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Background Effective communication in the intensive care unit (ICU), such as conferences between clinicians and family members as surrogate decision–makers, is key since patients frequently lack decision-making capacity because of the severity of their illness. However, there is little evidence about family conferencing, processes and missed opportunities during family conferences from the perspective of family members. This study explored the process, structure and missed opportunities during family conferencing among the family members of patients in the intensive care unit (ICU) of one Regional Referral Hospital in western Uganda. Methods A qualitative study was conducted in the general ICU. Close family members who participated in patient care provided information about the family conferencing procedure. The data were collected via individual interviews, transcribed verbatim and analysed using content analysis as described by Krippendorff. Findings The participants were middle-aged and ranged from 25 to 60 years, with good level of education, and most of them were employed. The generated categories were dichotomized into two sections. The first section explored the factors related to the process linked to readiness and the structure of family conferences. The observations included accidental meetings, which were conducted in unfamiliar places, were attended by an unintegrated disciplinary team, and mostly discussed patients’ values, care and treatment management. Uncertain experiences revealed perceived satisfactory communication to some family members, whereas others reported sadness with missed opportunities in the process of family conferences. Conclusion Family conferences lack adequate preparedness, and family members’ emotions are missed in care. This study recommends that family conferencing protocols be followed to enhance effective communication skills that align with family members’ emotions. Text box 1. Contributions to the literature There is little evidence on family conferencing processes and missed opportunities during family conferences of life-sustaining treatment to Patients in ICU from the perspective of family members especially in low-income countries. Missed opportunities, uncertain experience, and unmet expectations of family members trigger stress and anxiety of family members subsequently affect patients’ care in the ICU. Family conferencing protocols on the family conference, processes, content are urgently needed to improve effective communication skills that align with family members’ emotions.

Global health equity is at a historically tenuous nexus complicated by economic inequality, climate change, mass migration, racialized violence, and global pandemics. Social medicine, collective health, and structural competency are interdisciplinary fields with their own histories and fragmentary implementation in health equity movements situated both locally and globally. In this paper, we review these three fields’ historical backgrounds, theoretical underpinnings, and contemporary contributions to global health equity. We believe that intentional dialogue between these fields could promote a generative discourse rooted in a shared understanding of their historical antecedents and theoretical frameworks. We also propose pedagogical tools grounded within our own critical and transformative pedagogies that offer the prospect of bringing these traditions into greater dialogue for the purpose of actualizing the human right to health.

Uganda's public healthcare system faces significant systemic challenges in delivering care, contributing to poor health outcomes. In response, a North-South partnership between Massachusetts General Hospital (MGH), Mbarara University of Science and Technology (MUST), and Mbarara Regional Referral Hospital (MRRH) implemented the First Mile Project, a seven-year initiative (2018-2024) designed to strengthen the regional health system in southwestern Uganda. Guided by local priorities, the program aimed to improve access to care, enhance clinical capacity, expand medical education, and promote research and innovation. Project activities were devised collaboratively between investigators at MGH and MUST/MRRH, with robust local leadership and oversight. Key initiatives included clinical staffing in critical departments, construction of a regional isolation ward and oxygen plant. Additionally, the program provided scholarships for medical training, support for community-based care and continuing medical education, and provision of research and innovation grants. The program trained over 1500 health workers, supported 93 scholarships, increased access to specialized clinical services, and facilitated community outreach to thousands of households. The project also awarded 74 research grants and supported over 30 locally incubated innovations. Through this comprehensive, equity-focused approach, First Mile demonstrated how collaborative, locally driven partnerships can effectively strengthen health systems in low-resource settings. Lessons from the initiative underscore the importance of sustained local leadership and integrated clinical and research efforts. A 20-year history of collaboration and mutual trust ensured open dialogue between partners and helped support the success of the project. The First Mile model provides a promising example for future health system strengthening initiatives globally.

The Mbarara University of Science and Technology (MUST)'s First Mile Community Health Program (FMCH) has facilitated community placement of clinical residents at Primary Healthcare (PHC) facilities within the MUST catchment area in southwestern Uganda. While community-based training of medical residents is common in sub-Saharan Africa, little is known about how PHC facility leaders perceive its effect on service delivery in Uganda. This assessment aimed to describe the perspectives of PHC facility leaders on the impact of clinical residents' community placements on PHC services in southwestern Uganda between 2018 and 2023. From July 2018 to December 2023, 152 clinical residents from ten specialties were placed at PHC facilities in southwestern Uganda. This was a cross-sectional study based on qualitative data-collection techniques. This study focused on MUST clinical residents and PHC facilities in the MUST catchment in southwestern Uganda. We conducted KIIs with 15 health facility leaders until no new ideas emerged. Data were deductively analyzed using WHO's five strategic directions. Transcripts were transcribed verbatim, repeatedly reviewed, and coded into predefined categories. Interviewers bracketed their own experiences to ensure facility leaders' perspectives were accurately captured. Of the 15 facility leaders interviewed, most were male and from government HC IVs. Leaders reported that resident placements improved health service delivery through community engagement, enhancing care models through training, mentorship and low-cost innovations, and improving service coordination, including establishing specialized clinics and promoting better use of equipment. Residents also supported advocacy and resource mobilization. However, short placements, inconsistent outreach, staff shortages and lack of specialists limited continuity and sustainability. Facility leaders reported perceived improvement in strengthening PHC services by the clinical residents. Sustaining these gains will require institutionalized partnerships and evaluation of long-term impact. This could contribute to the advancement of primary healthcare services.

Introduction Efforts to reduce maternal and newborn deaths, especially in sub-Saharan Africa, have not been sufficient to achieve Sustainable Development Goal (SDG) 3 for 2030. The quality of care around childbirth is critical for both mothers and newborns, and the use of evidence-based practices (EBPs) is vital in ensuring optimal outcomes. However, there is a paucity of recent research on the use of evidence-based practices in childbirth health facilities. Aims This study aimed to describe the use of intrapartum evidence-based practices for facility-based births in rural lower public health facilities in Midwestern Uganda. Methods A descriptive retrospective chart review was conducted of mothers who delivered at all public health facilities in the Kasese and Bundibugyo districts. Mothers who had given birth in 42 health facilities two months preceding the study period were systematically sampled using probability proportionate to the size of expected respective facility births. Data was collected between November and December 2024. A structured questionnaire adopted from the World Health Organization (WHO) Quality Maternal and Newborn Care (QMNC) was used to extract data on the use of EBPs. A descriptive analysis was done, and the results were presented as frequencies and percentages. Results Of the 353 mothers, 73.1% (n=258) were monitored using a partograph. Blood pressure (BP) was the least monitored at only 23.6% (n=83). At admission, apart from Leopold's examination, which was performed and recorded in 86.7% (n=306) of the charts, all other practices were below 50%. About 32.3% (n=114) of the charts had a documented management plan, and all expected laboratory investigations were in less than 2% of the charts. The record of the examination of newborns prior to discharge was low, at 15.6% (n=55). The coverage of EBPs was lowest in hospitals and highest in facilities at the health center 3 (HCIII) level. Conclusions The findings indicate a need for strategies and research to improve the implementation of evidence-based practices in rural public health facilities, especially in hospitals.

Abstract In rural Uganda where birth dose vaccination for hepatitis B is not routine, we implemented a pilot program for preventing mother-to-child transmission that effectively identified women with high-risk hepatitis B virus (HBV) infection and started antiviral treatment during pregnancy. Further work is required to enhance antiviral adherence through delivery to ensure effective prevention of vertical HBV transmission.