Background to Child Health and Development Centre.
Child Health and Development Centre (CHDC) was established as a National Capacity Building Unit for Child Survival and Development in 1989 in the then Faculty of Medicine, Makerere University. This was as a result of the growing recognition for the need to mobilize, and more systematically and effectively involve available expertise within the university, in community based activities to promote sustainable child survival and development. This necessitated strong interdisciplinary linkages, training at community level, methods of promoting community empowerment, improved relations between communities and government support services as well as action oriented operational research, monitoring and evaluation mechanisms.
Through research, training and community engagement, CHDC created opportunities for effective interaction and partnerships between the university (staff and students), communities (involving the people that the capacity building program was to benefit) and the government (from district officials to policy makers). The focus was on the areas of primary health care, primary and non-formal education, nutrition, water and sanitation and women and children’s well-being and development more generally.
CHDC has over the years evolved into a fully fledged university department in the School of Medicine, College of Health Sciences with eight full time academic staff. It continues to promote a holistic approach to children, women and communities’ health needs and well-being through interdisciplinary approaches to research and training at community level, promoting community empowerment as well as creating opportunities for effective interaction and partnerships between the university, communities and government. In addition CHDC also continues to strengthen research capacity through research and research training. CHDC’s work is premised on the conviction that children, women and communities’ health needs and well-being go beyond biomedicine, to encompass complexities in families, communities, institutions of care and public policies. This is very much reflected in the research and training projects undertaken by CHDC staff.
Strengthen research capacity through research training.
Within the College of Health Sciences, CHDC staff trains and supervises Health Science students on the COBERS program on how to: work closely with community members and district officials in assessing the health situation at the community level and in assisting the community and district officials at that level in identifying their health priority needs and problems. The program also teaches students to analyze the causes of the problems and formulate possible approaches for their solutions. This involves working with the people at the community level to enable and empower them to solve their own problems and appraising the outcomes of the action-oriented research to guide future direction, sustainability and replication of such efforts. During the training, students are equipped with skills in identifying local health problems, seeking scientifically based but simple solutions, and assisting in implementation, monitoring and evaluation mechanisms at community level.
The Tororo Community Health (TORCH) project was a 15 year collaborative project between CHDC and the universities of Copenhagen and Arhus in Denmark. The project was funded by Danida. In response to persistent inequities in the national health systems and the existence of effective interventions that were not reaching children, women and communities that need them most in addition to the difficulties in effectively delivering services and mobilizing communities to utilize them, CHDC in collaboration with the universities of Copenhagen and Arhus designed and implemented a capacity building project known as the Tororo Community Health (TORCH) Project that focused on the dynamics of the changing health systems; the health system interaction with local communities and the changing health needs of children, women and the community as a whole. The Project sought to contribute to better health by building confidence and knowledge among health workers and local communities over a period of 15 years.
The Project adopted a multi-disciplinary approach including disciplines such as health system analysis, health economics, medical anthropology and epidemiology, with a primary focus on women and children. The broad-based approach involved long-term engagement, capacity development and creating opportunities for effective interaction and partnerships between the university, communities and government. CHDC staff sat with the District Health Team at their regular planning meetings and in later evaluations and follow-up processes. They provided training in the information technology necessary to handle data from the health units and developed a training package to strengthen the Health Management Information System. The research teams went out to communities and listened to people’s concerns, experiences, needs and expectations. The most important outcome of the Project was the individual and institutional capacity developed at Child Health and Development Centre. The Centre’s staff continues to work with other districts throughout the country and to train the next generation of health care and social science professionals in community-oriented approaches.
The TORCH Project inspired the establishment of the Working Group on Social and Political Aspects of HIV/AIDS in Uganda, based at the Child Health Development Centre. This was a network of anthropologists conducting research in East Africa. The first working group meeting was held at the Child Health and Development Centre (CHDC), on 20 August 2007. The meeting was attended by 11 researchers, Ugandan and foreign-based. All were working on non-biomedical aspects of AIDS treatment in Uganda. During this meeting additionally researchers were identified, as potential contributors to a working group.
The importance of linking research-based discussions with the policy makers, donors, and service providers in AIDS treatment was stressed. Successful collaboration at the district levels by the TORCH project has taken place for more than a decade. Also, in the Kampala AIDS network of government, donors, and NGOs, researcher-practitioner collaboration has taken place. This includes a workshop held at CHDC at the initiation of the ARV roll-out in the country (2004) and a pair of workshops held in Denmark and Sweden with the collaboration of Ugandan and Scandinavian-based researchers (supported by AIDSNET, NAI and RUC).
Training through ChildMed (Quality Medicine Use for Children in Uganda)
The overall objective of the ChildMed Project was to contribute to improving the quality of medicine use for children in Uganda through multi-disciplinary research and to build capacity by research training. The research plan was developed jointly by Ugandan and Danish participants during a workshop in Kampala. It was hypothesized that appropriate medicinal treatment depends on four key dimensions: coherency of policies relevant to children’s medicine use; accurate diagnostic procedures; availability and adequate use of appropriate medicines; effective communication of perceptions and knowledge. These dimensions were explored through case studies of four contrasting medication scenarios: Respiratory diseases, epilepsy, HIV/AIDS and worms (schistosomiasis). The project activities fell into 3 phases with each phase ended with a workshop for relevant actors. Outputs of the project comprise of 4 Masters Degrees, 4 PhD degrees, 2 completed post-docs, situational analyses, policy briefs, 23 scientific papers and a book. To support ownership, sustainability and implementation the findings were shared with Ugandan stakeholders at different levels: Politicians, policy makers, health care staff, NGOs and researchers and the researched population. Research dissemination also took place through conference presentations and publications in international journals.
CHDC has had research and training collaborations with many different international and national agencies including; ICF/MACRO, AMREF-Uganda, Belgian Technical Cooperation, CARE International (U), Christian Children Fund (CCF), DANIDA, Delivery of Improved Services for Health (DISH), Department For International Development (DFID), PATH, GOAL (Ireland), GTZ, OXFAM, RUWASA, SIDA, Support for Analysis and Research in Africa (SARA/AED), USA, UNICEF, USAID, WHO/TDR, Women Infant Nutrition (WINS/AED), World Bank, and World Vision. Government Ministries that have used CHDC expertise include the Ministry of Health, Ministry of Education and Ministry of Finance, Planning, and Economic Development.