will have lasting effects on local notions of statehood and argues for a public authorities lens in times of crisis. [ABSTRACT FROM AUTHOR]

Agriculture has been the backbone of African economies, and agricultural development has the potential to drive overall economic growth. Considering the importance of agriculture in Africa, foreign aid donors have supported the sector to help push economic growth and reduce poverty. Studies indicate governance quality of a recipient country is an important factor for agricultural aid. Building upon this, the paper explores how bilateral donors provided agricultural aid to two African countries that have different institutional quality, Ghana and Uganda. The analysis of agricultural aid in those two countries was carried out with bilateral aidprofile data from 2011 to 2022. Despite the similar economic importance of agriculture in Ghana and Uganda, donors to Ghana invested the largest amount in agriculture among aid sectors, followed by health. On the other hand, donors to Uganda supported mainly health-relevant sectors with agriculture being ranked only fifth. Donors in both countries implemented agricultural aid mostly as project types. Yet, donors disbursed their aid funds through different aid channels. Donors to Ghana disbursed 48% of agricultural aid funds through the public sector institutions channel (or the state channel). By contrast, donors to Uganda disbursed only 24% of agricultural aid funds through the state channel, essentially bypassing Ugandan public agencies. They instead provided 76% of agricultural aid through the non-state channels such as non-governmental organizations, multilateral organizations, and private entities. Similar donor preferences of the aid disbursement channels were observed with total aid across all aid sectors. Overall, the donor aid profiles suggested donors provided Ghana with more flexible agricultural aid, while in Uganda they controlled agricultural aid more tightly. There could exist multiple underlying reasons for this, but the different level of institutional quality is highly likely one of the possible reasons. For foreign aid, governance quality is an important issue equally to both donors and recipients. [ABSTRACT FROM AUTHOR]

Objectives Artemisinin-resistant Plasmodium falciparum malaria is currently spreading globally, including in Africa. Artemisinin resistance also leads to resistance to partner drugs used in artemisinin-based combination therapies. Sequencing of kelch13 , which is associated with artemisinin resistance, culture-based partner drug susceptibility tests, and ELISA-based growth measurement are conventionally used to monitor resistance; however, their application is challenging in resource-limited settings. Methods An experimental package for field studies with minimum human/material requirements was developed. Results First, qPCR-based SNP assay was applied in artemisinin resistance screening, which can detect mutations within 1 h and facilitate sample selection for subsequent processes. It had 100% sensitivity and specificity compared with DNA sequencing in the detection of the two common artemisinin resistance mutations in Uganda, C469Y and A675V. Moreover, in the partner drug susceptibility test, the cultured samples were dry-preserved on a 96-well filter paper plate and shipped to the central laboratory. Parasite growth was measured by ELISA using redissolved samples. It well reproduced the results of direct ELISA, reducing significant workload in the field (Pearson correlation coefficient: 0.984; 95% CI: 0.975–0.990). Conclusions Large-scale and sustainable monitoring is required urgently to track rapidly spreading drug-resistant malaria. In malaria-endemic areas, where research resources are often limited, simplicity and feasibility of the procedure is especially important. Our approach combines a qPCR-based rapid test, which is also applicable to point-of-care diagnosis of artemisinin resistance and centralized analysis of ex vivo culture. The approach could improve efficiency of field experiments and accelerate global drug resistance surveillance. [ABSTRACT FROM AUTHOR]

Background: Up to 1.45 billion people currently suffer from soil transmitted helminth infection, with the largest burden occurring in Africa and Asia. Safe and cost effective deworming treatment exists, but there is a debate about mass distribution of this treatment in high prevalence settings. While the World Health Organization recommends mass administration of anthelmintic drugs for preschool and school-aged children in high (>20%) prevalence settings, and several long run follow up studies of an influential trial have suggested large benefits that persist over time, recent systematic reviews have called this recommendation into question. Methods and findings: This paper analyzes the long-term impact of a cluster-randomized trial in eastern Uganda that provided mass deworming treatment to preschool aged children from 2000 to 2003 on the numeracy and literacy skills of children and young adults living in those villages in 2010-2015. This study uses numeracy and literacy data collected seven to twelve years after the end of the deworming trial in a randomly selected subset of communities from the original trial, by an education-focused survey that had no relationship to the deworming study. Building on an earlier working paper which used data from 2010 and 2011 survey rounds, this paper uses an additional four years of numeracy and literacy data (2012, 2013, 2014, and 2015). Aggregating data from all survey rounds, the difference between numeracy scores in treatment versus control communities is 0.07 standard deviations (SD) (95% CI -0.10, 0.24, p = 0.40), the difference in literacy scores is 0.05 SD (95% CI -0.16, 0.27, p = 0.62), and the difference in total scores is 0.07 SD (95% CI -0.11, 0.25, p = 0.44). There are significant differences in program impact by gender, with numeracy and literacy differentially positively affected for girls, and by age, with treatment effects larger for the primary school aged subsample. There are also significant treatment interactions for those living in households with more treatment-eligible children. There is no evidence of differential treatment effects on age at program eligibility or number of years of program eligibility. Conclusions: Mass deworming of preschool aged children in high prevalence communities in Uganda resulted in no statistically significant gains in numeracy or literacy 7-12 years after program completion. Point estimates were positive but imprecise; the study lacked sufficient power to rule out substantial positive effects or more modest negative effects. However, there is suggestive evidence that deworming was relatively more beneficial for girls, primary school aged children, and children living in households with other treated children. Research approval: As this analysis was conducted on secondary data which is publicly available, no research approval was sought or received. All individual records were anonymized by the data provider prior to public release. [ABSTRACT FROM AUTHOR]

This paper investigates the complex relation between protracted donor interventions and the production of customary authority. More specifically, the paper analyses the impact of post-conflict donor interventions (and their withdrawal) on the position of customary chiefs in the Acholi region in northern Uganda. As important brokers between international aid agencies, the Ugandan government and Acholi communities, customary chiefs became key actors in post-conflict peacebuilding programmes. Using the concepts of extraversion and development brokerage, the paper demonstrates how dwindling access to external donor funds has strongly affected Acholi customary authority. To secure their authority and legitimacy, customary chiefs re-shifted from an 'outward' to an 'inward' orientation, a process that we call 'introversion' [ABSTRACT FROM AUTHOR]

Purpose: The paper aims to assess the effects of taxes and benefits on inequality and poverty in five African countries: Ghana, Mozambique, South Africa, Uganda and Zambia. Design/methodology/approach: The authors use newly developed micro-simulation models to analyse the distribution and composition of incomes. Findings: The study's results suggest that income-based measures result in higher levels of poverty and inequality than consumption-based measures. The country with the most effective system in terms of reducing income inequality and poverty is South Africa; in Ghana, the tax-benefit system was found to have the smallest impact on inequality. The systems of Uganda, Mozambique and Zambia were estimated to have no poverty-reducing properties; many individuals remain largely unaffected by them as they are too poor to pay direct taxes, and benefits are very modest and narrowly targeted. Originality/value: While consumption data are crucial for measuring poverty, income data are becoming vital for assessing the extent to which tax-benefit policies achieve redistribution in economies where own-consumption is becoming less significant and the share of people in employment is increasing. To the best of the authors' knowledge, this is the first study where poverty and inequality are measured in both terms, for several African countries in a common framework. [ABSTRACT FROM AUTHOR]

This paper seeks to identify the factors that explain how members of parliament improved budget scrutiny using unique empirical data collected in Uganda. Two instances are studied that mark the improvements. First, the 2001 Budget Act that established the Parliamentary Budget Committee with large competencies for African standards. Second, the change in the 2012 Health Budget, a rare instance when parliament made significant budget amendments. The analysis reveals that political entrepreneurs used a window of opportunity to build a coalition for change. The window of opportunity opened at an event organised by civil society. The process that followed improved legislative budget scrutiny in a country with strong executive systems and strong patronage. Two factors have proven influential that are understudied in the current literature, civil society and female members of parliament. [ABSTRACT FROM AUTHOR]

Through some empirical studies, the flow of FDI and trade openness have proven to support economic growth in developing countries. This paper examines the significance of FDI and trade openness in five African countries (Ghana, Morocco, Kenya, Uganda, and Zambia). The study employed the panel data analysis method using data from the World Bank for the period 1994-2019 for the five selected countries. The result from the Random effect model indicated that FDI positively supports growth, whereas trade openness harms economic growth in these countries. The outcome further revealed that Uganda enjoys more significance than the other countries using the countries' dummies through the pooled model estimation. We recommend that various governments focus more on exports, reduce imports, attract more FDI through incentives, and create a regulatory environment that is friendly to FDI. [ABSTRACT FROM AUTHOR]

In this paper, we examine how oil-related activities in the Albertine region have the potential to influence conflicts of different forms and intensity in Uganda, a new African oil producer in the making. We view this through the lens of the future, for which we propose the 'in-the-making' perspective. Through this approach we identify three geographies of conflict, framed around three local narratives on mobility, namely: the peripatetic tradition of a social group commonly known as 'Balaalo', speculative labour mobility and ensuing narratives about oil-induced pressure on fishing, and the link between elephant mobility and community grievances. With this paper we seek to contribute to the growing body of empirical research on Uganda's oilscape, and add a case to the existing work on the interface between oil exploitation and social practices across various oil-producing world regions. We conclude that in Uganda's pre-oil situation, the emergence of complex local narratives, resulting from a combination of lack-or inadequacy-of information, pre-existing but low-lying ethnic sentiments, and institutional challenges, are important indicators of how materialities of the future frame relationships within societies today. [ABSTRACT FROM AUTHOR]

Previous research has consistently highlighted the importance of stakeholder engagement in identifying and developing solutions to ethical challenges in genomic research, especially in Africa where such research is relatively new. In this paper, we examine what constitutes good ethical practice in research, from the perspectives of genomic research participants in Uganda. Our study was part of a multi-site qualitative study exploring these issues in Uganda, Ghana and Zambia. We purposively sampled various stakeholders including genomic research participants, researchers, research ethics committee members, policy makers and community members. This paper presents the findings from in-depth interviews with 27 people with diabetes who had participated in a diabetes genomic study. Data were collected using semi-structured interviews. Manual thematic content analysis was conducted using a framework approach. Findings indicate three key requirements that research participants see as vital for genomic research to be more responsive to research participants' needs and contextual realities: (1) de-emphasising the role of experts and institutions in the consenting process, (2) clarity about the timing and nature of feedback both of findings relevant to the health of individuals and about the broad progress of the study, and (3) more effective support for research participants during and after the study. [ABSTRACT FROM AUTHOR]

Introduction: Homebirths are common in low and middle income countries and are associated with poor child survival. We assessed the feasibility of using smartphones by village health workers for pregnancy registration and the effectiveness of health text messages (SMS) sent to pregnant women through village health workers in reducing homebirths in rural Uganda. Methods: A non-randomised intervention study was undertaken in 26 villages. In the intervention arm, village health workers registered pregnant women (n = 262) in 13 villages using a smartphone app (doForm) and paper forms and gestation age-timed SMS were sent through village health workers to the pregnant women. In 13 control villages, (n = 263) pregnant women were registered on paper forms only and no SMS was sent. The main outcome was place of birth measured through a self-report. Logistic regression with generalised estimating equations was used to explore the effect of the intervention. Results: Comparing 795 corresponding data fields on phone and paper revealed that numeric variable fields were 86%-95% similar while text fields were 38%-48% similar. Of the 525 pregnant women followed, 83 (15.8%) delivered at home. In the adjusted analysis, the intervention was associated with lower odds of homebirths [AOR = 0.38, 95%CI (0.15–0.97)]. Muslim religion [AOR = 4.0, 95%CI (1.72–9.34)], primary or no maternal education [AOR = 2.51, 95%CI (1.00–6.35)] and health facility distance ≥ 2 km [AOR = 2.26, 95%CI (0.95–5.40)] were independently associated with homebirths. Conclusion: Village health workers can register pregnant women at home using phones and relay gestation age specific SMS to them to effectively reduce homebirths. [ABSTRACT FROM AUTHOR]

To understand the impact of the COVID-19 public health response on families of children with disabilities in Central Uganda we conducted phone interviews with parents and children during the first 5 months of the outbreak (March - July 2020). Most parents and children were well informed about COVID-19 and were keen to adhere to government prevention measures. The majority said lock-down measures had a negative effect on their mental and physical health, social life, finances, education and food security. Access to medical services and medication for chronic illness had been limited or absent due to restrictions in travel, some facilities restricting access, and limited financial resources. The majority of parents reported loss of work which resulted in difficulties in finding enough food and paying rent. Parents worried about children missing education and friends. We suggest greater attention to children with disabilities and their families when implementing mitigating and long-term responses. This paper reports a study with families of children with disabilities in Uganda during the Coronavirus pandemic in 2020, known as COVID-19. Families of children with disabilities in Uganda are well informed about COVID-19 and try to follow prevention measures. Families of children with disabilities have difficulties meeting daily basic needs as they were unable to work and had no income during the COVID-19 related lock down. The COVID-19 response affects access to health and rehabilitation services for children with disabilities in Uganda. Parents of children with disabilities struggle with home education and learning due to lack of access to accessible learning materials and learning support in Uganda. The COVID-19 response affects the peer support networks and social support for parents of children with disabilities in Uganda. Children with disabilities and their families should be involved and considered in the development and implementation of the COVID-19 response. [ABSTRACT FROM AUTHOR]

Introduction: This article examines recent moral panics over sex education in Uganda from historical perspectives. Public outcry over comprehensive sexuality education erupted in 2016 over claims that children were being taught "homosexuality" by international NGOs. Subsequent debates over sex education revolved around defending what public figures claimed were national, religious, and cultural values from foreign infiltration. Methods: This paper is grounded in a survey of Uganda's two English-print national newspapers (2016–2018), archival research of newspapers held at Uganda's Vision Group media company (1985–2005), analyses of public rhetoric as reported in internationally and nationally circulating media, textual analysis of Uganda's National Sexuality Education Framework (2018), formal interviews with Ugandan NGO officers (3), and semi-structured interviews with Ugandan educators (3). Results: Uganda's current panic over sex education reignited longstanding anxieties over foreign interventions into the sexual health and rights of Ugandans. We argue that in the wake of a 35-year battle with HIV/AIDS and more recent controversies over LGBT rights, both of which brought international donor resources and governance, the issue of where and how to teach young people about sex became a new battleground over the state's authority to govern the health and economic prosperity of its citizens. Conclusions: Ethno- and religio-nationalist rhetoric used to oppose the state's new sexuality education policy was also used to justify sex education as a tool for economic development. Policy Implications: Analyzing rhetoric mobilized by both supporters and detractors of sex education reveals the contested political terrain policy advocates must navigate in Uganda and other postcolonial contexts. [ABSTRACT FROM AUTHOR]

The role of foreign aid in promoting growth and development in general is a debatable issue and remains unsettled at both the theoretical and empirical level. It is evident that the African continent has substantially received large amounts of foreign aid since the 1960s, but little improvement has taken place or observed in its socio-economic development. This essay considers the statement as to whether foreign aid is a blessing or a curse to Africa. Uganda will be used as a cases study in this paper. [ABSTRACT FROM AUTHOR]

As in other African countries, activists in Uganda play an important role during political campaigns. Monetary handouts, called 'transport refund', often facilitate their participation. Although these handouts often cover more than just the costs of transportation, the label indicates that mobility is seen as an important financial item for campaign activists. Despite this, little has been published about the role that mobility plays in the processes of political mobilisation in Africa. This article therefore examines mobility as an important yet neglected aspect of political mobilisation by evaluating the role of motorcycle taxi riders during elections in Uganda. Usually referred to as Boda‐Bodas, they are essential short‐distance transport providers in the country. Beyond that, being Boda‐Boda has become a way of survival, a form of social organisation, and a promise that every youth can make a living if he dares to face the dangers of the country's accident‐prone roads. Politicians have since discovered the potential of these bold young men and recruit them en masse ahead of elections. Based on fieldwork conducted between 2018 and 2022, this paper examines the unique mobilities inherent in Boda‐Bodas. It finds that characteristic mobilities enable their movements as transport providers and argues that these mobilities also enhance political rallies. Boda‐Boda motorcycle riders have therefore become a crucial activist group during political campaigns in Uganda. This acticle reviews the role of Boda‐Boda motorcyclists during political rallies in Uganda. It uses a mobility lens to highlight how political mobilisation modernised through the inclusion of more mobile activists. [ABSTRACT FROM AUTHOR]

Due to small firm sizes and inter-linkages between household and business finances, small-scale entrepreneurs in developing countries are inherently vulnerable to temporary and permanent income shortfalls, and hence household poverty. While the International Labour Organisation (ILO) generally defines self-employment without employees as vulnerable employment, little empirical research has been done on the extent to which the self-employed are indeed vulnerable. This paper makes two main contributions: first, it operationalises the concept of vulnerability in the context of self-employment in developing countries by defining vulnerability as the risk of having business income below a living wage threshold. Secondly, it investigates the extent and correlates of vulnerability. Using a six-year balanced entrepreneur panel dataset from Kampala, Uganda, it is shown that the self-employed are heterogeneous with respect to vulnerability and observed earnings: 58–74% of the samples are classified as vulnerable in a given year and mostly earn incomes below the living wage threshold. Vulnerable entrepreneurs are shown to be significantly different from non-vulnerable entrepreneurs in several dimensions, including those that do not directly predict income. [ABSTRACT FROM AUTHOR]

Objectives: HIV virological failure remains a major threat to programme success in sub‐Saharan Africa. While HIV drug resistance (HIVDR) and inadequate adherence are the main drivers of virological failure, the individual, clinical and health system characteristics that lead to poor outcomes are not well understood. The objective of this paper is to identify those characteristics among people failing first‐line antiretroviral therapy (ART). Methods: We enrolled a cohort of adults in HIV care experiencing virological failure on first‐line ART at five sites and used standard statistical methods to characterize them with a focus on three domains: individual/demographic, clinical, and health system, and compared each by country of enrolment. Results: Of 840 participants, 51% were women, the median duration on ART was 3.2 years [interquartile range (IQR) 1.1, 6.4 years] and the median CD4 cell count prior to failure was 281 cells/µL (IQR 121, 457 cells/µL). More than half of participants [53%; 95% confidence interval (CI) 49–56%] stated that they had > 90% adherence and 75% (95% CI 72–77%) took their ART on time all or most of the time. Conversely, the vast majority (90%; 95% CI 86–92%) with a completed genotypic drug resistance test had any HIV drug resistance. This population had high health system use, reporting a median of 3 (IQR 2.6) health care visits and a median of 1 (IQR 1.1) hospitalization in the preceding 6 months. Conclusions: Patients failing first‐line ART in sub‐Saharan Africa generally report high rates of adherence to ART, have extremely high rates of HIV drug resistance and utilize significant health care resources. Health systems interventions to promptly detect and manage treatment failure will be a prerequisite to establishing control of the HIV epidemic. [ABSTRACT FROM AUTHOR]

The resource curse literature argues that oil production reshapes the fiscal contract between citizens and the state: politicians become less responsive to citizen taxpayers and more likely to use public revenues for their own benefit. This paper examines whether and how bureaucrats influence this breakdown of the fiscal contract. Analysing results of a survey experiment conducted with government employees in Ghana and Uganda, we find that, when primed to think about oil revenue, bureaucrats do not generally express attitudes indicating that they contribute to the resource curse. Although oil revenue does lead some Ghanaian bureaucrats to become less interested in responding to taxpayers, this finding does not operate as predicted, i.e. by bureaucrats expressing greater partiality towards the ruling elite. Instead, we attribute this outcome to 'disgruntled employees' – political outsiders with low salaries – who, unlikely to benefit from oil revenue, become disaffected from citizen service. The results shed new light on processes through which resource extraction changes state institutions. [ABSTRACT FROM AUTHOR]

Unhealthy alcohol use fuels difficulties with HIV disease management and potentiates secondary transmission of HIV but less is known about how these alcohol use expectancies may shape alcohol use behaviors, particularly in the presence of depressive symptomatology. In this paper, we utilize data from a prospective study of 208 people living with HIV in Southwest Uganda, to examine the correlates of alcohol use expectancies and their association with unhealthy alcohol use. Affective depressive symptoms were positively associated with alcohol use expectancies. Gender moderation was observed such that depression was more strongly associated with alcohol use expectancies among women. In unadjusted analyses, alcohol use expectancies were marginally associated with unhealthy alcohol use and this association was not significant in adjusted analyses. Findings underscore the need to strengthen screening for depression and alcohol use within HIV care services, particularly among women. [ABSTRACT FROM AUTHOR]

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Introduction: The proportion of older persons in developing countries is increasing with no clear evidence of improvement in physical health. The aim of this paper was to examine the factors associated with older persons’ physical health in rural Uganda. Methods: This paper is based on a cross-sectional study of 912 older persons age 60 years and older across four major regions of Uganda. The study was conceptualized basing on World Health Organization quality of life BREF (WHOQOL-BREF). Analysis was done at three levels, that is, frequency distributions were generated to describe background characteristics of respondents and cross-tabulations were done to determine associations between dependent and each of the independent variables. Ordinal logistic regression was used to determine the predictors of physical health. Results: The likelihood of good physical health is high among older persons (Ops) who controlled their household assets (OR = 3.64; CI = 1.81–7.30) or the household assets controlled by their spouses (OR = 4.44; CI = 1.91–10.32) relative to those whose household assets were controlled by their children. There is high likelihood of good physical health among those who engage in physical activities (OR = 2.28; CI = 1.52–3.43) compared to those who do not. Conclusion: The findings have various policy implications, including creating an enabling environment and building capacities of older persons to remain in control of their household assets. Interventions focusing on deepening sensitization of older persons about importance of physical exercises could be a viable strategy for improving physical health of older persons. [ABSTRACT FROM AUTHOR]

Several nations have reformed both their mathematics pedagogy and curriculum. The remaining challenge is to review teaching and learning resources to support the renewed pedagogy and curriculum. This paper responds to the following question: what pedagogy and curriculum are depicted in textbooks used in Uganda? Ugandan textbooks were analyzed in terms of mathematics content structure and genre, and presentation of written and non-written voice and looks (appearance). Whereas certain Ugandan mathematics textbooks used the narrative form and others chose to eliminate the use of extensive text, these textbooks include common characteristics such as spiral coverage of mathematics content. A few strides toward reform pedagogy, such as use of contexts familiar to learners in development of rules and concepts, were evinced among selected Uganda textbooks. More strides are needed in revising a majority of textbooks to align with the renewed curricula on certain aspects including integrating learning tools—digital and non-digital—within the textbook resources. A critical reflection on curriculum renewals adopted from other countries is needed when designing textbooks to match these renewals. [ABSTRACT FROM AUTHOR]

One of the most universal patterns in the spatial distribution of poverty in developing countries is that the incidence of poverty is lower in urban areas than in rural areas. It is widely accepted, though less well documented, that remote rural areas tend to be poorer than areas with good market access. Furthermore, there is concern that remote rural areas may not benefit equally from economic growth. In this paper, we examine poverty trends in rural Uganda to test whether remote rural areas benefit from economic growth to the same degree as better connected rural areas. Applying a variant of small‐area estimation methods to household survey data and several Demographic and Health Surveys carried out over 10 years, we confirm that remote rural areas are poorer than better connected rural areas, but find no evidence that they have fallen further behind over this period. [ABSTRACT FROM AUTHOR]

Pesticides are an important and widely used tool for crop protection, but they also pose significant risks to agricultural sustainability, human health and the environment. In this paper, we examine whether mass media campaigns can help improve pesticide knowledge and change pesticide use behaviour among smallholder farmers in Rwanda and Uganda. We also assess the individual and combined effects of the campaign channels, which include interactive radio, plant health rallies, mobile SMS and video screenings. Applying a doubly robust method to survey data from 1327 maize-producing households across the two countries, we find that the mass media campaigns are significantly associated with improved farmer knowledge of pesticide risks and safety precautions. While the campaigns appear not to have discouraged the use of synthetic pesticides, they are significantly associated with increased adoption of safer alternatives to pesticides, including sustainable integrated pest management practices. The campaigns are also significantly correlated with increased use of protective equipment against pesticide exposure in both countries and reduced incidence of pesticide-related illnesses in Rwanda. We conclude that mass media campaigns (particularly using multiple complementary channels) can be effective in enhancing farmers' knowledge about pesticide risks and safety measures, and promote the adoption of safer pest management strategies. • The effects of mass media campaigns on pesticide use behaviour among farmers are studied. • Campaigns improve farmers' knowledge of pesticide risks and safety measures. • Campaigns boost the adoption of environmentally safer alternatives to synthetic pesticides. • Campaigns are associated with increased use of personal protective equipment items. • Effects are more pronounced for farmers exposed to multiple ICT channels. [ABSTRACT FROM AUTHOR]

Genomic research and biobanking present several ethical, social and cultural challenges, particularly when conducted in settings with limited scientific research capacity. One of these challenges is determining the model of consent that should support the sharing of human biological samples and data in the context of international collaborative research. In this paper, we report on the views of key research stakeholders in Ghana on what should count as good ethical practice when seeking consent for genomic research and biobanking in Africa. This study was part of a multi-country qualitative case study conducted in three African countries: Ghana, Uganda and Zambia under the auspices of the Human Heredity and Health in Africa initiative (H3Africa). Our study suggests that while participants are willing to give consent for their samples and associated data to be used for future research purposes, they expect to receive feedback about the progress of the research and about the kinds of research being undertaken on their samples and data. These expectations need to be anticipated and discussed during the consent process which should be seen as part of an ongoing communication process throughout the research process. [ABSTRACT FROM AUTHOR]

Background: The recently adopted Sustainable Development Goals call for the end of poverty and the equitable provision of healthcare. These goals are often at odds, however: health seeking can lead to catastrophic spending, an outcome for which cancer patients and the poor in resource-limited settings are at particularly high risk. How various health policies affect the additional aims of financial wellbeing and equity is poorly understood. This paper evaluates the health, financial, and equity impacts of governmental and charitable policies for surgical oncology in a resource-limited setting. Methods: Three charitable platforms for surgical oncology delivery in Uganda were compared to six governmental policies aimed at improving healthcare access. An extended cost-effectiveness analysis using an agent-based simulation model examined the numbers of lives saved, catastrophic expenditure averted, impoverishment averted, costs, and the distribution of benefits across the wealth spectrum. Findings: Of the nine policies and platforms evaluated, two were able to provide simultaneous health and financial benefits efficiently and equitably: mobile surgical units and governmental policies that simultaneously address surgical scaleup, the cost of surgery, and the cost of transportation. Policies that only remove user fees are dominated, as is the commonly employed short-term “surgical mission trip”. These results are robust to scenario and sensitivity analyses. Interpretation: The most common platforms for increasing access to surgical care appear unable to provide health and financial risk protection equitably. On the other hand, mobile surgical units, to date an underutilized delivery platform, are able to deliver surgical oncology in a manner that meets sustainable development goals by improving health, financial solvency, and equity. These platforms compare favorably with policies that holistically address surgical delivery and should be considered as countries strengthen health systems. [ABSTRACT FROM AUTHOR]

Inclusive education interventions in low-income countries are dominated by definitions and frameworks from disability studies and educational research scholars from high-income countries. Disability studies scholars have argued for valuing diverse understandings and a different discourse when studying disability and inclusion in low-income countries. In this paper, we explore the meaning of belonging and inclusion to parents of children with disabilities in central Uganda. Through case study analysis we aim to give alternative starting points for inclusive primary education programmes. We explore the themes 'missing parts', the 'ability to manage', 'belonging to a family', and 'being given a chance' as key concepts of disability and inclusion. We argue not to translate parents' descriptions into international categories and framework, but to reflect on the larger and underlying meaning of the concepts to form a more culturally embedded and relevant starting point of education for all. We propose to address the gaps of the postcolonial education system that has taken teachers' and families' away from the concept of 'obuntu bulamu', and focus interventions on re-creating this togetherness and value the strength of concepts of belonging and caring for each other. [ABSTRACT FROM AUTHOR]

Adolescent girls and young women have recently gained a central position in gender equality and development. However, little research investigates female experiences of the complex dynamics of both change and resistance to change in gender norms and structures. Drawing on the work of Bourdieu, Connell and Schippers to analyse longitudinal in-depth interviews, this paper explores how girls in northern Uganda learn, challenge and (re)produce patriarchal structures throughout the life-course and across social fields. It highlights the costs, consequences and benefits at stake in expressing hegemonic femininity and expands understanding of how adolescent girls and young women actively strategise to protect their wellbeing and create space for contestation. Findings call for greater attention to the coexistence of resistance to, and reproduction of, gender orders, and offer opportunities for additional research for theory building and programme implementation. [ABSTRACT FROM AUTHOR]

Energy services are crucial to human wellbeing and development, and without reliable energy, it is difficult to escape subsistence lifestyles and poverty. Here, we report on four identical capacity rural minigrid interventions undertaken in Kenya and Uganda with differing socioeconomic characteristics and demographics. The research outcomes presented briefly discuss the preparation stages of the interventions including community surveys that informed the technical design, deployment phases, and setup of the community cooperatives to manage the minigrid projects. The main focus here is on lessons learned, including system design and minigrid performance under various load profiles. The results show a clear and increasing uptake of power by the communities with intensities varying depending on the electricity tariff used. Across the four minigrids, daily electricity growth rates are seen to vary by a factor of 8. The Ugandan minigrids operated at close to utility grid tariff and reached the 28-kWh/day design limit within two years. By contrast, the Kenyan minigrids charged a higher cost recovery tariff, which capped the demand and systems operate below the design limit. These findings have implications not only to system design but also to system stability and longevity. The approach taken here, of community centered cooperatives running the delivered minigrids, is now embedded within the rural electrification authorities/agencies in both countries, with additional similar projects being planned in 2019/2020. The application, ramifications, and replication of such a minigrid concept as compared to other approaches are also discussed in this paper. [ABSTRACT FROM AUTHOR]

Microcredit transactions in developing countries create risks for borrowers that are routinely overlooked in the literature. This paper argues that common microfinance-lending methodologies that allow lenders to collateralize loans and unilaterally collect this security create opportunities for malicious lenders to steal from clients in good standing. In places where any lender can simply call itself a 'microfinance institution' (MFI), opportunistic lenders can use the halo effect associated with microfinance to encourage borrowers to make themselves unusually vulnerable to theft. Evidence of these abuses can be seen in a case study of Uganda, where theft and fraud by a small number of microfinance institutions created a large-scale crisis and contributed to a precipitous decline in trust in the financial sector as a whole. Even when it occurs only on the margins of the sector, I conclude, this type of opportunism may have problematic implications for all MFIs and undermine efforts to increase financial inclusion. This possibility provides a new impetus to consider innovative regulatory approaches for microfinance. [ABSTRACT FROM AUTHOR]

A considerable body of literature suggests that immigration undermines voluntary contributions to public goods because it leads to ethnic diversity, which erodes social trust. This article posits that the effect of immigration outweighs that of ethnic diversity, so that immigration may explain why ethnic diversity is negatively associated with social trust and public goods provisioning. I also highlight a need to emphasize the moderating influence of transaction costs when analyzing provisioning problems associated with immigration and ethnic diversity. To examine my hypotheses, I use a mixed-method research design to study public goods management in randomly selected communities in rural Uganda whose rates of immigration and levels of ethnic diversity vary. I analyze community-level attempts at collective action that involve substantially different costs; that is, contributing to toilet construction and participating in litter pickup programs. The findings suggest that socio-political barriers to collective action for public goods provisioning may have less to do with the stock of demographic diversity than the flow rate of demographic change. The same findings suggest a more micro-level explanation that transcends the erosive effects (of immigration and ethnic diversity) on social trust to emphasize the moderating influence of transaction costs. [ABSTRACT FROM AUTHOR]

Background: Timely access to evidence increases the prospects for evidence informed decision making. We evaluated user experiences of a Clearing House for Health Policy with the aim of increasing access to evidence about the Uganda health system and interventions. Methods: We conducted in‐depth interviews with 15 potential users including policymakers, health policy advisors, health managers and researchers to provide evidence on their experience with the clearinghouse. On average participants took 20 minutes to first navigate the site and 45 minutes to perform search tasks and complete the interview. Results: Most respondents successfully searched for information with accuracy and completeness in a short time. Participants commended the performance and expressed high regard for the credibility of the clearinghouse. The majority felt that using the resource was worth their effort. The clearinghouse provided appropriate functionalities for information searching. Navigating and finding information from the site was achievable. However, inadequate background information about the site and lack of current information were widely reported. Conclusion: Our paper provides insights on the issues that can be addressed to improve online resources for health policy and system information in a limited resource setting. Users' experience of such resources can be improved by regularly appraising and appropriately indexing the contents, and optimising the capacity to customise information. [ABSTRACT FROM AUTHOR]

Approximately 1.8 million people were displaced in northern Uganda as a result of the LRA conflict. This paper explores risk and protective factors as well as examples of resilience among women in northern Uganda resettling after armed conflict and internal displacement. The risk and resilience ecological framework is used to identify and understand these factors along the multiple levels of the ecological social system. Risk factors included poor health, loss of instrumental and emotional support networks, and land vulnerability. Protective factors included engagement in livelihood and sociocultural activities with others. Resilience was located in the women's coping and maintenance of family and social relationships. [ABSTRACT FROM AUTHOR]

The increased mortality rate among the Acoli people of northern Uganda is anecdotally blamed on excessive consumption of cheap and widely available sachet-packaged alcohol in the region. In this paper, we quantify this perceived association by determining statistically the health risks associated with ingesting 20 heavy metals in 17 popular spirits products consumed in Acoli. Thirteen of these products were industrially packaged in sachets (locally known as ‘sachet,’ waragi, arege or moo lyec) and four were locally produced Lira-Lira spirits from Bolo, Awere and Teso Bar in the region and Nsambya in southern Uganda. A Scottish whisky purchased in San Diego (USA) was our reference. Risk assessment was performed according to standardized protocols developed by the United States Environmental Protection Agency (US EPA). Our results show that a strong correlation indeed exists between health risks and ingestion of spirits in Acoli. At >2.5 sachets/day for 240 day/year over a lifetime for example, the risk of developing cancer due to exposure to As, Pb and Cr alone is 1 in 102,041. This estimate excludes ethanol, a known carcinogen, and 17 heavy metals also studied due to lack of their cancer slope factors. The primary non-cancer related health risk factor in all samples tested is ethanol with unacceptably high health index of four. The Lira-Lira spirits, with 100–6000% copper above the US EPA limit for intake by oral ingestion in water, would be the ‘cleanest’ without copper and at par with the Scottish whisky. Collectively, we find that no amount of alcohol consumed in Acoli is safe. Preventive measures are therefore recommended to reduce mortality in Acoli in particular, and in Uganda in general. These measures should include public education, better public policies, creating productive economic activities other than brewing alcohol, and social activities that engage people away from drinking. [ABSTRACT FROM AUTHOR]

Background: Older persons report poor health status and greater need for healthcare. However, there is limited research on older persons' healthcare disparities in Uganda. Therefore, this paper aimed at investigating factors associated with older persons' healthcare access in Uganda, using a nationally representative sample. Methods: We conducted secondary analysis of data from a sample of 1602 older persons who reported being sick in the last 30 days preceding the Uganda National Household Survey. We used frequency distributions for descriptive data analysis and chi-square tests to identify initial associations. We fit generalized linear models (GLM) with the poisson family and the log link function, to obtain incidence risk ratios (RR) of accessing healthcare in the last 30 days, by older persons in Uganda. Results: More than three quarters (76%) of the older persons accessed healthcare in the last 30 days. Access to healthcare in the last 30 days was reduced for older persons from poor households (RR = 0.91, 95% CI: 0.83-0.99); with some walking difficulty (RR = 0.90, 95% CI: 0.83-0.97); or with a lot of walking difficulty (RR = 0.84, 95% CI: 0.75-0.95). Conversely, accessing healthcare in the last 30 days for older persons increased for those who earned wages (RR = 1.08, 95% CI: 1.00-1.15) and missed work due to illness for 1-7 days (RR =1.19, 95% CI: 1.10-1.30); and 8-14 days (RR = 1.19, 95% CI: 1.07-1.31). In addition, those who reported non-communicable diseases (NCDs) such as heart disease, hypertension or diabetes (RR= 1.09, 95% CI: 1.01-1.16); were more likely to access healthcare during the last 30 days. Conclusion: In the Ugandan context, health need factors (self-reported NCDs, severity of illness and mobility imitations) and enabling factors (household wealth status and earning wages in particular) were the most important determinants of accessing healthcare in the last 30 days among older persons. [ABSTRACT FROM AUTHOR]

Purpose - Beer-bananas in Central Uganda are important for smallholder farmers' livelihoods, especially for those that process the banana into beer and spirits. The purpose of this paper is to understand how actors in the beer-banana value chain are affected and how they are managing disease has become an important issue since the outbreak of the bacterial banana disease Xanthomonas Wilt. Design/methodology/approach - The authors conducted an exploratory study focusing on producers of beer-bananas; brewers and non-brewers, and on retailers in Central Uganda and in Kampala. The authors conducted surveys with these value chain actors and we used baseline data, collected through a household survey in the project sites. Findings - Results showed that Banana Xanthomonas Wilt (BXW) has drastically reduced productivity of beer-banana systems, resulting in reduced sales volumes of beer-bananas and processed products and consequently reduced incomes. Application of disease control measures was generally higher among those farmers that brew. Research limitations/implications - This being an exploratory study, the samples for the different value chain actors were rather small. Future research should address: product quality and opportunities for differentiation; effects of beer-banana processing on rural communities; adoption of BXW control measures. Originality/value - Beer-bananas are often neglected in research; this paper shows that is unfounded since beer-banana production and processing are important for many people's livelihood. More insight into what motivates farmers to control the disease is essential to protect these people's livelihoods. [ABSTRACT FROM AUTHOR]

The most effective way to finance universal health coverage (UHC) is through compulsory prepaid funds that flow through the government budget. Public funds—including on-budget donor resources—allow for pooling and allocation of resources to providers in a way that aligns with population health needs. This is particularly important for low-income settings with fiscal constraints. While much attention is paid to innovative sources of additional financing for UHC and to implementing strategic purchasing approaches, the government budget will continue to be the main source of health financing in most countries—and the most stable mechanism for channeling additional funds. The government budget should therefore be front and center on the strategic purchasing agenda. This commentary uses lessons from Tanzania and Uganda to demonstrate that more can be done to use the government budget as a vehicle for making health purchasing more strategic, across all phases of the budget cycle, and for making greater progress toward UHC. Actions need to be accompanied by measures to address bottlenecks in the public financial management system. [ABSTRACT FROM AUTHOR]