In May 2022, we received a delegation from Karolinska Institute that is working together with the Makerere University School of Public Health. We met with Dr. Rhoda Wanyenze from Makerere University and Dr. Tobias Alfven from the Karolinska Institute to learn about their collaboration that was started as a result of the 22 years of research cooperation between Uganda and Sweden with the support of Sida. Here is what they had to share.
Interview with Dr. Rhoda Wanyenze
Prof. Rhoda, it is a pleasure to meet with you today. Can you tell us a little bit about yourself?
I am Prof. Rhoda Wanyenze and I am the Dean of the School of Public Health at Makerere University. I am also the co-chair of the working group for the Center of Excellence for Sustainable Health together with Dr Tobias from the Karolinska Institute.
Can you give us a short summary of what the School of Public Health is doing together with Karolinska Institute?
Our current collaboration with the Karolinska Institute is building on a relationship of about 22 years of collaboration in research and capacity building through PhD training. This collaboration has made a tremendous impact in terms of growing the number of PhD's and collaborative research at Makerere University. It has been beneficial for both of our institutions. We have been discussing innovations in research that we've done in Uganda that have been beneficial and have been tested in Sweden and the other way round. After all, we share some of the same challenges in health although we are thousands of miles apart.
For this current collaboration we are looking at solving the challenges around sustainable health. We have created a Center of Excellence for Sustainable Health which is a virtual center. (read more on this link: https://cesh.health/)We are looking at innovatively and creatively exploring how we can resolve the health challenges of today without hurting the future because health is determined by many things that happen outside health. Looking at the interlinkages in the Sustainable Development Goals, for example, education has an impact on health, and we also know that issues that happen within the agricultural or energy sectors also have an impact on health as they are quite intertwined.
We are trying to look beyond the focus on health as healthcare, to the broad spectrum of prevention and health promotion, where the impacts outside the sector affect what happens within health. We have just seen, for example, during COVID, where we know that whatever you are doing in health impacts other sectors outside health immensely, and the other way around is also true.
We are therefore trying to look at this in a multidisciplinary and multi sectoral way where we also touch on a broad spectrum of issues, but at the center of it is equity and not leaving certain populations behind. We are looking at populations that are most at risk of being left behind, and this could be within countries or across countries and regions. For example, right now, we have been talking about research capacity, so we are looking at research capacity within Uganda where we have had a lot of privilege and support from Sida, but we are leaving Somalia behind, so we have now started working with Somalia so that we can also get them on board and improve their research capacity.
In terms of focus for the Center, we are looking at issues across the entire life course including issues affecting children and adults so that one can have a meaningful life. We are also specifically looking at issues of sexual and reproductive health, and most recently, we're also thinking about the issues around the environment and climate and its impact on health. This has become critical, especially in some of our countries with a rapidly growing population and environmental degradation like in Uganda.
When we degrade our environment it affects us too, leading to things like food scarcity which affects our livelihoods. It also alters the dynamics of disease. We are now thinking in terms of this ecosystem where we exist, how we can coexist peacefully and that is a big part of the sustainable health we are looking at. You can't think sustainable health without thinking about the environment.
The way we are defining health today is looking at how we can ensure our health without compromising the health of future generations. We do that by not damaging the environment within which we live. Today we might be comfortable and happy, but we are leaving a problem for future generations because of our actions today.
We must ask ourselves how we can achieve good health today and tomorrow. We should focus on both the promotive and preventive aspects of health and not just clinical care but also making sure that the actions of today are not compromising the welfare of the people tomorrow. We are therefore thinking more long term so that we can consider the future generations. That is sustainability.
If you're talking about other sectors like energy and agriculture, is this going to be more of a collaborative engagement with the whole of Makerere University spearheaded by the School of Public Health?
Sustainable health comes with working across boundaries because most of the issues affecting health are outside of the health sector. We have to work with people in the energy and agriculture sectors and those working in food science and technology as food security also has an impact on health. What we're trying to do is to break the silos and work together in a collaborative way so that we can be able to achieve more impact in the livelihoods of people.
All of these disciplines and sectors have a lot of synergies in practice and when we focus on one sector alone, it is not efficient in terms of research investments, and it is also not very good in terms of outcomes. We are thinking about not only working more collaboratively within the university, but also doing research and developing tools that can help to achieve more multi sectoral activity at the level of policy and implementation. For example, in government, we can't just have health working alone and then agriculture working separately. We saw all this during the COVID pandemic, and we saw how everybody was very unhappy with the decisions we took in health. When the health sector is thinking alone, you might close another sector that is the most critical to achieving your outcomes in health. However, if you bring in other sectors and plan together then you come up with more workable solutions in terms of the interventions you should implement. That way, whatever you do in health benefits from what's happening in agriculture without one hurting the other.
COVID has perhaps given us one of those examples, but I think the same is true for many things. When you think about nutrition, it is one of the biggest challenges we have in health. We want people that are well nourished who are not eating more or less than they need to. But where does the food come from? We don't grow food in the health sector. Someone in agriculture is working on that and the people in business are actually working on it too, because there is the whole value chain around ensuring that we get to the food we need.
Uganda and Sweden are very different in terms of their societies and their health challenges. Are there synergies that you can leverage between Makerere University and Karolinska? Can you leverage these differences when it comes to research?
Actually, those differences also come with opportunities to learn. For example, we have had a team that sat down to analyze how Sweden has achieved a very low childhood mortality when in Uganda we have continued to have a very high mortality rate. It's not just a difference of investments that one country is rich and the other country is not, but rather the difference in approaches and interventions that can be adapted to the local context. We are exploring adapting interventions that can help us to improve childhood survival in Uganda. In the workshop we had, we brought in critical stakeholders, not just health workers, but the communities to consult them on how the interventions can be adapted here so that we can achieve the same results.
We have very strong community systems in Uganda that can be utilized to mobilize households to improve childcare, nutrition and immunization coverage so that our children are healthier. We can activate some of those systems using the experiences that we have seen in Sweden and then the next step is to jointly implement and evaluate the intervention.
We also have innovations here in Uganda that are good and can be tested in other countries. For example, one of our colleagues from Karolinska has been sharing an experience of testing the use of mobile technology to help people that need rehabilitative services in Uganda, because they have to walk very long distances to access the health centers. Increasingly, we are now using mobile phones to deliver information about health and what you should do for your patients. They are now also testing a similar intervention in Sweden, so there are a lot of opportunities to learn from one another.
**************************
Interview with Tobias Alfven
Tell us a little bit about yourself. Who are you and what do you do?
I am Tobias Alfven, an Associate Professor and a pediatrician from Karolinska Institute, and I am co-chairing the working group for the Center of Excellence for Sustainable Health together with Professor Rhoda Wanyenze from Makerere University at the School for Public Health.
Karolinska and Makerere University have been in this partnership for some years, especially through our Research Cooperation supported by Sida. What your benefit from this collaboration?
There are many benefits. I think for Karolinska where I come from and for Makerere, it's our joint collaboration that has led to so many good findings for Sweden, for Uganda and for the world, because we have worked together for 22 years with this long-standing collaboration, we have not had to rush. We knew that we had to work hard, but also that we have something long standing that we can work on and build on and that builds trust. So, we know that we can trust the colleagues from Uganda and the colleagues from Uganda know that they can trust us.
After more than 20 years of collaboration with Sida support, it is time to move on to the next phase and that's why we together have created the Center of Excellence for Sustainable Health because the health challenges and the global challenges today in the world, that's not something that you can work on alone to create a sustainable and healthy planet. You have to work together.
This is a great way of moving forward. How do you think Karolinksa Institute and Makerere University can benefit from this collaboration? Sweden and Uganda are very different, and you are talking about sustainable health. How do you think you can benefit from each other in this?
I think it's right that we are not the same, but all contexts are different, even cities and neighborhoods in Sweden are different, and I think if you have global challenges you have to work together on a global scale and there are many ideas that we get from the colleagues here at Makerere that we now use back in Sweden and the other way around. If you stay within your own boundaries and work, you don't get these new great ideas.
It is great that we can now meet again in person for the first time in three years, and that's why it's so nice to be here. Meeting our counterparts and discussing with them how we can establish a long-term collaboration so we can continue working together.
Our first project is the Center of Excellence. The idea is 3 years old, and we have been working together now for two years.
Is there any anything that has come out of it so far? Is there research currently being done under the Centre of Excellence?
Mostly we have been working in research and we have also been working on a capacity building project. Under this collaboration we have established the Managing Innovation for Sustainable Health for fragile settings (MISH project). This is a collaboration between Makerere University, Karolinska Institute, Benadir University in Somalia and the Kinshasa School of Public Health in the Democratic Republic of Congo. We have had cohorts of between 20 and 25 students from different sectors working on sustainable health and very concrete ideas of how they can make a change and learn to be an innovator using a sustainable health approach to make a difference. This has been a great success in the College at Makerere and now we will have an event tomorrow where we will gather all the participants in the second cohort. Karolinska is here as facilitators for this program.
How long do you expect this collaboration to last? Is there a time limit?
We have had a workshop with the working group from Makerere University and Karolinska regarding the Center of Excellence for Sustainable Health. We discussed the importance of making this collaboration sustainable and addressing challenges that we need to tackle. We want to find solutions for long term challenges, but of course if we don't deliver and if we don't make a difference, we will not continue. It is important all the time to evaluate what we do. So far, in two years, we have delivered a lot and we are planning now for the future of our collaboration. Hopefully we will make the world a better place for our children and our grandchildren.
How long does each cohort run for?
There are different programs. The first program is the Managing Innovation for Sustainable Health which is a one-year program, and now we're running it for the second time currently, and we have just got approval that we shall continue next year as well. Then we have another program which is called the SDGCap where we are working with the same countries by trying to build broader sustainable societies. At the moment it is a two-year program, but it's a bit broader.
The smaller one-year program is financed by the Swedish Institute and the longer program is financed by Sida and then we have some seed funding from smaller funders as well. We also have funding from Makerere University that funds part of the programs.
Compiled by Andrew Byaruhanga, Communications Officer, Embassy of Sweden Kampala
