Can Domestic Food Production Provide Future Urban Populations with Food and Nutrition Security?—Insights from Bangladesh, Kenya and Uganda

Population growth and urbanization increasingly put pressure on our planet's availability of areas needed for food production. The dependencies on domestically produced food are increasingly judged favourable, following the consequences of the Ukrainian war, with escalating fuel and grain prices and less accessibilities to low-income groups. It is, however, unclear whether land is domestically available. Applying a food system approach, the main aim of this article is to investigate spatial foodsheds and theoretical self-sufficiency for food production needed to supply increasing future populations in a selection of cities, including estimates for Dhaka in Bangladesh, Nairobi in Kenya and Kampala in Uganda. The projected foodshed scenario areas for the years 2020 and 2050 are estimated for the production of three core products currently extensively produced and consumed in the three countries. They show that it is not possible to feed an ever-increasing urban population based on domestic production alone. International trade, new technological developments and new consumer demands for less area-intensive food production systems may give solutions to the immense challenge of feeding the world's population with nutritious food in 2050. However, to ensure fair and inclusive transition pathways for low-income groups: (1) affordability and accessibility of trade opportunities, technologies and products, (2) a common vision aiming for the SDGs, including SDG2: Zero hunger and SDG11: Sustainable Cities and Communities as well as (3) best practices in co-creation and cooperation with the most vulnerable urban and rural populations, are highly needed.

SCALE – critical care: collaborative leadership for improving health

ContextThe SCALE critical care project is a collaborative health workforce capacity and educational development initiative, between the Ministry of Health Uganda, and the NHS in the UK. The clinical leads are consultants in Anaesthesia and Intensive care from Cambridge, UK and Kampala, Uganda.Issue/ChallengeUganda faces a many challenges with the workforce in critical care, for both medical and nursing staff. There is significantly limited critical care training burdened with difficulties in retention of staff. In 2020 there were 1.3 ICU beds per million population, however this has been expanded as a result of the COVID 19 pandemic. There is now a need to ensure that skilled human resources are available to ensure functional critical care capacity and development of the speciality.The SCALE critical care project is structured around 3 co-dependent initiatives:A distance learning programme including online learning and medical grand roundsLong term placements in the UK for medical and nursing staffLong and short term placements for UK volunteers, with a focus on practical support and educational deliveryAssessment of issue and analysis of its causesKey stakeholders include senior intensive care doctors leading the development of critical care in Uganda and Cambridge, the Ugandan Ministry of Health, the Uganda UK Health Alliance (UUKHA) and many other partners including RCOA, Association of Anesthesiologists of Uganda, Health Education England and Cambridge Global Health Partnerships.There have been reciprocal visits on both sides, including the permanent secretary for health visiting Cambridge in April 2022. During the UK team’s visit to Uganda we were able to gain a broad understanding of critical care delivery, meeting nurses, doctors on the unit to senior hospital directors at a range of hospitals in both Kampala and Mbarara.ImpactAnticipated long term benefits include increased critical care staffing experience, capacity and job satisfaction. Improvement in multidisciplinary working (training of doctors and nurses is occurring in parallel, involvement of physiotherapy and biomedical engineering also proposed).Ultimately, we hope that in the future this work will be characterised by improved patient outcomes and reduced mortality as well as development of research capacity alongside the clinical aspects of the project.InterventionThere has been development of leadership and management for both sides of the partnership at many levels. The junior members of the team are able to participate in high level discussions and gain an understanding of how sustainable and reciprocal partnerships are developed and evolve. The more senior leaders are able to learn from healthcare in another culture, and mentorship of the future healthcare leaders in critical care.Involvement of stakeholders, such as patients, carers or family members:Patients are not currently directly involved in the project.Key MessagesSustainable partnerships require investment from senior leaders in order to develop and affect meaningful change.Development of critical care capacity through clinical training, leadership and research will ensure that patients will benefit not just from access to critical care, but from the wider benefits to healthcare that result, in Uganda as well as in the UK through the development of clinical, leadership and teaching skills volunteers will experience.Lessons learntUndertaking such an ambitious programme requires a large time commitment from senior leaders on both sides of the partnership at a time when healthcare resources are stretched. Whilst much time is volunteered, the support of the hospitals and governments has been critical to the success and sustainability of the project.Measurement of improvementOutput measurement will include increase in critical care workforce numbers in Uganda, with a plan 6-10 MTI doctors to be hosted by Cambridge University Hospitals.We collect feedback from the grand rounds and seek to improve content and delivery accordingly.Publication of novel research from Uganda will be a lo ger term measurement once the research strand of the partnership is developed.Strategy for improvementThe first MTI doctor is due to arrive in the UK late in 2022;there will be ongoing training â€' both clinical intensive care medicine, but also in other critical areas such as leadership and management training. The doctors who undergo the MTI training will return to Uganda to be the future leaders and drivers of intensive care medicine training.The SCALE Critical Care project is truly collaborative. Training of doctors alone will not lead to meaningful or sustainable development â€' training of the multidisciplinary team including nurses and physiotherapists is a critical part of the project.

Urban Refugees’ Digital Experiences and Social Connections During Covid-19 Response in Kampala, Uganda

The Covid-19 crisis and its aftermath challenged economies and societal sectors globally. Refugees in developing countries are particularly vulnerable to the socio-economic impacts of the Covid-19 pandemic. In Uganda, refugees significantly compose the marginalized urban population, dependent largely on the informal sector, and are severely affected by the crisis amidst limited social protection interventions. This article draws on key informant interviews with refugees and refugee-led organizations to examine the diverse ways through which social capital within refugees and host communities in Kampala enabled and shaped digitally mediated responses to sustain livelihoods, social wellbeing, and access to information and economic resources in the wake of the pandemic. The findings indicate that digitally enabled and mediated social networks and/or connections through bonds, bridges, and links are crucial in supporting refugees to cope with crisis effects. Networks of friends, families, and institutions are sustained by digital spaces that support the everyday lives of urban refugees through communication, social protection, livelihood continuity and recovery, and service improvisation during and after the crisis. The fragmented digital infrastructure, digital divide, limited government support, language barrier, and circulation of fake news challenged the utility of digital social networks in mobilizing support for refugees during the crisis. Digital technologies offer opportunities to strengthen social support and potentially mobilize refugee livelihoods in cities with fluid programs for displaced communities. The best practices around sustained multi-platform communications, technological innovations, data collection, and robust community engagement should be leveraged to garner the opportunities offered by technologies towards stimulating inclusive crisis responses.

Access to HIV/AIDS or TB care among refugees in Kampala, Uganda: exploring the enablers and barriers during the COVID-19 pandemic.

The rapid spread of COVID-19 has overwhelmed the existing health care systems, finding it challenging to provide essential health services besides the COVID-19 response interventions. Refugees are disproportionately affected by the COVID-19 pandemic because of the barriers they face to access health care. However, there is limited research that investigates how access to HIV/AIDS or TB care services by urban refugees is affected during pandemics such as the COVID-19. This study adopted a cross-sectional survey utilizing quantitative (N=229) and qualitative data (26 in-depth interviews and 8 key informant interviews) held among urban refugees living in Kampala, Uganda. Results revealed that more females (75%) than males (25%) were able to access TB or HIV/AIDS services during COVID-19 related lockdowns. A decrease in queues, delivery of drugs through Village Health Teams (VHTs), proximity to health facilities, supply of necessities like food and the reception at the health facilities facilitated access to TB or HIV/AIDS services. On the other hand, restrictions on public transport, high transport costs, unemployment and subsequent poverty were barriers to access to TB or HIV/AIDS services. Results offer major insights into the effect of COVID-19 control measures on disruption of access to services particularly in relation to being able to access service points. The findings suggest that recognizing structural barriers to uninterrupted or continued access to HIV/AIDS or TB services during pandemics such as COVID-19 can go a long way in helping stakeholders to design measures that make it possible for more urban refugees to access HIV/AIDS or TB services.

Keeping Safe From COVID-19, 2020

In the 2018 series Dreams and Consequences, I navigated the subject of behavioral norms by studying the practices of young people on university campuses. In her artistic practice, Nabulime uses ordinary objects such as soap, sieves, clothing, mirrors, cans, metal parts of cars, and other found materials to address specific social issues related to disease, gender, and the environment. Nabulime has been awarded numerous fellowships, including the Commonwealth Fellowship Award (UK, 1997, 2012), Robert Sterling Fellowship, Vermont Studio Center (USA, 2011), African Stones Talk Sculpture Symposium (Kenya, 2011), British Academy International Visiting Fellowship (UK, 2009 and 2008, and a Residency Award by Mind Power Projects at the Maryland Institute College of Art (MICA) and Living Classrooms in Baltimore, Maryland (2015).

Can I tell you, my story? A critical hermeneutic inquiry into the life narratives of Ugandan children living within an orphanage in Kampala

Reforming this approach requires contextualised critical understandings of the childrens experiences and perspectives of their institutionalisation, to reduce the misidentification and misappropriation of children as orphans. [...]operationalising the theoretical lens of Bourdieu within critical hermeneutic analyses, this article draws upon the narratives of 30 children living within an orphanage in Kampala, to enhance critical understandings of their experiences, perspectives, and behaviours throughout transition from home to an orphanage, via the streets of Kampala, illuminating how and why they come to be living there. [...]policy makers, practitioners, humanitarian, and missionary actors involved in the provision of childcare, could amend their approaches to ensure children's rights are upheld, and in so doing, more efficaciously facilitate their health and wellbeing. [...]to contribute to this process, this article presents the findings of a critical hermeneutic study of the life story narratives of 30 children living within an orphanage in Kampala, who have formerly lived on the streets. [...]the article concludes that despite current policies aligned with the UNCRC (1989), children facing poverty are severely disenfranchised, the extent of which increasing as they are separated from family within transition from home to a CCI, via the streets of Kampala. Contrasted by beliefs and social norms surrounding CCIs, children go to the streets as means of navigating poverty, wherein socialised dispositions and stereotypes contribute to their experiences of physical and sexual abuse, exploitation, and disempowerment. [...]extensive enhancement of dialogue is required between policy makers, practitioners, professionals, humanitarian, and missionary actors involved in the provision and reform of children's care in Uganda.