Framework for effective public digital records management in Uganda

This thesis examines the framework for effective management of digital records in Uganda, which was undertaken by a detailed study of the 23 ministries, which form the Uganda Public Service (UPS). Areas of research inquiry included establishing the current state of digital records in the UPS and revealing the factors impeding the managing of digital records. This raised many issues about the way in which digital records are created, maintained and used, including possible lines of action to resolve current digital records management (DRM) problems. It also considered how the DRM services and practices used elsewhere could be adopted to suit the UPS environment. The status of DRM and the factors affecting the creation, use, maintenance and disposition of digital records were critically reviewed and evaluated and, towards the end, the thesis recommends strategies and makes proposals that could contribute to the development of DRM services in the UPS. The study adopted a mixed methods research approach and drew on the ‘records continuum’ concept for its analytical framework. The study drew on data from primary and secondary (literature and research reports) sources. Data collection from primary sources was carried out using questionnaires and semi-structured interviews, which made it possible to study the personal perspectives and experiences of those involved in the management of records and of digital systems in Uganda. The approach provided insight into the UPS ministries, where data was collected from senior and middle managers, ICT managers and records managers, through a total of 40 interviews. This approach was essential in so far as it focused on the importance of the meanings that emerged as respondents defined their DRM requirements through interpersonal interactions and it guided the data collection, analysis and reflection activities. The analysis of the findings of the study revealed that the problems with DRM are largely due to the absence of ICT facilities with recordkeeping functionality, a lack of clear policies, guidelines and procedures, and to the fact that the Uganda Records and Archives legislation is not fully implemented and not properly enforced. It is argued that the failure to fully implement the National Records and Archives Act has led to a lack of appropriate institutional and managerial structures. Other problems include the lack of a reliable power supply and of sufficient financial resources and human capacity. Although no UPS ministry has a complete Electronic Document and Records Management System (EDRMS), the survey of many ministries provided comprehensive evidence of the dynamism in the use of ICT that led to the generation of digital records. The problems and challenges elaborated upon in the study have shown that a successful DRM service depends on a number of factors. While it is not strictly possible to generalise the findings from this purposive sample to the whole of the Government of Uganda, it is likely that the issues identified in this study will apply to the whole of the Uganda public sector and, to some extent, to other sub-Saharan African countries. The study concludes that in order to facilitate a DRM service in the UPS, the objective should be to enable increased creation and keeping of records by digital means. The proposed recommendations are categorised into four key factors: the need for formal legal infrastructure; the need to establish formal instruments in particular a national archives agency with appropriate policies, procedures and guidelines; and the development of both robust DRM infrastructure and of appropriately skilled human resource capacity. These factors are necessary and need to be addressed urgently, and specifically for Uganda, in order to ensure accountable government for the citizens of Uganda in the digital world

Framework for effective public digital records management in Uganda.

This thesis examines the framework for effective management of digital records in Uganda, which was undertaken by a detailed study of the 23 ministries, which form the Uganda Public Service (UPS). Areas of research inquiry included establishing the current state of digital records in the UPS and revealing the factors impeding the managing of digital records. This raised many issues about the way in which digital records are created, maintained and used, including possible lines of action to resolve current digital records management (DRM) problems. It also considered how the DRM services and practices used elsewhere could be adopted to suit the UPS environment. The status of DRM and the factors affecting the creation, use, maintenance and disposition of digital records were critically reviewed and evaluated and, towards the end, the thesis recommends strategies and makes proposals that could contribute to the development of DRM services in the UPS. The study adopted a mixed methods research approach and drew on the ‘records continuum’ concept for its analytical framework. The study drew on data from primary and secondary (literature and research reports) sources. Data collection from primary sources was carried out using questionnaires and semi-structured interviews, which made it possible to study the personal perspectives and experiences of those involved in the management of records and of digital systems in Uganda. The approach provided insight into the UPS ministries, where data was collected from senior and middle managers, ICT managers and records managers, through a total of 40 interviews. This approach was essential in so far as it focused on the importance of the meanings that emerged as respondents defined their DRM requirements through interpersonal interactions and it guided the data collection, analysis and reflection activities. The analysis of the findings of the study revealed that the problems with DRM are largely due to the absence of ICT facilities with recordkeeping functionality, a lack of clear policies, guidelines and procedures, and to the fact that the Uganda Records and Archives legislation is not fully implemented and not properly enforced. It is argued that the failure to fully implement the National Records and Archives Act has led to a lack of appropriate institutional and managerial structures. Other problems include the lack of a reliable power supply and of sufficient financial resources and human capacity. Although no UPS ministry has a complete Electronic Document and Records Management System (EDRMS), the survey of many ministries provided comprehensive evidence of the dynamism in the use of ICT that led to the generation of digital records. The problems and challenges elaborated upon in the study have shown that a successful DRM service depends on a number of factors. While it is not strictly possible to generalise the findings from this purposive sample to the whole of the Government of Uganda, it is likely that the issues identified in this study will apply to the whole of the Uganda public sector and, to some extent, to other sub-Saharan African countries. The study concludes that in order to facilitate a DRM service in the UPS, the objective should be to enable increased creation and keeping of records by digital means. The proposed recommendations are categorised into four key factors: the need for formal legal infrastructure; the need to establish formal instruments in particular a national archives agency with appropriate policies, procedures and guidelines; and the development of both robust DRM infrastructure and of appropriately skilled human resource capacity. These factors are necessary and need to be addressed urgently, and specifically for Uganda, in order to ensure accountable government for the citizens of Uganda in the digital world.

Enhanced infection prophylaxis reduces mortality in severely immunosuppressed HIV-infected adults and older children initiating antiretroviral therapy in Kenya, Malawi, Uganda and Zimbabwe: the REALITY trial

Meeting abstract FRAB0101LB from 21st International AIDS Conference 18–22 July 2016, Durban, South Africa. Introduction: Mortality from infections is high in the first 6 months of antiretroviral therapy (ART) among HIV‐infected adults and children with advanced disease in sub‐Saharan Africa. Whether an enhanced package of infection prophylaxis at ART initiation would reduce mortality is unknown. Methods: The REALITY 2×2×2 factorial open‐label trial (ISRCTN43622374) randomized ART‐naïve HIV‐infected adults and children >5 years with CD4 <100 cells/mm3. This randomization compared initiating ART with enhanced prophylaxis (continuous cotrimoxazole plus 12 weeks isoniazid/pyridoxine (anti‐tuberculosis) and fluconazole (anti‐cryptococcal/candida), 5 days azithromycin (anti‐bacterial/protozoal) and single‐dose albendazole (anti‐helminth)), versus standard‐of‐care cotrimoxazole. Isoniazid/pyridoxine/cotrimoxazole was formulated as a scored fixed‐dose combination. Two other randomizations investigated 12‐week adjunctive raltegravir or supplementary food. The primary endpoint was 24‐week mortality. Results: 1805 eligible adults (n = 1733; 96.0%) and children/adolescents (n = 72; 4.0%) (median 36 years; 53.2% male) were randomized to enhanced (n = 906) or standard prophylaxis (n = 899) and followed for 48 weeks (3.8% loss‐to‐follow‐up). Median baseline CD4 was 36 cells/mm3 (IQR: 16–62) but 47.3% were WHO Stage 1/2. 80 (8.9%) enhanced versus 108(12.2%) standard prophylaxis died before 24 weeks (adjusted hazard ratio (aHR) = 0.73 (95% CI: 0.54–0.97) p = 0.03; Figure 1) and 98(11.0%) versus 127(14.4%) respectively died before 48 weeks (aHR = 0.75 (0.58–0.98) p = 0.04), with no evidence of interaction with the two other randomizations (p > 0.8). Enhanced prophylaxis significantly reduced incidence of tuberculosis (p = 0.02), cryptococcal disease (p = 0.01), oral/oesophageal candidiasis (p = 0.02), deaths of unknown cause (p = 0.02) and (marginally) hospitalisations (p = 0.06) but not presumed severe bacterial infections (p = 0.38). Serious and grade 4 adverse events were marginally less common with enhanced prophylaxis (p = 0.06). CD4 increases and VL suppression were similar between groups (p > 0.2). Conclusions: Enhanced infection prophylaxis at ART initiation reduces early mortality by 25% among HIV‐infected adults and children with advanced disease. The pill burden did not adversely affect VL suppression. Policy makers should consider adopting and implementing this low‐cost broad infection prevention package which could save 3.3 lives for every 100 individuals treated