Browsing by Author "Barugahare, John"

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    Ethical and human rights considerations in public health in low and middle-income countries: an assessment using the case of Uganda’s responses to COVID-19 pandemic
    (BMC Medical Ethics, 2020) Barugahare, John; Nakwagala, Fredrick Nelson; Mwaka Sabakaki, Erisa; Ochieng, Joseph; Sewankambo, Nelson K.
    In response to COVID-19 pandemic, the Government of Uganda adopted public health measures to contain its spread in the country. Some of the initial measures included refusal to repatriate citizens studying in China, mandatory institutional quarantine, and social distancing. Despite being a public health emergency, the measures adopted deserve critical appraisal using an ethics and human rights approach. The goal of this paper is to formulate an ethics and human rights criteria for evaluating public health measures and use it to reflect on the ethical propriety of those adopted by the government of Uganda to contain the spread of COVID-19. Main body: We begin by illustrating the value of ethics and human rights considerations for public health measures including during emergencies. We then summarize Uganda’s social and economic circumstances and some of the measures adopted to contain the spread of COVID-19. After reviewing some of the ethics and human rights considerations for public health, we reflect upon the ethical propriety of some of Uganda’s responses to COVID-19. We use content analysis to identify the measures adopted by the government of Uganda to contain the spread of COVID-19, the ethics and human rights considerations commonly recommended for public health responses and their importance. Our study found that some of the measures adopted violate ethics and human rights principles. We argue that even though some human rights can sometimes be legitimately derogated and limited to meet public health goals during public health emergencies, measures that infringe on human rights should satisfy certain ethics and human rights criteria. Some of these criteria include being effective, strictly necessary, proportionate to the magnitude of the threat, reasonable in the circumstances, equitable, and least restrictive. We reflect on Uganda’s initial measures to combat the spread of COVID-19 and argue that many of them fell short of these criteria, and potentially limit their effectiveness. Conclusion: The ethical legitimacy of public health measures is valuable in itself and for enhancing effectiveness of the measures. Such legitimacy depends on the extent to which they conform to ethics and human rights principles recommended for public health measures.
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    Experiences and practices of key research team members in obtaining informed consent for pharmacogenetic research among people living with HIV: a qualitative study
    (Research Ethics, 2022) Ochieng, Joseph; Kaawa-Mafigiri, David; Munabi, Ian; Nakigudde, Janet; Nabukenya, Sylvia; Nakwagala, Frederick N.; Barugahare, John; Kwagala, Betty; Ibingira, Charles; Twimwijukye, Adelline; Sewankambo, Nelson; Mwaka Sabakaki, Erisa
    This study aimed to explore experiences and practices of key research team members in obtaining informed consent for pharmacogenetics research and to identify the approaches used for enhancing understanding during the consenting process. Data collection involved 15 qualitative, in-depth interviews with key researchers who were involved in obtaining informed consent from HIV infected individuals in Uganda for participation in pharmacogenetic clinical trials. The study explored two prominent themes: approaches used to convey information and enhance research participants’ understanding and challenges faced during the consenting process. Several barriers and facilitators for obtaining consent were identified. Innovative and potentially effective consenting strategies were identified in this study that should be studied and independently verified.
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    Nature and history of the CIOMS International Ethical Guidelines and implications for local implementation: A perspective from East Africa
    (Developing World Bioethics, 2020) Barugahare, John; Kutyabami, Paul
    The theme of the 10th Annual Research Ethics Conference organized by the Uganda National Council for Science and Technology (2018) was “Evolution of Research Ethics in Uganda and the Region: Past, Present and Future”. We were asked to address the topic: “The History of CIOMS and the recent changes in the international ethics guidelines: implications for local research”. The thrust of the conference was to track progress in ensuring ethical conduct of research, highlight challenges encountered, and to propose strategies for effective and meaningful implementation of international ethical guidelines in local contexts. Consequently, the purpose of this paper is to comment on the implications of the history of CIOMS ethical guidelines and suggest strategies for their effective and meaningful implementation in the East African region, and perhaps the whole of Sub‐Saharan Africa. Inferring from the ‘evolutionary’, ‘flexible’, and ‘general’ nature of the CIOMS guidelines, we proposed a six‐point strategy for ensuring their effective and meaningful implementation in local contexts. This strategy is in the form of obligations for local research regulators and researchers, the fulfillment of which will go a long way towards their smooth and meaningful implementation in local contexts. These obligations are: ensuring evidence‐ based adaptation of each individual guideline; ensuring sufficiently judicious and motivated RECs membership; acting proactively to ensure harmony between bioethics and local legal regimes; cultivating a ‘bioethics culture’ among the public; moving towards regional bioethics governance; and playing an active and meaningful role in future revisions of these guidelines.
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    Political analysis of rapid change in Uganda’s health financing policy and consequences on service delivery for malaria control
    (The international journal of health planning and management, 2004) Waalwo Kajula, Peter; Kintu, Francis; Barugahare, John; Neema, Stella
    The aim of this study was to assess the political and social dynamics resulting from the rapid change in user-fee reforms in Uganda and the effects on service delivery for malaria control. Using political mapping and political risk analysis techniques, the study analysed qualitative and quantitative data obtained from secondary data sources and key actors in the policy arena. The results have shown that the feasibility of user-fees in Uganda was undermined by the absence of strong central government leadership and strategies to manage the politics of the reforms. The resultant rapid change in policy adversely affected the recurrent expenditures of health units that previously relied heavily on cost sharing, which led to a chronic shortage of malaria drugs and undermined the ability of health facilities to hire and motivate staff. The study results demonstrate that in order to contribute positively to healthcare delivery goals for malaria control in endemic countries, user-fees require full ownership and strong political leadership by the central government. Decentralization, when merely used as a strategy to navigate the political risks associated with user-fees, is unlikely to succeed without a centrally coordinated and managed process of policy formulation and acceptance involving wider consultations and political management of interest groups.
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    Stakeholders’ Perspectives on Rationing COVID-19 Vaccines Amidst Extreme Scarcity: A Qualitative Study
    (Research Square, 2021) Barugahare, John; Kwagala, Betty; Ochieng, Joseph
    In the context of scarce health-resources robust priority setting for access to existing interventions is critical for at least two reasons: ensuring efficient use of resources, and equitable access to existing interventions. This need is more urgent, and its achievement more intractable in severely resource-constrained health systems, of Low and Middle Income Countries, such as Uganda. COVID-19 pandemic and the resulting need for large-scale and immediate vaccination amidst extreme scarcity of vaccines in Uganda necessitated an exploration of stakeholders’ perspectives on the country’s priority setting for access to COVID-19 vaccines. We aimed at exploring stakeholders’ perspectives on priority setting for COVID-19 vaccination in Ugandan. Methods: We conducted key informant and in-depth interviews with key stakeholders in the COVID-19 intervention including public health experts, clinicians, policy makers, human rights experts, bioethicists, legal fraternity, biomedical scientists and members from the general public. Stakeholders’ views were sought on the status of official guidelines for rationing COVID-19 vaccines; who they thought should get priority for vaccination and why; and what the process of setting such priorities should involve. Data were transcribed and analysed thematically using NVivo software (QSR international 2020). Results: There was concern about lack of clarity regarding context-specific guidance on priorities COVID- 19 vaccination. This concern was corroborated by the fact that national guidelines for COVID-19 vaccination are still in draft form and inaccessible to the public. Regarding who should get priority and why, dominant views indicated more concern for efficiency-cum-effectiveness at controlling the spread of the virus, although further probing revealed that some of these views were partly motivated by equity concerns. Most respondents felt that the process of developing the needed guidelines should have employed a bottom-up approach involving rigorous community engagement.