The nexus between the traditional system of governance and the local government system in Karamoja, Uganda

In the 1990s several countries in Africa adopted decentralisation policy reforms that coincided with a renewed interest in traditional institutions. This development has since sparked an intense debate on the compatibility of traditional systems of governance with decentralisation. The present article documents a case study conducted in Uganda’s Karamoja sub-region, a stronghold of traditionalism despite local government reforms. It concludes that although the traditional system of governance could help to link local communities with the modern local government system, the two structures have not been harmonised. Instead, they run on parallel and contradictory paths, which has had negative consequences for local governance and service delivery. The paper advocates blending the two to form a hybrid system in which they complement each other rather than being a source of conflict

Oil Politics and Land Tenure Changes in Uganda: Understanding the Curse of Dispossession in the Albertine Region

Although oil wealth has been applauded for being a sine qua non for development because of its profitability, its lucrativeness to global capitalism has empowered global powers and increased marginalization and poverty in the Oil Village Communities (OVCs) of developing countries. The thrust of this study was to analyze different ways oil politics influences land tenure changes and alienation of local citizens’ land rights through the process of land dispossession in Uganda’s Albertine region. Anchored within accumulation by dispossession discourse, the study used qualitative approach and employed in-depth interviews, focused group discussions, observations and documentary reviews as data collection instruments. Findings indicate that oil politics influenced land tenure changes through two causal mechanisms: disruption of existing land governance structures and the reconstitution of land interests in the Albertine region. These were manifested through compulsory large-scale land acquisitions for oil infrastructural developments such as oil refinery, central processing facilities and oil processing plants and the swift transfer of land holdings from customary to freehold land tenure relations. Consequently, short notice massive evictions, alienation of citizens’ land rights and inadequate or delayed land compensations pushed citizens to the land margins and suffered from the curse of dispossession. To realize inclusive development, there is need to consider all dimensions of development and restore the safety valves of the affected people, rather than fronting capitalist ideological conceptions that sideline the interests of the majority poor

Decentralisation and political empowerment of citizens in Karamoja, Uganda

For centuries, centralisation was the dominant model of governance in most parts of the developing world. However, since the mid-1980s many countries in Africa have adopted decentralisation owing to the failure of centralisation to deliver public goods to citizens. In 1992, Uganda adopted decentralisation policy reforms to give ordinary citizens more control over their own administration and development agenda. This article reports case study research conducted in Karamoja, Uganda to establish the extent to which decentralisation reforms have indeed empowered local people. Research findings revealed mixed results. Although decentralisation resulted in the creation of the local government system, which in principle offers representational governance for different interest groups in local communities, ordinary citizens have fallen short of being politically empowered. State–society power relations have remained unaltered in favour of local elites. The authors contend that for political empowerment of citizens to be achieved, there is a need to devolve a considerable amount of autonomy to local governments and review the law to make local elites subordinate to citizen representatives

Gender and innovation for climate-smart agriculture. Assessment of gender-responsiveness of RAN's agricultural-focused innovations

Ownership of agricultural production resources has generally been shown by research to be male dominated and to have wide disparities between males and females. The disparities are more pronounced in rural areas where women have less income, smaller pieces of land, and have inadequate market for their produce. In dealing with Climate Smart Agriculture (CSA) adoption and with agricultural technology adoption, there has been increasing recognition of the importance of focusing on the gender-based needs behind the adoption choice itself. Grounded in the belief that solutions to Africa’s resilience challenges lie in understanding what makes communities thrive in adversity, ResilientAfrica Network (RAN) is a multidisciplinary innovation lab that leverages the creativity and talent of youth, students, scholars and communities to develop and scale innovative ideas. Given how dominant agriculture is among RAN's problem sets for strengthening resilience through innovation, RAN sought to understand how supported innovations had contributed to gender-responsive climate smart agriculture solutions. What lessons could be learned from Women of Uganda Network (WOUGNET) in their history of engagement with women farmers to co-create a gender-responsive innovation process to strengthen resilience through the agricultural sector? With the support of CCAFS, RAN and WOUGNET conducted a gender assessment exercise to evaluate if the current solutions/innovations are gender responsive or not. Three innovations were selected that are primarily focused towards CSA and that had affordability and ease of use as key objectives. The gender assessment embraced a qualitative research approach. This choice was guided by the need to appreciate respondents’ understanding and experiences or perceptions of the different innovations that RAN has been nurturing and developing over the years. The respondents were purposively selected based on availability and on being located in any of the four Northern Uganda districts of Apac, Kole, Lira and Oyam where WOUGNET has actively engaged with women farmers. From the study, it was clear that men and women farmers are willing to embrace new technologies, practices and innovations in their pursuit of enhanced agricultural productivity and new opportunities. That said, a clearly gendered view emerged from the assessment in that uptake of the innovations was to a large extent driven by socio-cultural norms and expectations related to issues of ownership, work, decision making capacity, and income generation and control. For instance, use of the innovations can reduce time spent on farming activities and can open up time and space to explore new opportunities. However, if gender considerations are not taken into account, such time could be used to negatively impact on the work burden for women farmers as it may be taken that the women are now free to take on new work – even that which would have been previously done by the men in their households

Treatment outcomes of new tuberculosis patients hospitalized in Kampala, Uganda: a prospective cohort study.

BACKGROUND: In most resource limited settings, new tuberculosis (TB) patients are usually treated as outpatients. We sought to investigate the reasons for hospitalisation and the predictors of poor treatment outcomes and mortality in a cohort of hospitalized new TB patients in Kampala, Uganda. METHODS AND FINDINGS: Ninety-six new TB patients hospitalised between 2003 and 2006 were enrolled and followed for two years. Thirty two were HIV-uninfected and 64 were HIV-infected. Among the HIV-uninfected, the commonest reasons for hospitalization were low Karnofsky score (47%) and need for diagnostic evaluation (25%). HIV-infected patients were commonly hospitalized due to low Karnofsky score (72%), concurrent illness (16%) and diagnostic evaluation (14%). Eleven HIV uninfected patients died (mortality rate 19.7 per 100 person-years) while 41 deaths occurred among the HIV-infected patients (mortality rate 46.9 per 100 person years). In all patients an unsuccessful treatment outcome (treatment failure, death during the treatment period or an unknown outcome) was associated with duration of TB symptoms, with the odds of an unsuccessful outcome decreasing with increasing duration. Among HIV-infected patients, an unsuccessful treatment outcome was also associated with male sex (P = 0.004) and age (P = 0.034). Low Karnofsky score (aHR = 8.93, 95% CI 1.88 - 42.40, P = 0.001) was the only factor significantly associated with mortality among the HIV-uninfected. Mortality among the HIV-infected was associated with the composite variable of CD4 and ART use, with patients with baseline CD4 below 200 cells/µL who were not on ART at a greater risk of death than those who were on ART, and low Karnofsky score (aHR = 2.02, 95% CI 1.02 - 4.01, P = 0.045). CONCLUSION: Poor health status is a common cause of hospitalisation for new TB patients. Mortality in this study was very high and associated with advanced HIV Disease and no use of ART

Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study.

BACKGROUND: In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART) regardless of CD4 count. We describe retention in care and factors associated with loss to follow-up (LTFU) among women initiated on Option B+ as part of an evaluation of the effectiveness of the national program. METHODS: We conducted a retrospective cohort analysis of data abstracted from records of 2,169 women enrolled on Option B+ between January and March 2013 from a representative sample of 145 health facilities in all 24 districts of the Central region of Uganda. We defined retention as being alive and receiving ART at the last clinic visit. We used Kaplan-Meier analysis to estimate retention in care and compared differences between women retained in care and those LTFU using the chi-squared test for dichotomized or categorical variables. RESULTS: The median follow-up time was 20.2 months (IQR 4.2-22.5). The proportion of women retained in HIV care at 6, 12 and 18 months post-ART initiation was 74.2%, 66.7% and 62.0%, respectively. Retention at 18 months varied significantly by level of health facility and ranged from 70.0% among those seen at hospitals to 56.6% among those seen at lower level health facilities. LTFU was higher among women aged less than 25 years, 59.3% compared to those aged 25 years and above, 40.7% (p = 0.02); among those attending care at lower level facilities, 44.0% compared to those attending care at hospitals, 34.1% (p = 0.01), and among those who were not tested for CD4 cell count at ART initiation, 69.4% compared to those who were tested, 30.9% (p = 0.002). CONCLUSION: Retention of women who were initiated on Option B+ during the early phases of roll-out was only moderate, and could undermine the effectiveness of the program. Identifying reasons why women drop out and designing targeted interventions for improved retention should be a priority

Retention in care among HIV-infected pregnant and breastfeeding women on lifelong antiretroviral therapy in Uganda: A retrospective cohort study.

The study conducted a retrospective cohort analysis of data abstracted from records of 2,169 women enrolled on Option B+ between January and March 2013 from a representative sample of 145 health facilities in all 24 districts of the Central region of Uganda.Background: In 2013, Uganda updated its prevention of maternal-to-child transmission of HIV program to Option B+, which requires that all HIV-infected pregnant and breastfeeding women be started on lifelong antiretroviral therapy (ART) regardless of CD4 count. We describe retention in care and factors associated with loss to follow-up (LTFU) among women initiated on Option B+ as part of an evaluation of the effectiveness of the national program. Methods: We conducted a retrospective cohort analysis of data abstracted from records of 2,169 women enrolled on Option B+ between January and March 2013 from a representative sample of 145 health facilities in all 24 districts of the Central region of Uganda. We defined retention as ªbeing alive and receiving ART at the last clinic visitº. We used Kaplan-Meier analysis to estimate retention in care and compared differences between women retained in care and those LTFU using the chi-squared test for dichotomized or categorical variables. Results: The median follow-up time was 20.2 months (IQR 4.2±22.5). The proportion of women retained in HIV care at 6, 12 and 18 months post-ART initiation was 74.2%, 66.7% and 62.0%, respectively. Retention at 18 months varied significantly by level of health facility and ranged from 70.0% among those seen at hospitals to 56.6% among those seen at lower level health facilities. LTFU was higher among women aged less than 25 years, 59.3% compared to those aged 25 years and above, 40.7% (p = 0.02); among those attending care at lower level facilities, 44.0% compared to those attending care at hospitals, 34.1% (p = 0.01), and among those who were not tested for CD4 cell count at ART initiation, 69.4% compared to those who were tested, 30.9% (p = 0.002). Conclusion: Retention of women who were initiated on Option B+ during the early phases of roll-out was only moderate, and could undermine the effectiveness of the program. Identifying reasons why women drop out and designing targeted interventions for improved retention should be a priority

Proportion of women on Option B+ retained in care at 6, 12 and 18 months, over time, by level of health facility.

<p>Proportion of women on Option B+ retained in care at 6, 12 and 18 months, over time, by level of health facility.</p