Over 70 enthusiastic professionals and academics from six African countries converged on Busia District (Uganda) and Busia County (Kenya), in a bid to learn, identify and co-create interventions that can effectively address RCCE issues related to rabies and Mpox. Supported by USAID, the Africa One Health University Network (AFROHUN) organized a two-week Transboundary Disease Risk Communication and Community Engagement (TD-RCCE) training from October 27 to November 6, 2024, at the Busia cross-border sites.
This Mentored Experiential Learning and Training (MELT) program brought together in-service professionals from Uganda, Kenya, Democratic Republic of Congo, Senegal, Tanzania, and Cameroon, representing fields such as animal health, human health, public health, and behavioral sciences. Participants had previously completed AFROHUN’s 5-week TD-RCCE online training, with others from Uganda having completed the Infectious Diseases Management (IDM) course. Some OH-IDM Uganda trainees, under the OHW-NG project, focused on Mpox surveillance and challenges faced with the porous border, referral mechanism of Mpox cases, and home management of cases. They were selected from seven USAID-supported Regional Emergency Operations Centers across the country. Additionally, four of the sixteen trainees received funding from the Uganda Health Activity, a USAID-supported initiative.
Participants engaged in field activities within Busia District-Uganda and Busia County- Kenya, and surrounding border areas, working with local leaders, district technical teams, RCCE partners including USAID SBCA, National One Health Platforms (NOHP) and public and private sectors. These activities included community engagements and collaboration with key stakeholders to co-create solutions for zoonotic and infectious disease challenges such as rabies and mpox.
Prior to the MELT, virtual sessions were organised which introduced participants to the AFROHUN, Kenya and Uganda local context and cultural dynamics, facilitated by local government officers, Global Health Security (GHS) partners, NOHP, MAAIF and the AFROHUN team. During the MELT, participants focused on cross-border disease dynamics, prevention, detection, and control, employing the human-centered, iterative design thinking approach to identify and develop innovative solutions.
The participants visited communities engaged in various activities, including hunting, agriculture, cross-border trade as well as schools. Engagements were also held with institutions like the ross-border authorities on both sides, Alupe University, Alupe Veterinary Science Research Centre, Mbale Regional Veterinary Laboratory, Emergency Operations Centres on both sides, the Busia District One Health Platform, district/county hospitals, among other key institutions.
Discussions and interactions were vibrant, dynamic, enriching, and provided eye-opening experiences for the trainees.
The exposure and hands-on training in design thinking and mental modelling was a high point for many of the participants that had never been exposed to it.
Tabitha Kiberenge a Health Promotion specialist from Kakamega County – Kenya explains how her field experience connected with the design thinking training.
“We visited a school in Busia Uganda (where the children of hunters go) and I was traumatized. The situation at that school was so bad, I really felt angry and sad that the children in that school were left to study in such conditions. The latrines had no doors, hygiene was very poor, it was really sad. To make matters worse, the children couldn’t communicate with us, we were only able to speak with the teachers. A few days later we were taken through the design thinking training and I was able to see how I can break through with the issues at the school. That training was a game changer for me, because using readily available materials and models, were visually created an intervention. Working with trainees from different professional backgrounds was another experience all together, ideas were flowing, and we created something beautiful”.
Tabitha, extreme left, with her team-mates during the design thinking phase of the training.
For Goretti Akol Olupot of Busoga Region Emergency Operation Centre, in Uganda, her experience dialoguing with the Siteko community in Majenje Ward, Busia County in Kenya, was an eye-opener of the immense potential that exists in the communities to create change. In the interaction with this community, for example, the MELT team learnt that although functional knowledge about rabies disease was limited, the community had nevertheless established a form of event-based surveillance for rabies.
By the end of the dialogue between the community members and Goretti and her colleagues, the community members felt empowered and informed about rabies prevention and the management of dog bites. Armed with this knowledge, the community was mobilized to bring their pets for mass vaccination which was scheduled for the following day, November 1, 2024.
“The community dialogue at Siteko Primary School marked a significant step towards improving public health in Siteko Village. Through education and shared responsibility, the residents left with a renewed commitment to preventing rabies and ensuring the well-being of both their families and their animals. The collaboration between the One Health Team and the community exemplifies the power of grassroots initiatives in combating public health challenges. Together, they are paving the way for a healthier, safer future for all”, Goretti Akol Olupot.
Photo showing community dialogue meeting at Siteko Primary School in Siteko Village, Majenje Ward, Busia County, Kenya.
Before his immersion into Uganda and Kenya community life, Kandhe Gabha’bey Carmel
from DRC was pre-occupied with fear of the unknown. Fear that he would not be able to communicate with anyone, as his language competency was in French, fear that he would not be able to understand the cultures of the people in the two countries, and fear that these would impede his learning experience. He shares his experience below.
“Early in the morning of the second day of the MELT, I boarded the bus with two of my newly met friends, to visit a small village located south of the Kenya-Uganda border, precisely in Busia. Not knowing in reality what awaited me, because; indeed, I would have to face a community that I could only communicate with in English yet I speak only French and whose practices and attitudes would be different from those of my culture. After two and a half hours of driving, we arrived. Contrary to what I could imagine, what this remote and isolated village would be like, I am surprised to find myself in front of a group of people, of a people, of a structurally organized community, with a team of community leaders. highly organized; with very advanced collaborative approaches with different stakeholders including the veterinarian, doctors and nurses, ecosystem conservators, hunters, etc.
My experience with this community presented to me a model to bring back home to the DRC, where rural communities have not yet integrated the essential notions which are at the center of the RCCE to deal with the zoonoses which threaten my country. Currently the country is struggling with issues of rabies and Mpox. The MELT training activities should be continued as far as possible, to enable the strengthening of the local capacities of each African country to have a solid workforce capable of dealing with public health emergencies and zoonotic diseases”.
Kandhe (5th from the right, standing in light blue shirt, in second row) poses for a group photo with his teammates and the community members.
Photos showing Kandhe and his colleagues dialoguing with the community during their MELT immersion in the cross-border communities of Busia.
The MELT cross-border experience was not only limited to a few professionals from the African countries that have AFROHUN presence. Key decision makers in global health, One Health, and higher education also attended this enriching and deeply insightful experience. These included Professor William Bazeyo the AFROHUN Chief Executive Officer, Dr. Haruna Lule, who is responsible for AFROHUN work at the USAID Mission in Uganda and Ms. Marilyn Crane, Senior International Higher Education Advisor in the Emerging Threats division of the Office of Infectious Diseases, Bureau for Global Health USAID Washington.
The leadership trio was able to, among other high level engagements, hold discussions with Alupe University management on collaboration areas, Busia District and Busia County leadership, Alupe Veterinary Science Research Centre, Kenya Medical Training College, among other key stakeholders.
At the Veterinary Science Research Centre, Professor Bazeyo emphasized the knowledge co-creation aspect of the MELT.
“We have come to learn; how do we create community understanding of these issues and what do we learn from what you are doing? If we see these diseases in the lab, how do we want the communities to see these same diseases the way we see them? Without them being in the lab?”
He also noted that students who are members of the Student One Health Innovation Clubs (SOHICs) have a lot to contribute to the work of the research centre as they learn.
During the official opening ceremony at the Busia Uganda side, Professor Bazeyo noted that Busia is on the way to becoming a leading example in the implementation of the One Health approach.
Professor William Bazeyo speaks at the opening ceremony on the Uganda side
At the same ceremony held at the Gold Star Hotel, Ms. Marilyn Crane alluded to the ongoing efforts within USAID to localize its development support,emphasizing that local capacity is important to register achievements in the different areas of work, at the national level. The MELT, building capacity within in-service professionals from diverse sectors for RCCE for infectious diseases is key in ensuring that this work is done.
At the Veterinary Science Research Centre, she expressed hope that “you will be able to initiate working with partners across the border in Uganda to address the common issues of trypanosomiasis that has been used in animals, it can yield more results”.
Her overall impression of the MELT and its impact on workforce development was one of immense pride and appreciation of what AFROHUN is doing in equipping
Dr. Haruna Lule was happy to note that Busia District has continued to grow in dealing with outbreaks, saying that he has been monitoring how the district is performing and has exhibited excellent inter-sectoral collaboration. He issued a caution, however. “Over 260 Mpox cases have been confirmed in Uganda and I caution Busia that districts close to you are registering cases. See how to work with them to stem the spread of the outbreak”, he noted.
As the current Chair of the Busia District One Health Committee/Platform, Dr. Barasa, the District Veterinary Officer noted that as they implement the One Health approach, they are learning every day and reviewing practices, reporting and treatment protocols. Currently, when a person gets bitten by a dog, they first go to the health facility to get first aid, as opposed to the original procedure when they had to first report to the veterinary office.
There are other critical areas where the team has learned useful lessons that have contributed to improved performance.
“We have learnt that it is children who mainly own and manage the dogs in the homes. So we are now conducting vaccinations for rabies during holidays when the children are available to take the dogs for vaccination, and have seen an increase in the numbers of animals presented for vaccination. We have also learnt and appreciated the strength of One Health in dealing with these issues and we continue to learn everyday”, Dr. Barasa, Busia District Veterinary Officer.
One of the biggest challenges he mentioned is the phenomenon of roaming dogs that makes identification of vaccinated and un-vaccinated dogs, and therefore effective monitoring of rabies, challenging.
Despite this challenge and a few others, the district team has been able to register commendable achievements. These include the vet sector hooking onto the Ministry of Health Hub system for collection and delivery of laboratory samples.
During the training that lasted nine days, there was intense interactions within the trainees, the trainers and the mentors
Out of these discussions and out of the MELT, ten key interventions emerged listed below:
- Strengthening Mpox surveillance via the 6767 electronic platform.
- Task shifting and sharing in One Health to address HR shortages.
- “Happy Dog, Healthy Community” cluster model for rabies prevention.
- Cross-border RCCE Strategy for Rabies Control.
- Value chain innovation to increase PEP accessibility.
- “One Border, One Health” cross-border collaboration platform.
- Integrated one stop diagnostic lab network.
- “One Bite, One Health” communication initiative.
- KACHERO platform for data sharing and disease monitoring.
- “More than a Village for Change” with community leaders in One Health.
AFROHUN disseminated these interventions to stakeholders in Kenya and the Uganda Busia One Health team following the Experiential Learning.
The above proposed interventions developed during the Uganda/Kenya Cross-Border MELT program are currently in development. With resource support, these innovative solutions are ready to be implemented and have impact potential to enhance transboundary disease prevention and control.
In terms of next steps, individual and or group action plans will be developed and trainees will be mentored to have them implemented for the next three months.
The co-creation of knowledge and interventions was appreciated by both the community and the other stakeholders engaged during the whole process.
