Altogether 25 key informants, representing both the College and external stakeholder institutions and organizations, were interviewed. They were senior leaders at various levels of their organizations or institutions. Table provides a summary of external stakeholder characteristics and perspectives found in the KI interviews.
Stakeholder characteristics and perspectives
Stakeholders, current and potential
A number of stakeholders or potential collaborators of the College or its constituent units of varied categories were identified or mentioned by the KIs. They included:
(a) Government Ministries of Health (MOH), Education & Sports (MOES), Finance (MOF) and Local Government( MOLG); District Local Governments, and Parliament, in particular the Social Services Committee;
(b) Statutory Bodies: Uganda Medical and Dental Practitioners Council (UMDPC), Uganda Nurses and Midwives Council (UNMWC), the Health Service Commission (HSC), the Pharmacy Board, and the Allied Health Workers Council, Health Service Commission (HSC), and Uganda Virus Research Institute;
(c) Faith-Based Organizations: Uganda Catholic Medical Bureau, Uganda Protestant Medical Bureau, Uganda Muslim Medical Bureau, and the Joint Medical Stores;
(d) International organizations and NGO: International College for Health Cooperation in Developing Countries, German Academic Exchange Service, Bill and Melinda Gates Foundation, Rockefeller Foundation;
(e) Multi-lateral agencies: United Nations Fund for Population Activities, United Nations Children's Emergency Fund (UNICEF) and World Health Organization;
(f) Bi-lateral Agencies: United Kingdom Department of International Development, Danish International Development Agency, European Union, Canadian International Research Center, Swedish International Development Agency, United States Agency for International Development, Center for Disease Control and Prevention, Italian Cooperation;
(g) Local Agencies: private hospitals, Uganda National Health Consumers Organization (UNHCO);
(h) other universities, both local and foreign: Gulu University, Mbarara University, Johns Hopkins, Columbia, Alberta, Muhimbili, Moi, and MacMaster.
Notable in their absence were the local private business sector. All of our repeated efforts to obtain interviews with them were unsuccessful.
The Ministry of Education & Sports (MOES) is directly responsible for the University and exercises power over the College through The Universities and Other Tertiary Institutions Act, 2001. This Act sets up The National Council for Higher Education to implement its provisions. The Act empowers the NCHE to among other things ensure minimum standards for courses of study and to establish any university unit(s) as a constituent college of a public university. Indeed it is under this Act that the MakCHS was established as a constituent college of Makerere University in 2008.
Some of the statutory bodies also have some powers over the activities of the College or its individual departments. The UMDPC, UNMWC and Pharmacy Board are mandated by law to regulate medical, nursing and pharmacy training standards, respectively. They have power to withhold recognition or accreditation of the respective units of the College under the law (The Medical and Dental Practitioners Statute, The Nurses Midwives Act, 1996 and Pharmacy and Drugs Act, 1971). The College is represented on these bodies. So far none of these bodies have found it necessary to evoke the use of their powers with respect to College activities, but these powers do give the bodies some influence and leverage over the College.
The UMDPC, UNMWC and Pharmacy Board also have power to control medical, nursing and pharmacy practice, as well as, promote professional and ethical practices of these professionals in the country. Some key informants including some from these bodies alluded to the need for more vigorous training to enhance professionalism and ethical conduct among College graduates. This quote summarizes their views.
“Professionalism of College graduates is wanting; training is lacking something ethically. Health workers of these days are not committed to their work. They lack ethics in the way they do their work.” (KI, statutory body).
The stakeholders that have some power by law over MakCHS (e.g. MOES, UMDPC) exercise influence through legal means. However, most stakeholders that were mentioned, in particular international organizations and foreign collaborating universities, exercise influence through funding research activities and staff and infrastructure development, thus having leverage over decisions about the research activities in the College and about staff as well as infrastructure development.
Stakeholder interests in, perspectives about the capacity and functioning of the college
Some stakeholders reported that they fund College activities because their interest is to develop the capacity of the College to address what they perceive to be the country’s priority health needs. The following quote captures the stakeholders’ view about the college’s capacity and in what direction they would wish it to be channeled:
“The College has very good academic capacity with a concentration of talent. We want technical support from the College to generate evidence through operational research to intervene in priority problems.” (KI, donor agency).
However, a KI from the College leadership put it differently:
“These institutions and organizations have missions; therefore what motivates them to collaborate with us is what we do that enhances what they do.” (KI, MakCHS leadership)
These apparently divergent views reflect different interpretations of the interests of the stakeholders in the College by the stakeholders themselves and the college management. However, both internal and external stakeholders interviewed were more or less unanimous that the initiative for collaboration was coming more from external collaborators rather than the College. This makes research activities at the College donor driven. An internal stakeholder in admitting this said:
“As the College, we do not sell ourselves to the outside world. The College needs to become very innovative, creative and strategic and seek information in knowing the player out there.” (KI, MakCHS leader).
International and bilateral organizations concurred:
“The College needs to sell itself.” (KI, NGO)
Some of the stakeholders have an investment in the College’s activities because they are consumers of its products, namely the graduates that offer services in the health care system. In this category are HSC, the faith-based NGOs, districts and the private hospitals. It was even suggested that some of their facilities could be used for training purposes. Indeed districts provide accommodation to the students free of charge while they are doing field study/work. The clients/patients interests were reportedly represented by Uganda National Health Consumer Organization with a view to protecting and promoting patients’ rights.
Structures and mechanisms for stakeholder involvement
The mechanisms and structures through which the stakeholders collaborate with the College were reported to be either contracts or memoranda of understanding. The line ministry and the statutory bodies have national laws defining structures for relating with the College while a member of UNHCO sits on the Institutional Review Boards of the Schools of Medicine and Public Health. However, the College is in the process of putting in place the needed structures and mechanisms for mobilizing and managing grants.
“We need a development office, grant and contracts office to fund raise, allocate and manage the funds,” (KI, MakCHS leadership)
Table provides a summary of external stakeholder characteristics and perspectives found in the KI interviews. The stakeholders’ perspectives about the college were reflected as interests and as concerns. They were also expressed as expectations so as to enhance the proper functioning of the college in order to ensure sustainability. All these included among others the need for the college to put more emphasis on research, training in ethics, training in management and networking more widely as well as engaging with the private sector.
Stakeholder power mapping
Figure maps the current stakeholders on the basis of their level of power, influence and interest in the functioning and development of the college vis-a-viz their role and support given to the college. Stakeholders were categorized on a perceived rating of level of power and influence against their role, interest, as well as, their expectations on the development and functioning of the college as a first rate institution The stakeholders were broadly grouped into 4: (A) low interest/low power, (B) high interest/low power, (C) low interest/high power, and (D) high interest/high power.
Figure 1 Critical stakeholder mapping for the college. [9,10]
• Group A requires the College to focus minimal effort. They, in general, do not pose a serious threat to the College. The group would include private health care providers and the private business sector.
• Group B, despite their high interest, have little direct influence over the College, and simply need to be kept informed about college business. These may include HSC, faith-based organizations and civil society organizations.
• Group C, may or may not realize the degree of effect they have over the College but definitely must be kept satisfied. Withdrawal of their support can be catastrophic to College development and functioning. These include some government ministries, parliament and civil society.
• Group D are the most important constituency for the college and must be kept satisfied because they have interest, power, and influence over the college. In this group one would put MOES, MOH, statutory bodies in health and the donors.
For this assessment we adopted Olsen’s definition of sustainability, “An institution is sustainable when operated by a system with long-term ability to mobilize and allocate sufficient and appropriate resources (manpower, technology, information and finance) for activities that meet public needs/demands” [8
]. He emphasized that an organization’s ability to produce certain desired activities and support functions ( benefits)
should be sustained and be linked to the position of its stakeholders, internal and external. Therefore the ability of MakCHS to ensure adequate resources for its activities is closely linked to its capacity and activity profile, as well as, the role and contributions of its present and future stakeholders, the context notwithstanding.
“The College is full with capacity to use resources and train good health professionals because it has good brains behind it, for example it has a good number of professors and other good professionals.” (KI, International NGO).
However, the College is operating in a resource constrained environment and is under-funded. It is relatively ‘young’ and is in the process of putting in place structures to acquire the needed organizational capacity to execute its mandate effectively and efficiently. There was a view expressed by some study participants that since the College is in its ‘infancy’, it needs leaders, managers, and planners who can think big to move it forward, not just academicians. In this regard KIs suggested that the college network widely, taking initiative to market itself in order to mobilize and use resources effectively, including resources from the private sector to help the College do its work.
“It [MakCHS] has to come up with a strategic plan which will enable it to profitably and effectively utilize resources. Funds should be directed towards useful activities like improving infrastructure and capacity in training and research among others.” (KI, international NGO)
“Having a vision; the College should not think small. Let it spread outside Kampala. For example, acquire land for expansion in areas like Mbale, Fortportal, Kabale, Arua, so that all regions in the country can easily be served by the College.” (KI, multi-lateral agency)
Another view was echoed for the College to develop into a research institution to generate new knowledge relevant to solving the health needs of the country and share that knowledge widely. A suggestion to embrace new technologies was also made.
“Furthermore, they have to show that they are not only a learning institution, but a place where new knowledge can be generated. It should therefore engage in relevant research which can change the existing events for the better. It should pronounce itself as an institution which imparts extra-ordinary skills and a place with necessary admirable attributes.” (KI, international health agencies)
“Finally, resources should be directed towards quality training and research, modern technological advancement be embraced and encourage the collaboration with the private sector.” (KI, local health NGO)
Most external KIs expressed the view that the initiative should come from the College and it should be relevant.
“The College should start the initiative.” (KI, multi-lateral agency)
A leading internal stakeholder from within the College was in agreement with most of the views expressed by other stakeholders thus:
“As the College we need to become very innovative, creative and strategic. We must do better than others; we need to fight for quality assurance, we need more land for expansion, we need more funds to upgrade our facilities. The College needs more funds to carry out research that is meaningful and relevant to this country and be able to translate this research into practice.
Mobilizing resources is a big challenge we need to put formal structures for managing resources; and reporting to the funders is also a challenge. Allocation becomes difficult when you have a challenge of mobilizing and extremely less resources. We need a development office, grant and contracts office to fund-raise, allocate and manage the funds. We have it in plan that this office will do this task on a day-to-day basis. We need to embrace ICT whether it is in research, management, education because it will enable us to tap more opportunities elsewhere.” (KI, MakCHS leader)