MIT GOV/LAB conducts research in multiple countries and collaborates with on-the-ground academics and practitioners. This collaboration allows MIT GOV/LAB to gain a better understanding  of the local context, offers mutual research support, and provides opportunities to learn from each other. 

Rawlance Ndejjo is an Assistant Lecturer in the Department of Disease Control and Environmental Health at Makerere University School of Public Health (MakSPH). In 2021, MIT GOV/LAB partnered with MakSPH, led by Dean Rhoda Wanyenze, to study people’s uptake of COVID-19 vaccines and willingness to vaccinate in four African countries. As a part of this project, MIT GOV/LAB studied how trust in government and institutions affect adherence to Covid-19 measures.  

Rawlance speaks with MIT GOV/LAB Policy & Communications Associate, Akshat Singh, about his professional experience, his interest in public health, and the challenges of being a practitioner-researcher in Uganda.

Akshat: Could you tell me a little about your academic and professional background? How did you end up in the public health space?

Rawlance: Growing up, I was very interested in health and its determinants and bridging inequity gaps in health outcomes. My bachelor’s degree in Environmental Health Sciences helped me appreciate how the environment in which we are born, grow, work and live is influential in predicting health outcomes. Moreover, it made me see the bigger picture of how broad public health interventions can be more impactful than individual treatment-oriented strategies. No wonder, after my bachelors’ degree, I worked with several professors at MakSPH on research to improve the uptake of several public health interventions most of which were preventive in nature. In late 2021, I completed my PhD in Medical Sciences where I examined the implementation of a community cardiovascular disease prevention program in two districts in Uganda.

Image: Rawlance Ndejjo.

Akshat: Your research in collaboration with MIT GOV/LAB included studying Covid-19 and vaccine uptake. An underlying theme of the research works was citizens’ trust in the government and its effect on healthcare delivery. Could you tell us about how this partnership came about to be?  What are some interesting insights you gained through the research? 

Rawlance: Our collaboration with the MIT GOV/LAB started in mid-2021. At that time, we were planning a research project on Covid-19 vaccine uptake under our Bill and Melinda Gates funded-Covid-19 assessment project. Our project officer working with his colleague who was overseeing the MIT project linked us with the MIT GOV/LAB team who were interested in exploring similar work with additional perspectives around trust, and that’s how the collaboration came about. We held several discussions with the MIT GOV/LAB team to plan for the research and have recently successfully implemented five surveys in our four countries of focus. Two of these surveys were implemented in Uganda. 

From our research, we found varying levels of vaccine uptake across the different countries but these correlated with similar factors. One of those key factors was trust in government and institutions which was strongly correlated with vaccine uptake. I believe if people feel more connected to governments, they are more likely to be responsive to public health interventions. We’ve seen this across different countries. The other key correlates of vaccine uptake were knowledge about vaccines, having members in the social network who had accessed vaccines and having not declined a vaccine before. It was surprising that in certain areas, high intention to get vaccinated didn’t always equate to high uptake as several variables such as low availability of vaccines, and perceived high waiting times dissuaded people from getting vaccinated.

Akshat: You have collaborated with several international partners. Have there been any challenges, and if so how have you overcome them?

Rawlance: We have several partners in Africa, Europe, and the US and working with each of them comes with a different set of challenges. I feel that sometimes there is less appreciation of local contexts by partners leading to unrealistic expectations. For instance, in the past partners have asked us to run interventions, which they may have implemented elsewhere but would not be relevant in Uganda. To deal with that, we try to share the local context and also facilitate partnerships with local stakeholders such as ministries that allows us to make grounded expectations. 

We also sometimes run into trouble with attribution when our researchers in Africa don’t get sufficient credit for the work they do. We try to resolve this amicably but sometimes partners aren’t receptive. We’re currently building an operational chain to specify how publication credits have to be handled preemptively, so that we can prevent this problem altogether.

Akshat: It is interesting how you have to navigate through the specific challenges of researching in the Global South while maintaining cordial partnerships, and I’m glad that building operational chains has been helpful! Moving on from research- when you aren’t working, what is your favorite pastime?

Rawlance: Whenever I get the chance, I like to read. I’m currently reading ‘David & Goliath’ by Malcolm Gladwell. I think that Gladwell’s perspective on success is fascinating. I also love ‘Americanah’ by Chimamanda Ngozi Adichie. Her commentary on life, love, race in Nigeria and the US is sublime.

Header: Rawlance (extreme right) and his team pose with health workers at Kawolo Hospital following a training they had delivered on cardiovascular disease prevention. Credits: MakSPH communications office.