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In July 2019, Ebola in the Democratic Republic of Congo (DRC) was declared a public health emergency of international concern and neighbouring countries were put on high alert. This paper examines the intersections of gender, caregiving, and livelihood practices in Uganda's border districts that emerged as key factors to consider in preparedness and response. This paper is based on an anthropological study of the Ebola context among Bantu cultures. We report on data from focus group discussions and key informant interviews with various sectors of the community. The study identified intersecting themes reported here: (1) women as primary caregivers in this context; and (2) women as providers, often in occupations that increase vulnerability to Ebola. Findings demonstrate the role that women play inside and outside the home as caregivers of the sick and during burials, and intersections with livelihood-seeking strategies. Because women's caregiving is largely unpaid, women face a double burden of work as they seek other livelihood strategies that sometimes increase vulnerability to Ebola. Epidemic response should address these intersections and the context-specific vulnerabilities of caregivers; it should also be localised and community-centred and able to attend to the cultural as well as the economic needs of a community. [ABSTRACT FROM AUTHOR]

Notions of 'participation' in sexuality education has gained considerable traction in recent years - with participation being regarded as a fundamental right and a critical means to empower young people. However, the notion has increasingly been subject of debate, with critics problematising the manner in which participation is operationalised, and questioning the assumed impact of participation in relation to sexuality education goals. This paper contributes to these debates by examining the under-researched gendered dimensions of participation of young people in sexuality education. It utilises data from a qualitative study conducted in 2015 on young women and men's (10-15 years old) perceptions of their participation in the dance4life programme, an in-school sexuality education programme in Jinja district in eastern Uganda. The paper highlights subtle but important differences between young men and women's participation in the programme, which are arguably reflective of existing gendered hierarchies. We conclude by providing recommendations on how to address gender differences in participation. [ABSTRACT FROM AUTHOR]

Although the first private university in Uganda was founded in 1988 and the private university sector has since grown rapidly to become one of the most prominent features of higher education (HE) in Uganda, the contribution of private universities (PUs) to the provision of HE has remained largely unexplored and as such, less understood. The purpose of this paper, then, is to analyse the contribution of PUs to the provision of HE in Uganda, using theories of the non-profit organisations and Geiger's conceptual framework about rationales for growth of the PUs. The paper is based on data that were collected through qualitative interviews conducted in 2008 with six faculty deans from Uganda Christian University (UCU); reviews of paper and web-based documents from the National Council for Higher Education (NCHE) and the PUs in Uganda; and reviews of national and internal literature about private higher education (PHE). Data analysis reveals that excess demand for HE, per se, was not responsible for the growth of the PUs in Uganda; instead, it created opportunities for individuals and organisations to establish PUs. Because of their diverse backgrounds and the policy environment in which they exist, PUs undertake various roles in the provision of HE. [ABSTRACT FROM AUTHOR]

With over 1.4 million refugees, Uganda is Sub-Saharan Africa's largest refugee-hosting nation. Bidi Bidi, Uganda's largest refugee settlement, hosts over 230,000 residents. There is a dearth of evidence-based sexual violence prevention and post-rape clinical care interventions in low- and middle-income humanitarian contexts tailored for refugee youth. Graphic medicine refers to juxtaposing images and narratives, often through using comics, to convey health promotion messaging. Comics can offer youth-friendly, low-cost, scalable approaches for sexual violence prevention and care. Yet there is limited empirical evaluation of comic interventions for sexual violence prevention and post-rape clinical care. This paper details the study design used to develop and pilot test a participatory comic intervention focused on sexual violence prevention through increasing bystander practices, reducing sexual violence stigma, and increasing post exposure prophylaxis (PEP) knowledge with youth aged 16–24 and healthcare providers in Bidi Bidi. Participants took part in a single-session peer-facilitated workshop that explored social, sexual, and psychological dimensions of sexual violence, bystander interventions, and post-rape clinical care. In the workshop, participants completed a participatory comic book based on narratives from qualitative data conducted with refugee youth sexual violence survivors. This pilot study employed a one-group pre-test/post-test design to assess feasibility outcomes and preliminary evidence of the intervention's efficacy. Challenges included community lockdowns due to COVID-19 which resulted in study implementation delays, political instability, and attrition of participants during follow-up surveys. Lessons learned included the important role of youth facilitation in youth-centred interventions and the promise of participatory comics for youth and healthcare provider engagement for developing solutions and reducing stigma regarding SGBV. The Ngutulu Kagwero (Agents of change) project produced a contextually and age-tailored comic intervention that can be implemented in future fully powered randomized controlled trials to determine effectiveness in advancing sexual violence prevention and care with youth in humanitarian contexts. [ABSTRACT FROM AUTHOR]

Background: Results-based financing has been promoted as an innovative mechanism to improve the performance of health systems in achieving universal health coverage. Several results-based financing models were implemented in Uganda between 2003 and 2015 but with limited national scale-up. Objective: This paper examines the evolution of results-based financing models and the reasons for the slow national adoption and implementation in Uganda. Methods: This was a qualitative study based on document review and key informant interviews. The models were compared to show modifications overtime. The reasons for the slow national scale-up were analyzed using variables from the Diffusion of Innovations Theory. Results: This study covered seven schemes implemented in the Ugandan health sector between 2003 and 2015. The models evolved in several aspects: 1) donor reliance with fundholding and purchasing delegated to non-state organizations; 2) establishment of ad-hoc structures for learning; 3) recent involvement of the government agencies in verification processes; 4) Involvement of public providers, and 5) expansion of services purchased from the national minimum health-care package. The main reasons for slow national adoption were the perceived complexity and incompatibility with public sector systems. The early phases comprised barriers to public sector reforms. However, recent adjustments to the schemes have enabled greater involvement of public providers and government stewardship. Stakeholders also reported progressive learning across projects and time. Conclusion: Overall, the study findings show scheme actors' deliberate efforts to adapt their models to the Ugandan health system and public sector context. Results-based financing is a complex intervention that takes time for the capacity to be built among vital actors. Progressive re-designing of models enhances fitness to the health systems context. From this study, we advise that Uganda and similar countries should undertake deliberate efforts to customize such models to the capacity and institutional architecture of their health systems. [ABSTRACT FROM AUTHOR]

This paper explores the influence of the community-based rehabilitation approach among international development actors in Gulu, Uganda through the lens of policy transfer. Developed by international organizations, this approach has been promoted as a meaningful way to address the needs of persons with disabilities in low-income countries. This qualitative case study consists of a questionnaire completed by representatives from 25 different organizations, in addition to semi-structured follow-up interviews with 8 development professionals. The findings indicate that the community-based rehabilitation approach has had some influence, as respondents appeared cognisant of key principles of the approach in relation to persons with disabilities. However, detailed knowledge of the approach is mainly limited to the field of health, and there were few current examples of the approach being implemented. These results illustrate the challenges of implementing community-based rehabilitation specifically, as well as broader issues related to the transfer of international policy ideas to the Global South. Community-based rehabilitation is a way of helping people with disabilities in low-income countries where services are limited Development organizations in Gulu, Uganda (like the local government and non-governmental organizations) think that this approach is a good way to support people with disabilities Only a few of the people interviewed for this study had a strong understanding of the community-based rehabilitation approach, and these people mostly worked in the health sector There were no examples of community-based rehabilitation programs in Gulu at the time of the study, but some projects (mostly in the health field) used some ideas drawn from the approach Local development organizations find it difficult to apply policy ideas like community-based rehabilitation, especially when they do not have consistent funding [ABSTRACT FROM AUTHOR]

To reach the most vulnerable individuals in under-resourced countries, health communication interventions increasingly move towards the community level. However, little is known about how health information spreads through local social networks. This paper maps the health information network of a rural trading centre in Uganda. As part of a five-year ethnographic study of sustainable community health resources, ego networks were obtained for 231 village residents in March 2014. Using both ethnographic and social network data, we analyze how the village social network is structured, and how this structure may influence the transmission of health information. Results show a network with low average proximity, with a small number of individuals, notably key administrative officials, much closer connected to many other community members than average. However, because of social partitioning in the village network, a number of people are outside the social clusters in which the top influencers are located. [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]

Background: Persons with disabilities have often been overlooked in the context of HIV and AIDS risk prevention and service provision. This paper explores access to and use of HIV information and services among persons with disabilities. Methods: We conducted a multi-country qualitative research study at urban and rural sites in Uganda, Zambia, and Ghana: three countries selected to exemplify different stages of the HIV response to persons with disabilities. We conducted key informant interviews with government officials and service providers, and focus group discussions with persons with disabilities and caregivers. Research methods were designed to promote active, meaningful participation from persons with disabilities, under the guidance of local stakeholder advisors. Results: Persons with disabilities emphatically challenged the common assumption that persons with disabilities are not sexually active, pointing out that this assumption denies their rights and – by denying their circumstances – leaves them vulnerable to abuse. Among persons with disabilities, knowledge about HIV was limited and attitudes towards HIV services were frequently based upon misinformation and stigmatising cultural beliefs; associated with illiteracy especially in rural areas, and rendering people with intellectual and developmental disability especially vulnerable. Multiple overlapping layers of stigma towards persons with disabilities (including internalised self-stigma and stigma associated with gender and abuse) have compounded each other to contribute to social isolation and impediments to accessing HIV information and services. Participants suggested approaches to HIV education outreach that emphasise the importance of sharing responsibility, promoting peer leadership, and increasing the active, visible participation of persons with disabilities in intervention activities, in order to make sure that accurate information reflecting the vulnerabilities of persons with disabilities is accessible to people of all levels of education. Fundamental change to improve the skills and attitudes of healthcare providers and raise their sensitivity towards persons with disabilities (including recognising multiple layers of stigma) will be critical to the ability of HIV service organisations to implement programs that are accessible to and inclusive of persons with disabilities. Discussion: We suggest practical steps towards improving HIV service accessibility and utilisation for persons with disabilities, particularly emphasising the power of community responsibility and support; including acknowledging compounded stigma, addressing attitudinal barriers, promoting participatory responses, building political will and generating high-quality evidence to drive the continuing response. Conclusions: HIV service providers and rehabilitation professionals alike must recognise the two-way relationship between HIV and disability, and their multiple overlapping vulnerabilities and stigmas. Persons with disabilities demand recognition through practical steps to improve HIV service accessibility and utilisation in a manner that recognises their vulnerability and facilitates retention in care and adherence to treatment. In order to promote lasting change, interventions must look beyond the service delivery context and take into account the living circumstances of individuals and communities affected by HIV and disability. Persons with disabilities are vulnerable to HIV infection but have historically been excluded from HIV and AIDS services, including prevention education, testing, treatment, care and support. Fundamental change is needed to address practical and attitudinal barriers to access, including provider training. Rehabilitation professionals and HIV service providers alike must acknowledge the two-way relationship between HIV and disability: people with disability are vulnerable to HIV infection; people with HIV are increasingly becoming disabled. Peer participation by persons with disabilities in the design and implementation of HIV services is crucial to increasing accessibility. Addressing political will (through the National Strategic Plan for HIV) is crucial to ensuring long-term sustainable change in recognizing and responding to the heightened vulnerability of people with disability to HIV. [ABSTRACT FROM AUTHOR]

Introduction: Suicide is globally a severe problem with an estimated 700.000 deaths annually. Six of the 10 countries with the highest suicide rates worldwide are in Africa, though, reliable statistics are scarce. Method: In this qualitative interview study in Uganda, we analysed the stories of 16 people admitted to hospital following a serious suicide attempt. We focussed especially on each person's decision process towards their resolution to attempt suicide. Findings: Despite the huge heterogeneity of the narratives, we could identify problems regarding the sense of belonging and mattering in all the stories. Both the sense of belonging and mattering have been related to suicidal behaviour in earlier theories, but they were never studied together or under consideration of the influence of this specific cultural context. We found that the participants' sense of belonging and mattering to a large degree was influenced by their traditional communalistic context with a worldview where the line between the natural and spiritual world was blurry. Conclusion: This kind of knowledge could be a valuable source for health professionals in their treatment of suicidal persons; it could direct their approach to the core of each person's relational problems and meaning-making, which is crucial for their decisions with regard to suicide. [ABSTRACT FROM AUTHOR]

The Government of Uganda (GoU) has prioritized Science, Technology, and Innovation (STI) in its pursuit of a knowledge-based economy. While scholars have identified a positive association between innovation investment and performance, the role of R&D grants and investment in the commercialization of innovations and their influence on innovation performance require further clarification. The objective of this study is to examine the contribution of R&D funding and investment to the commercialization of innovations in Uganda. A qualitative research method was employed using case study and interview approaches. This method involves gathering various types of evidence including document reviews, field visits, and interviews with key informants and focus groups. Data analysis was conducted by matching themes derived from document reviews, case studies, and interviews. The study findings highlight the need for GoU to prioritize institutional development, address structural problems to innovation input, promote talent flow, and rationally build regional knowledge value chains to improve innovation and commercialization efficiency. The Uganda National Council for Science and Technology (UNCST) must maintain momentum in gathering STI indicators to support the evidence-based formulation of effective STI policies. This study provides theoretical and policy-oriented insights by emphasizing the significance of R&D funding and investment in facilitating the commercialization of innovations in Uganda. [ABSTRACT FROM AUTHOR]

The HIV response is hampered by many obstacles to progression along the HIV care cascade, with men, in particular, experiencing different forms of disruption. One group of men, whose stories remain untold, are those who have succumbed to HIV-related illness. In this paper, we explore how next-of-kin account for the death of a male relative. We conducted 26 qualitative after-death interviews with family members of male PLHIV who had recently died from HIV in health and demographic surveillance sites in Malawi, Tanzania, Kenya, Uganda, Zimbabwe and South Africa. The next-of-kin expressed frustration about the defiance of their male relative to disclose his HIV status and ask for support, and attributed this to shame, fear and a lack of self-acceptance of HIV diagnosis. Next-of-kin painted a picture of their male relative as rebellious. Some claimed that their deceased relative deliberately ignored instructions received by the health worker. Others described their male relatives as unable to maintain caring relationships that would avail day-to-day treatment partners, and give purpose to their lives. Through these accounts, next-of-kin vocalised the perceived rebellious behaviour of these men, and in the process of doing so neutralised their responsibility for the premature death of their relative. [ABSTRACT FROM AUTHOR]

Priority setting (PS) and resource allocation during health emergencies are key factors influencing an effective response. However, there is limited understanding of how priorities and resource allocation during disease outbreaks occur and the extent to which these processes are successful. This paper, based on 23 in-depth interviews with policy makers and a review of policy and emergency preparedness documents, used a PS evaluation framework to evaluate PS for disease outbreaks in Uganda. With regard to PS for disease outbreaks in Uganda, we identified a conducive socio-political-economical context, credible institutions, formal participatory prioritisation processes, evidence informed the processes, demonstrated implementation capacity, institutional strengthening and positive health outcomes. Factors that compromised the success of PS included limited resources - especially in between disease outbreaks and unfair processes. Investment in sustaining the established prioritisation infrastructure to oversee preparedness activities between the outbreaks would strengthen the prioritisation process. This should be supported with health system strengthening. The framework enabled us to evaluate some aspects of PS during disease outbreaks. The framework's inability to evaluate all aspects, and reported as opposed to actual PS calls for the integration of evaluation throughout the planning and implementation process to ensure validity and continuous implementation of improvement strategies. [ABSTRACT FROM AUTHOR]

Drawing on findings from a two-year in-depth qualitative study conducted in three rural areas in Uganda, this paper describes the ‘systematic structuring of vulnerability’ arising from young women's experiences of economic insecurity, and the impact this has on sexual decision-making and practices. It describes economic insecurity within young people's households, perceived gaps in parental provision for young women's basic needs, and the restrictions experienced by young women and men when trying to generate their own income. By examining the links between these experiences of economic vulnerability and young people's sexual decision-making and practices, this paper offers important pointers to the development of future approaches to sexual health programming which incorporate strategies to enhance young people's independent income generation opportunities and reduce their experiences of economic insecurity at home. [ABSTRACT FROM AUTHOR]

In the past few years, Africa has joined the rest of the world as an active participant in the Open Educational Resource (OER) movement with a number of home-grown and externally driven initiatives. These have the potential to make an immense contribution to teaching and learning in Sub-Saharan Africa (SSA). However, certain barriers prevent full participation. This paper reports on qualitative research that sought to investigate SSA's readiness to adopt OERs. This study involves three case studies based in higher education institutions involved in OER projects and located in Kenya, Uganda and South Africa. Contrary to the popular belief, findings indicate that low technological levels in Africa do not necessarily impede the adoption of such educational technologies; the real challenges facing the readiness to adopt OERs appear to be related to socio-economic, cultural, institutional and national issues. This paper argues for a complete mind shift in how people perceive OERs. It also proposes raising awareness of OERs at all levels, involving institutions and government, versioning OERs for the African context and conducting more research on OER adoption. [ABSTRACT FROM AUTHOR]

Non-communicable diseases including type 2 diabetes (T2D) are increasing rapidly in most Sub-Saharan African (SSA) countries like Uganda. Little attention has been given to how patients with T2D try to achieve treatment when the availability of public health care for their disease is limited, as is the case in most SSA countries. In this paper we focus on the landscape of availability of care and the therapeutic journeys of patients within that landscape. Based on fieldwork in south-western Uganda including 10 case studies, we explore the diabetes treatment options in the area and what it takes to access the available treatment. We analyse the resources patients need to use the available treatment options, and demonstrate that the patients’ journeys to access and maintain treatment are facilitated by the knowledge and support of their therapy management groups. Patients access treatment more effectively, if they and their family have money, useful social relations, and knowledge, together with the capacity to communicate with health staff. Patients coming from households with high socio-economic status (SES) are more likely to have all of these resources, while for patients with low or medium SES, lack of economic resources increases the importance of connections within the health system. [ABSTRACT FROM PUBLISHER]

This article analyses the process of institutionalisation among Ugandan opposition parties and highlights the tensions at play between party institutionalisation and broader party goals in authoritarian settings. Based upon qualitative research conducted between 2016 and 2023, we offer a historical analysis of the steps towards institutionalisation – understood as a process, rather than a state – taken by two Ugandan parties: the Forum for Democratic Change (FDC) and the Democratic Party (DP). Uganda features historical parties such as the DP that were severely weakened by the 'Movement era' but endured despite losing ground, and newer opposition forces, such as the FDC, that proved relatively stronger despite being divided over the question of building party structures, thus providing an interesting case study. Ultimately, this article demonstrates the complex, and at times conflicting, implications of institutionalisation for opposition parties' ability to achieve their objectives in an authoritarian regime. [ABSTRACT FROM AUTHOR]

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This paper is an analysis of the social interaction between drug sellers, their clients and local health care workers within a medical trial that introduced rapid diagnostic tests for malaria into private sector drug shops in Mukono District, Uganda. It locates the introduction of a new technology to test blood and a system of referral within the context of local concerns about the choice and evaluation of treatment; and the socially legitimated statuses, roles and hierarchies within the local health care system. Based on the multi-layered interpretation of 21 focus group discussions, we describe three key aspects of the trial central to local interpretation: openly testing blood, supervisory visits to drug shops and a new referral form. Each had the potential to shift drug shop vendors from outsider to insider of the formal health service. The responses of the different groups of participants reflect their situation within the health care system. The clients and patients welcomed the local availability of new diagnostic technology and the apparent involvement of the government in securing good quality health services for them from providers with often uncertain credentials. The drug shop vendors welcomed the authorization to openly test blood, enabling the demonstration of a new skill and newfound legitimacy as a health worker rather than simple drug seller. Formal sector health workers were less enthusiastic about the trial, raising concerns about professional hierarchies and the maintenance of a boundary around the formal health service to ensure the exclusion of those they considered untrained, unprofessional and untrustworthy personnel. [ABSTRACT FROM PUBLISHER]

This collaborative research study arose in response to the United Nations Sustainable Development Goals 2 and 3, which have amongst their targets an aim to eradicate preventable deaths in children under five years old. The research is founded on the aims of the Global Agenda for Social Work and Social Development which aims at strengthening the social work profession through linkages between global challenges and local responses. To address these issues through nutritious child feeding, it was essential to understand the views and experiences of SW and social development practitioners involved with child feeding practices. Through an online qualitative survey and reflexive thematic analysis, we explored the views and experiences of practitioners working with the Uganda Red Cross Society. Three themes were developed from analysis of the data: Lifestyle Choices & Restrictions; Limited Resources & Facilities; and Knowledge & Education. A reflection on the challenges encountered and advancing international social work through engagement with the Global Agenda are also presented. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) violates women's human rights and is a serious public health concern. Historically strategies to prevent IPV have focussed on individuals and their relationships without addressing the context under which IPV occurs. Primary prevention of IPV is a relatively new focus of international efforts and what SASA!, a phased community mobilisation intervention, seeks to achieve. Methods: Conducted in Kampala, Uganda, between 2007 and 2012, the SASA! Study is a cluster randomised controlled trial to assess the community-level impact of SASA! This nested qualitative study explores pathways of individual- and community-level change as a result of SASA! Forty in-depth interviews with community members (20 women, 20 men) were conducted at follow-up, audio recorded, transcribed verbatim and analysed using thematic analysis complemented by constant comparative methods. Results: SASA! influenced the dynamics of relationships and broader community norms. At the relationship level, SASA! is helping partners to explore the benefits of mutually supportive gender roles; improve communication on a variety of issues; increase levels of joint decision-making and highlight non-violent ways to deal with anger or disagreement. Not all relationships experienced the same breadth and depth of change. At the community level, SASA! has helped foster a climate of non-tolerance of violence by reducing the acceptability of violence against women and increasing individuals' skills, willingness, and sense of responsibility to act to prevent it. It has also developed and strengthened community-based structures to catalyse and support on-going activism to prevent IPV. Discussion: This paper provides evidence of the ways in which community-based violence prevention interventions may reduce IPV in low-income settings. It offers important implications for community mobilisation approaches and for prevention of IPV against women. This research has demonstrated the potential of social norm change interventions at the community level to achieve meaningful impact within project timeframes. [ABSTRACT FROM AUTHOR]

Although schools have been identified as important settings in which young people's sexual and reproductive health (SRH) can be promoted, there has been limited research into the role of teachers in delivering sex education programmes. This paper describes findings from a qualitative study of teachers' beliefs and attitudes towards young people's SRH in a Ugandan secondary school, and discusses the ways in which conservative attitudes to young people's sexual activity and an adherence to gender stereotypes can limit students' access to SRH information and services. Teachers' attitudes, beliefs and often superstitions relating to young people's sexual activity inevitably affect the content and nature of school-based sex education. Findings from this preliminary study suggest that, rather than assuming teachers act as neutral delivery mechanisms in schools, these attitudes and beliefs must be taken into consideration and addressed in the development of school-based sex education programmes. [ABSTRACT FROM AUTHOR]

In Uganda, mental health has gained increased attention in recent years, with several new initiatives to improve services. The mental health system, however, still faces many shortcomings. The aim of this paper was to explore what a range of stakeholders perceive as the main challenges facing Uganda's mental health system and the primary ways of addressing them. A total of 62 interviews and six focus groups were conducted with stakeholders drawn from national and district levels. Thematic analysis of the data was conducted using a framework analysis approach. The participants identified a number of challenges facing Uganda's mental health system, which included an outdated mental health legislation; low priority of mental health; absence of a mental health policy; inadequate integration with primary health care; staffing shortages; stigma and discrimination; and neglect of child and adolescent mental health. Various contradictory views between stakeholders, and discrepancies between knowledge, policy and practice were revealed. Recommendations included: revising the mental health legislation; finalizing the mental health policy; training primary health care workers in mental health issues; sensitization in the community; and involvement of traditional healers. There is a need for increased attention towards closing the gap between mental health policy, knowledge and practice in Uganda. [ABSTRACT FROM AUTHOR]

This paper defines the range of sexual partners chosen by out-of-school adolescents from Masaka District in rural south-west Uganda, and implications for sexual and reproductive health discussed. Data are drawn from a sexual health needs assessment using applied anthropological techniques with 31 adolescents, their parents, guardians and community leaders. Data were analysed using inductive thematic methods. Out-of-school adolescents are exposed to risk both stable and casual sexual relationships. Young men and women want a stable relationship with one reliable partner. Young men seek a 'steady' relationship with younger schoolgirls; some also seek multiple 'casual' relationships with young women easily convinced with gifts. Young women accept 'permanent' partnerships with traders or transport workers one-three years older than themselves; some accept 'casual' relationship with age mates, others have 'casual' relationships with older men. All relationships involve the exchange of gifts and money. Older partners, or 'sugar daddies', are valued, despite the knowledge they are more likely to be HIV positive, because they offer greater financial rewards than age mates. Though far less common, some older women seek relationships with younger men, but are treated with suspicion by young men, who believe they are seeking to 'infect' them 'maliciously' with AIDS. The community sees these relationships as a source of AIDS in adolescents, and condemn older men, whom they believe to be 'killing' the younger generation. Both young men and women are exposure to sexual health risk in their primary partnerships; young men in partnerships with schoolgirls who have concurrent partnerships with older men, unlikely to use condoms and young women with partners who work, and have casual relationships in urban trading centres. Health promotion encouraging partnership with age mates, discouraging sex with older partners and 100% condom use before marriage are most appropriate for out-of-school adolescents in this context. [ABSTRACT FROM AUTHOR]

This paper explores HIV patients' adherence to antiretroviral treatment (ART) in resource-limited contexts in Uganda and Ethiopia, where ART is provided free of charge. Qualitative semi-structured interviews were conducted with 79 patients, 17 peer counselors, and 22 providers in ART facilities in urban and rural areas of Ethiopia and Uganda. Interviewees voiced their experiences of, and views on ART adherence both from an individual and a system level perspective. Two main themes emerged from the content analysis: “Patients' competing costs and systems' resource constraints” and “Patients' trust in ART and quality of the patient-provider encounters.” The first theme refers to how patients' adherence was challenged by difficulties in supporting themselves and their families, paying for transportation, for drug refill and follow-up as well as paying for registration fees, opportunistic infection treatment, and expensive referrals to other hospitals. The second theme describes factors that influenced patients' capacity to adhere: personal responsibility in treatment, trust in the effects of antiretroviral drugs, and trust in the quality of counseling. To grant patients a fair choice to successfully adhere to ART, transport costs to ART facilities need to be reduced. This implies providing patients with drugs for longer periods of time and arranging for better laboratory services, thus not necessitating frequent revisits. Services ought to be brought closer to patients and peripheral, community-based healthworkers used for drug distribution. There is a need for training providers and peer counselors, in communication skills and adherence counseling. [ABSTRACT FROM AUTHOR]

This paper explores the workplace experiences of HIV-positive nurses and their attempts to manage HIV/AIDS stigma. An HIV diagnosis can have a major impact on an individual's psychological and emotional wellbeing. Moreover, caring for those suffering from chronic HIV-related illnesses comes with additional stress, which makes providing care more complex. Stigma-reduction and assisting with psychosocial support and wellbeing is an integral part of ensuring that care providers who are HIV-positive have good outcomes both for themselves and their patients. An ethnographic study with HIV-positive nurses was conducted from August 2005 to December 2007 at a Health Centre IV HIV clinic in rural Luweero district, Uganda. Data were gathered through clinical participant observation, informal conversations, recorded life histories, open-ended in-depth interviews and topical focus group discussions. Nurses are in a position to help people through negative life events, yet they may personally experience the same types of negative life events. In the absence of a system to provide support for HIV and AIDS clinical care providers, a group of HIV-positive nurses initiated a support process by creating safe spaces for interacting and seeking psychosocial support among themselves in a relatively secretive way. This process provided the nurses with a solid foundation for developing interventions to assist them through difficult times. [ABSTRACT FROM AUTHOR]

Cultural silence is frequently the outcome of deep-seated taboos regarding adults talking to children about sex and death. This paper examines the impact of cultural silence on the resilience of children orphaned by AIDS in Uganda. Cultural silence is often linked with denial. This article explores the complexities of cultural silence in terms of its causes, justifications and impacts. The findings from two small, in-depth qualitative studies among orphans who were being supported by community-based organisations in Kampala illustrate the impacts of cultural silence and disclosure on the coping ability of orphaned children. The first study involved 11 children orphaned by AIDS (four boys and seven girls, aged 12 to 17 years) and four parents widowed by AIDS (two men and two women) who were themselves living with HIV. (None of the parents interviewed were related to the orphans in the study.) In the second study, 10 HIV-positive mothers (aged 25 to 40) and nine children (six boys and three girls, aged 11 to 18) with HIVpositive mothers were interviewed. The discussion examines the findings by using a model of resilience, centred on the concepts of closeness and competence as conditions for coping. Cultural silence emerges as a risk factor that increases children's vulnerability through undermining both closeness and competence, while disclosure and openness -- the breaching of cultural silence -- are revealed as protective factors that may enhance resilience among children. [ABSTRACT FROM AUTHOR]

Background: Saving groups are increasingly being used to save in many developing countries. However, there is limited literature about how they can be exploited to improve maternal and newborn health. Objectives: This paper describes saving practices, factors that encourage and constrain saving with saving groups, and lessons learnt while supporting communities to save through saving groups. Methods: This qualitative study was done in three districts in Eastern Uganda. Saving groups were identified and provided with support to enhance members’ access to maternal and newborn health. Fifteen focus group discussions (FGDs) and 18 key informant interviews (KIIs) were conducted to elicit members’ views about saving practices. Document review was undertaken to identify key lessons for supporting saving groups. Qualitative data are presented thematically. Results: Awareness of the importance of saving, safe custody of money saved, flexible saving arrangements and easy access to loans for personal needs including transport during obstetric emergencies increased willingness to save with saving groups. Saving groups therefore provided a safety net for the poor during emergencies. Poor management of saving groups and detrimental economic practices like gambling constrained saving. Efficient running of saving groups requires that they have a clear management structure, which is legally registered with relevant authorities and that it is governed by a constitution. Conclusions: Saving groups were considered a useful form of saving that enabled easy acess to cash for birth preparedness and transportation during emergencies. They are like ‘a sprouting bud that needs to be nurtured rather than uprooted’, as they appear to have the potential to act as a safety net for poor communities that have no health insurance. Local governments should therefore strengthen the management capacity of saving groups so as to ensure their efficient running through partnerships with non-governmental organizations that can provide support to such groups. [ABSTRACT FROM PUBLISHER]

Uganda ranks first in female entrepreneurship in Africa, and Kampala is one of the country's most important urban/commercial hubs. The markets of Kalerwe, Mulagoo-Nsooba, Nakasero, Ntinda and Seguku constitute the research setting. Important trading centres, these markets are also relevant social spaces for locals to interact with each other. This research addresses Ugandan women's approaches to doing business and being entrepreneurs, offering a typology: business owner, survival entrepreneur, opportunity entrepreneur and transitional entrepreneur. Based on a qualitative methodology, 16 female entrepreneurs were interviewed during fieldwork (2019–2021). Data were collected through open-ended interviews, and a thematic analysis followed. By addressing female businesses from a postcolonial African perspective, the connections between culture and entrepreneurship are made explicit in understanding women's entrepreneurship, thus filling a gap in the existing literature which has mostly focussed on the informal/popular economies (as safe haven for victims of neoliberalism) or the African economic creativity (as panacea for development). Whether driven by necessity or opportunity, the results show that Ugandan women's entrepreneurial initiatives are grounded in cultural and social values that overcome the structural constraints they face. [ABSTRACT FROM AUTHOR]

Antibiotics are a routine part of everyday life in many contexts, contributing to the development of antimicrobial resistance (AMR). Our ethnographic research documents the ways that antibiotics have become a key part of everyday life for precariously employed urban day-wage workers living in a large informal settlement in Kampala, Uganda. We found that for many people, their daily work and ongoing health was entangled with antibiotic use; that is, people showed us how their antibiotic use cannot be separated from the realities of living in a politically, economically and environmentally degraded 'informal' landscape. Thinking through entanglement as itself a politics, we show how limited political power, inability to demand change, and inequitable access to good health care, are associated with high rates of infection and disease, precarious work, and polluted environments. Antibiotics, we argue, have become a way to negotiate the inequalities written into these informal urban landscapes; their use entangled with ongoing relations with labour, environment and bodily suffering. Through this approach, we show how antimicrobials are used in society, with an attention to how vulnerabilities, risks, and forms of abandonment and exclusion shape their everyday use. Antibiotic use is entangled with everyday life in informal settlements, and the politics that produce 'informality'. In Kampala today, the entanglement of antibiotics with life in informal settlements reveals how forms of urban segregation, life in 'slums' and their everyday acceptance, shape the pathways and uses of antimicrobials. [ABSTRACT FROM AUTHOR]

Medical internship is a key period for doctors' individual career planning and also a transition period for the broader labour market. We aimed to understand the complex set of factors influencing the career intentions and decisions of junior doctors, post-internship in Kenya and Uganda. We conducted semi-structured interviews with 54 junior medical officers and 14 consultants to understand doctors' internship experiences and subsequent employment experiences. We analysed the data using a mix of a direct content approach, informed by an internship experience and career intentions framework developed primarily from high-income country literature, alongside a more inductive thematic analysis. Echoing the internship experience and career intentions framework, we found that clinical exposure during internship, work–life balance, aspects of workplace culture such as relationships with consultants and other team members, and concerns over future job security and professional development all influenced Kenyan and Ugandan doctors' career preferences. Additionally, we added a new category to the framework to reflect our finding that interns might want to 'fill a health system gap' when they choose their future careers, based on what they witness as interns. However, often career intentions did not match career and employment decisions due to specific contextual factors, most importantly a shortage of job opportunities. We have shown how internship experiences shape medical doctors' career intentions in Kenya and Uganda and highlighted the importance of job availability and context in influencing doctors' career choices. [ABSTRACT FROM AUTHOR]

Cardiovascular disease (CVD) risk factors are increasing in many sub-Saharan African countries and disproportionately affecting communities in urban slums. Despite this, the contextual factors that influence CVD risk among slum communities have not been fully documented to guide interventions to prevent and control the disease. This study explored the drivers of CVD risk factors in slums in Kampala, Uganda. This qualitative study employed focus group discussions (FGDs) to collect data among slum residents. A total of 10 FGDs separate for gender and age group were held in community public places. Discussions were audio-recorded, transcribed, and transcripts analysed thematically with the aid of Atlas ti 7.0. Study themes and sub-themes are presented supported by participant quotations. Five themes highlighted the drivers of CVD risk factors in slum communities. (1) Poverty: a critical underlying factor which impacted access and choice of food, work, and housing. (2) Poverty-induced stress: a key intermediate factor that led to precarious living with smoking and alcohol use as coping measures. (3) The social environment which included socialisation through drinking and smoking, and family and peers modelling behaviours. (4) The physical environment such as the high availability of affordable alcohol and access to amenities for physical activity and healthy foods. (5) Knowledge and information about CVD risk factors which included understanding of a healthy diet and the dangers of smoking and alcohol consumption. To address CVD risk in slums, broad-ranging multisectoral interventions are required, including economic empowerment of the slum population, stress reduction and coping interventions, and alcohol legislation. Also, there is a need for community CVD sensitisation and screening as well as increasing access to physical activity amenities and healthy foods within slums. [ABSTRACT FROM AUTHOR]

Young migrants in sub-Saharan Africa are particularly vulnerable to HIV-acquisition. Despite this, they are consistently under-served by services, with low uptake and engagement. We adopted a community-based participatory research approach to conduct longitudinal qualitative research among 78 young migrants in South Africa and Uganda. Using repeat in-depth interviews and participatory workshops we sought to identify their specific support needs, and to collaboratively design an intervention appropriate for delivery in their local contexts. Applying a protection-risk conceptual framework, we developed a harm reduction intervention which aims to foster protective factors, and thereby nurture resilience, for youth 'on the move' within high-risk settings. Specifically, by establishing peer supporter networks, offering a 'drop-in' resource centre, and by identifying local adult champions to enable a supportive local environment. Creating this supportive edifice, through an accessible and cohesive peer support network underpinned by effective training, supervision and remuneration, was considered pivotal to nurture solidarity and potentially resilience. This practical example offers insights into how researchers may facilitate the co-design of acceptable, sustainable interventions. [ABSTRACT FROM AUTHOR]

Uganda continues to have poor maternal health indicators including a high maternal mortality ratio. This paper explores community level barriers affecting maternal health in rural Wakiso district, Uganda. Using photovoice, a community-based participatory research approach, over a five-month period, ten young community members aged 18-29 years took photographs and analysed them, developing an understanding of the emerging issues and engaging in community dialogue on them. From the study, known health systems problems including inadequate transport, long distance to health facilities, long waiting times at facilities and poor quality of care were confirmed, but other aspects that needed to be addressed were also established. These included key gender-related determinants of maternal health, such as domestic violence, low contraceptive use and early teenage pregnancy, as well as problems of unclean water, poor sanitation and women’s lack of income. Community members appreciated learning about the research findings precisely hence designing and implementing appropriate solutions to the problems identified because they could see photographs from their own local area. Photovoice’s strength is in generating evidence by community members in ways that articulate their perspectives, support local action and allow direct communication with stakeholders. [ABSTRACT FROM AUTHOR]

The Batwa (Twa), an Indigenous People of southwest Uganda, were evicted from their ancestral forest lands in 1991 due to establishment of the Bwindi Impenetrable Forest. This land dispossession forced Batwa to transition from a semi-nomadic, hunting-gathering livelihood to an agricultural livelihood; eliminated access to Indigenous food, medicines, and shelter; and shifted their healthcare options. Therefore, this exploratory study investigated why Batwa choose Indigenous or biomedical treatment, or no treatment, when experiencing acute gastrointestinal illness. Ten gender-stratified focus groups were conducted in five Batwa settlements in Kanungu District, Uganda (n = 63 participants), alongside eleven semi-structured interviews (2014). Qualitative data were analysed thematically, using a constant comparative method. Batwa emphasised that health-seeking behaviour for acute gastrointestinal illness was diverse: some Batwa used only Indigenous or biomedical healthcare, while others preferred a combination, or no healthcare. Physical and economic access to care, and also perceived efficacy and quality of care, influenced their healthcare decisions. This study provides insight into the Kanungu District Batwa's perceptions of biomedical and Indigenous healthcare, and barriers they experience to accessing either. This study is intended to inform public health interventions to reduce their burden of acute gastrointestinal illness and ensure adequate healthcare, biomedical or Indigenous, for Batwa. [ABSTRACT FROM AUTHOR]

Transactional sex is a topic within HIV research that is relatively undertheorised and lacking consensus. In this study, it is understood as the implicit, non-marital, non-commercial exchange of sex for material goods or social status, and we examine the phenomenon among youth. Within the existing literature, the paradigms of sex-for-survival and sex-for-consumption emerge, representing differing senses of agency, particularly among young women. Based on interviews with human service providers in Kampala, Uganda, we consider the latter paradigm, examining how providers frame transactional sex against the political-economic backdrop of consumer culture, including the mainstreaming of communication technology in youths' lives. We also examine providers' depictions of available models of response, focused mainly on HIV prevention, in the context of international and national policies and politics. This study aims to situate analyses of transactional sex within political-economic context, considering how structural shifts toward neoliberalism have shaped both this phenomenon of behavioural health, and the existing models of response. [ABSTRACT FROM AUTHOR]

Social workers across the globe are at the forefront of tackling elder abuse, as they are committed to social justice, human rights, and respect for human diversity. However, research on social workers' response to elder abuse in Sub-Saharan Africa remains scarce. This qualitative study assessed how social workers in Uganda have responded to elder abuse. In-depth semi-structured interviews were used to collect data from 21 social workers. The findings suggest that social work in Uganda has not asserted itself in the fight against elder abuse. The few social work interventions aimed at reducing the risk of elder abuse are mostly anti-poverty undertakings. Social workers mainly discussed the drivers of elder abuse, correlating them with their interventions, and challenges such as the absence of a specific law for older people, ignorance of older people's rights, and the underreporting of elder abuse. This study found that advocacy is needed for specific laws that protect the rights of older people, along with public awareness campaigns and the establishment of a research center for aging and later life. [ABSTRACT FROM AUTHOR]

Achieving universal HIV test-and-treat will require targeted interventions for those with worse outcomes, including advanced HIV. We conducted qualitative, semi-structured interviews with healthcare workers (HCWs) and people living with HIV (PLWH) at 5 HIV clinics in Kampala, Uganda, to understand barriers to care. PLWH enrolled started/restarted on HIV treatment ≤3 months prior. PLWH were grouped as 1) "ART-experienced" or those restarted therapy after ≥12 months off, 2) ART naïve CD4 count <100 cells/uL "late presenters" or 3) ART naïve CD4 count >350 cells/uL "early presenters". In-depth interviews were conducted in Luganda, translated, and transcribed verbatim. Between May and August 2017, 58 PLWH and 20 HCWs were interviewed. High stigma and low social support emerged as themes among all as barriers to care. Alcohol abuse was a barrier for men. Fear of domestic violence and abandonment were barriers for women, limiting disclosure of their HIV status to their male partners. Clinic factors such as rapport with staff, distance, efficiency, and privacy impacted care. Future interventions to decrease delayed ART initiation should target stigma and social support. Assisted disclosure, contact tracing, and alcohol abuse treatment should be implemented. Strengthening client support, reducing wait times, and increasing privacy assurances would improve care-seeking behaviors. [ABSTRACT FROM AUTHOR]

We investigated patterns and drivers of alcohol misuse and illicit drug use among young fisherfolk. We undertook this study in fishing communities on Koome Island, Lake Victoria, Uganda, from December 2017–July 2018. We conducted six group discussions with men (3) and women (3) and 33 in-depth interviews with: young people [users (n = 10); non-users (n = 2)], local leaders (n = 3), health workers (n = 2), parents (n = 5), alcohol/illicit drugs sellers/distributors (n = 5), law enforcement officers (n = 5). We sampled participants using purposive and snowball strategies. Interview themes included: knowledge, experiences and perceptions of alcohol use/illicit drug use, HIV risk behaviour and harm reduction. We mapped alcohol/illicit drug use outlets using a Geographic Information System to capture density, distribution and proximity to young people's homes. We coded and analysed qualitative data using thematic content analysis. Motivations for heavy drinking and illicit drug use were multifaceted and largely beyond individual control. Key contextual determinants included social norms around consumption (acceptability), price (affordability), and ease of purchase (availability). Prevention and harm reduction interventions to tackle alcohol misuse and illicit drug use should be aimed at the structural rather than individual level and must be conducted in tandem with strategies to control poverty and HIV. [ABSTRACT FROM AUTHOR]

Little is known about how teachers' personal sexual experiences influence their motivations and practices when teaching sexuality education. Cultural schema theory was used to explore teachers' personal experience of the onset of sexual activity and explain how sexuality education teaching is influenced by such experiences. In-depth interviews were conducted with 40 secondary school teachers in Kampala, Uganda. The interviews were transcribed verbatim and analysed using principles of grounded theory. Findings show that while teachers' personal experience of sexual initiation did not directly align with the content of their messages, due to the centrality and evocative function of these schemas these experiences strengthened teachers' motivation to teach sexuality education because they enabled them to empathise with students. The study concludes that teachers' personal experiences of sexual initiation provide intrinsic motivation for teaching sexuality education. The inclusion of dialogues and activities which encourage self-reflexivity in teacher education and training may improve the delivery of sex, sexuality and relationships education. [ABSTRACT FROM AUTHOR]

There is limited information about the use of on-demand and daily pre-exposure prophylaxis (PrEP) among adolescents and young people (AYP) in sub-Saharan Africa. We explored perceptions of both regimens among 14- to 19-year-olds perceived to be at high risk of HIV infection in Kampala, Uganda, using qualitative data collection methods. Data were analysed by theme and interpreted based on constructs from the framework of acceptability. Although there were no noticeable gender differences in preferences for a particular regimen, acceptability of PrEP depended on individual AYP sexual behaviour at the time of the study. Those who perceived themselves to be at increased risk of acquiring HIV preferred using daily PrEP, citing the consistency that comes from taking a pill daily and which they considered to be efficacious and safe. AYP who had less frequent sex preferred on-demand PrEP because it would enable them to "plan for sex". However, both groups perceived taking daily PrEP to be a burden, which was an impediment to acceptance of this form of PrEP. AYP anticipated that daily pill taking would be very stressful, requiring a lot of effort and would interrupt their daily routine. Therefore, while both on-demand and daily PrEP were acceptable and beneficial to these AYP, preferences for either regimen depended on self-perceived risk. Thus, oral PrEP use should be tailored to end-user preferences and risk profiles. [ABSTRACT FROM AUTHOR]

Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits. [ABSTRACT FROM PUBLISHER]

In Uganda, the uptake of maternal health services is very low, with only 41.1% of pregnant adolescent girls attending the eight antenatal visits that are recommended by the World Health Organisation. Uptake of maternal health services is essential in reducing the current level of adolescent pregnancies as well as its adverse effects on adolescent mothers and their babies, such as preterm deliveries, prolonged labour, death during pregnancy, and childbirth. No previous study has described pregnant adolescents' experiences with maternal health services in Uganda. This study aimed to describe the barriers and strategies needed to improve maternal health services among pregnant adolescents in Uganda. Data were collected in the Naguru Teenage Information and Health Centre in Uganda through individual interviews involving 31 pregnant adolescents. The transcribed interviews were inductively analysed through content analysis. The pregnant adolescents described difficulty in reaching, as well as lack of financial support to visit, the Naguru Teenage Information and Health Centre, which is a clinic providing youth friendly services. Feelings of being discriminated against and disrespected by health workers, and lack of privacy when receiving health services was major barriers that hindered their access to maternal health services. Pregnant adolescents' access to these services can be enhanced by improving health workers' working conditions, accelerating community and health worker awareness on ways to mitigate these barriers, and developing policies that encourage men's involvement in maternal health services. Adolescents in Uganda face considerable barriers to accessing improved and quality maternal health services. To mitigate these barriers, according to the adolescents, considerable efforts are required to tackle health workers' working conditions and sensitise the community on the importance of, as well as securing the availability of, maternal health services for pregnant adolescents. Future research should focus on pregnant adolescents who receive family support. [ABSTRACT FROM AUTHOR]

Genetic results are usually not returned to research participants in Uganda despite their increased demand. We report on researchers' perceptions and experiences of return of individual genetic research results. The study involved 15 in-depth interviews of investigators involved in genetics and/or genomic research. A thematic approach was used to interpret the results. The four themes that emerged from the data were the need for return of individual results including incidental findings, community engagement and the consenting process, implications and challenges to return of individual results. While researchers are willing to return clinically significant genetic results to research participants, they remain unsure of how this should be implemented. Suggestions to aid implementation of return of results included reconsenting of participants before receiving individual genetic results and increasing access to genetic counseling services. Community engagement to determine community perceptions and individual preferences for the return of results, and also prepare participants to safely receive results emerged as another way to support return of results. Researchers have a positive attitude toward the return of clinically significant genetic results to research participants. There is need to develop national guidance on genetic research and also build capacity for clinical genetics and genetic counseling. [ABSTRACT FROM AUTHOR]

There is growing interest in studying inequitable gender norms and their impact on health and wellbeing, particularly among adolescents. Studies have shown that discriminatory gender norms limit girls' access to power within their families and communities, reduce their educational and economic opportunities, and alter their own aspiration and ambitions for their lives. This comparative qualitative study sought to understand how gender norms manifest themselves in the lives of adolescents in two distinct settings: Uganda and Colombia. A total of 133 young people aged 13–21 years from Colombia and 109 from Uganda participated in either focus group discussions or individual semi-structured interviews in May 2017. Results reveal similarities and differences in how norms are learned, reinforced and resisted and how intersecting social factors affect the ability of adolescents to facilitate norm change. A key similarity was the primacy of parents and peers in the transmission and reinforcement of gender norms. However, setting-specific material and structural factors shaped the manifestation of power and policing of gender norms as well as the ability of young people to contest them. Lessons are identified for the future design of effective gender transformative interventions with adolescents. [ABSTRACT FROM AUTHOR]

Background: Non-communicable diseases are on the rise across sub-Saharan Africa. The region has become a targeted growth market for sugar-sweetened beverages, which are associated with weight gain, cardiovascular diseases and diabetes. Objective: To identify politico-economic factors relevant to nutrition-related fiscal policies, and to draw lessons regarding strategies to strengthen sugar-sweetened beverages taxation in the region and globally. Methods: We collected documentary data on policy content, stakeholders and corporate political activity from seven countries in east and southern Africa augmented by qualitative interviews in Botswana, Namibia, Kenya and Zambia, and stakeholder consultations in Rwanda, Tanzania and Uganda. Data were analysed using a political economy framework, focusing on ideas, institutions, interests and power, and a 'bricolage' approach was employed to identify strategies for future action. Results: Non-communicable diseases were recognised as a priority in all countries. Kenya, Zambia, Rwanda, Tanzania and Uganda had taxes on non-alcoholic beverages, which varied in rate and tax base, but appeared to be motivated by revenue rather than health concerns. Botswana and Namibia indicated intention to adopt sugar-sweetened beverage taxes. Health-oriented sugar-sweetened beverage taxation faced challenges from entrenched economic policy paradigms for industry-led economic growth and was actively opposed by sugar- sweetened beverage-related industries. Strategies identified to support stronger sugar-sweetened beverage taxation included shifting the economic discourse to strengthen health considerations, developing positive public opinion, forging links with the agriculture sector for shared benefit, and leadership by a central government agency. Conclusions: There are opportunities for more strategic public health engagement with the economic sector to foster strong nutrition-related fiscal policy for non-communicable disease prevention in the region. [ABSTRACT FROM AUTHOR]

With the under-five child mortality rate of 46.4 deaths per 1000 live births, Uganda should accelerate measures to reduce child deaths to achieve the Sustainable Development Goal 3. While 60–70% of frontline health services are provided by the private sector, many low-level private health facilities (LLPHF) are unregistered, unregulated, and often miss innovative and quality improvement strategies rolled out by the Ministry of Health. LLPHF need support in order to provide quality health care. To explore the perspectives of health workers and policy makers on external support given to LLPHF providing health care for children in Mbarara District, Uganda. We carried out a qualitative study, in which 43 purposively selected health workers and policy makers were interviewed. The issues discussed included their views on the quantity, quality, factors determining support received and preferred modalities of support to LLPHF. We used thematic analysis, employing an inductive approach to code interview transcripts and to identify subthemes and themes. The support currently provided to LLPHF to manage childhood illnesses is inadequate. Health providers emphasised a need for technical capacity building, provision of policies, guidelines and critical supplies as well as adopting a more supportive supervisory approach instead of the current supervision model characterised by policing, fault finding and apportioning blame. Registration of the health facilities and regular submission of reports as well as multi-stakeholder involvement are potential strategies to improve external support. The current support received by LLPHF is inadequate in quantity and quality. Capacity building with emphasis on training, provision of critical guidelines and supplies as well as and supportive supervision are key strategies for delivering appropriate external support to LLPHF. [ABSTRACT FROM AUTHOR]

Results-based financing initiatives have been implemented in many countries as stand-alone projects but with little integration into national health systems. Results-based financing became more prominent in Uganda's health policy agenda in 2014–2015 in the context of the policy imperative to finance universal health coverage. To explore plausible explanations for the increased policy interest in the scale-up of results-based financing in Uganda. In this qualitative study, information was collected through key informant interviews, consultative meetings (2014 and 2015) and document reviews about agenda-setting processes. The conceptual framework for the analysis was derived from the work of Sabatier, Kingdon and Stone. Four alternative policy arguments can explain the scale-up of results-based financing in Uganda. They are: 1) external funding opportunities tied to results-based financing create incentives for adopting policies and plans; 2) increased expertise by Ministry of Health officials in the implementation of results-based financing schemes helps frame capacity accumulation arguments; 3) the national ownership argument is supported by increased desire for alignment and fit between results-based financing structures and legitimate institutions that manage the health system; and 4) the health systems argument is backed by evidence of the levers and constraints needed for sustainable performance. Shortages in medicines and workforce are key examples. Overall, the external funding argument was the most compelling. The different explanations illustrate the strengths and the vulnerability of the results-based financing policy agenda in Uganda. In the short term, donor aid has been the main factor shifting the policy agenda in favour of results-based financing. The high cost of results-based financing is likely to slow implementation. If results-based financing is to find a good fit within the Ugandan health system, and other similar settings, then policy and action are needed to improve system readiness. [ABSTRACT FROM AUTHOR]

District Health Management Teams (DHMTs) are often entry points for the implementation of health interventions. Insight into decision-making and power relationships at district level could assist DHMTs to make better use of their decision space. This study explored how district-level health system decision-making is shaped by power dynamics in different decentralised contexts in Ghana, Malawi and Uganda. In-depth interviews took place with national- and district-level stakeholders. To unravel how power dynamics influence decision-making, the Arts and Van Tatenhove (2004) framework was applied. In Ghana and Malawi, the national-level Ministry of Health substantially influenced district-level decision-making, because of dispositional power based on financial resources and hierarchy. In Uganda and Malawi, devolution led to decision-making being strongly influenced by relational power, in the form of politics, particularly by district-level political bodies. Structural power based on societal structures was less visible, however, the origin, ethnicity or gender of decision-makers could make them more or less credible, thereby influencing distribution of power. As a result of these different power dynamics, DHMTs experienced a narrow decision space and expressed feelings of disempowerment. DHMTs' decision-making power can be expanded through using their unique insights into the health realities of their districts and through joint collaborations with political bodies. [ABSTRACT FROM AUTHOR]

As part of a multicentre study on kidney disease (ARK) undertaken in Malawi, South Africa and Uganda we undertook a social science component in Uganda to gather information on people's understandings and perceptions of a diagnosis of kidney dysfunction, treatment and treatment seeking. We recruited 46 people who had been given information about kidney dysfunction and had been found to have some, usually early, signs of mild impairment. Data were collected during two in-depth interviews. Most participants had heard of the condition, but half denied knowledge of the health status of their kidneys or receiving results of tests from the clinic team. This response may have been linked to a lack of symptoms, for those with early stage kidney dysfunction. The treatment people reported receiving caused some uncertainty about condition severity. This may be because several people were treated for other conditions (such as urinary tract infections) and did not require treatment specifically for kidney disease. In our study, participants assessed illness severity based on symptoms and treatment and compared with the progression of other conditions. [ABSTRACT FROM AUTHOR]