In its journey of more than 100 years, Makerere University has made mutually beneficial partnerships and collaborations locally and internationally. Among these is the Makerere University-Yale University (MUYU) collaboration, a bidirectional, clinical education capacity building partnership. The collaboration began when in 2002, when representatives from the Departments of Medicine at Makerere College of Health Sciences (MakCHS) and Mulago National Referral Hospital (MNRH), as well as Yale School of Medicine (YSM), first met in Kampala to discuss the development of a partnership between the institutions. The first Memorandum of Understanding between YSM and MakCHS was signed in 2006, officially creating the MUYU collaboration, and has subsequently been renewed three times. The most recent renewal in 2025 expanded the relationship beyond the health professions schools, to make MUYU a collaboration at the University level.

The major goal of this collaboration is to enhance systems to improve patient care delivery through the enhancement of medical education, clinical training and research. To-date, the collaboration takes particular pride in the Ugandan faculty alumni who have become experts in specific clinical subspecialties, and have moved on to lead various projects at MakCHS, and to hold leadership positions at MakCHS, MNRH, and Kiruddu National Referral Hospital (KNRH). The primary focus of the collaboration is to enhance the clinical training of students and residents, as well as interaction of faculty in both institutions. The overall objective is to promote bilateral human resource capacity building with the ultimate goal of improving patient care through the cross interaction of faculty/consultants, and clinical training of undergraduate and postgraduate students. Since 2006, this collaborative program premised on the following specific areas:

1. Training of selected MakCHS/MNRH junior and mid-level faculty and staff at YSM

2. Medical student exchange program between YSM and MakCHS.

3. Clinical experiences at MNRH/KNRH for YSM-sponsored postgraduate students (residents) and faculty.

4. Improvement of infrastructure at MakCHS-MNRH to support training of postgraduate students towards improved care of patients.

5. Development of infrastructure for scholarship and applied research on training of health care workers and patient care.

Methods and Outcomes:

1. MUYU Exchange program outputs

As of October 2025, the MUYU collaboration has trained 32 Ugandan JUNIOR AND MID LEVEL doctors (faculty, physicians, and Senior House Officers), two nurses and 52 medical students.

1.1 Professional Development Activities and outcomes

 MakCHS faculty members and MNRH physicians who have participated in the bidirectional program has done observership training at YSM and the affiliated Yale New Haven Hospital (YNHH) in various subspecialties. These have included Cardiology, Critical Care-Internal Medicine, Emergency Medicine, Endocrinology, Gastroenterology, Hematology, Infectious Diseases, Nephrology, Neurology, Pathology, Pulmonology, Obstetrics & Gynaecology, Oncology, Rheumatology, Surgery-Paediatric, and Surgery-Endocrine. To date, all these clinicians have returned to Uganda and many are now sub-specialists in their chosen fields.

During the COVID-19 pandemic, with the stringent travel restrictions, MUYU piloted virtual training activities. Here, 3 physicians were trained online with counterparts at YNHH, and all subsequently travelled to YSM/YNHH to undertake 6-month-long, in-person observerships by the end of 2024.

1.2 MakCHS undergraduate students

Undergraduate medical students have also participated in the MUYU training program. Since 2009, a total of 46 fourth-year medical students from Makerere University have had 4 weeks rotations in internal medicine at YSM/YNHH. This has included 2-4 students per year, both males and females. The number of students is dictated by the availability of funding from YSM as well other sources. 

Upon return, the students write their reflections and give a talk to their Makerere colleagues about their experiences, and how these could impact on their clinical training and future clinical practice. However, during the 2020 and 2021 years, due to travel restrictions caused by COVID-19 pandemic, a virtual training activity was piloted and pioneered with 6 selected medical students in conjunction with 5 medical students from YSM.  Selection was based on their active participation in community work, research writing and activeness during the COVID-19 pandemic lockdown. These kinds of interactions facilitate networking which support individual participants in their career growth as well as the connection between the collaborating institutions.

1.3 Other Makerere University students

Additionally, through the MUYU program, Makerere University students have been selected from the Schools of Medicine, Law and Business to participate in the joint Yale Global Health Students United for Regional and Global Education (YGH SURGE). The SURGE program was founded and launched by two Yale School of Medicine students in 2020 in collaboration with the YSM Office of Global Health Education. The program was developed in response to an increased need for international interdisciplinary collaboration on global public health issues during the COVID-19 pandemic. Logistics to facilitate these virtual activities were provided by the YSM Office of Global Health (Department of Internal Medicine).

2. Reciprocal student, resident and faculty visits from YSM to MakCHS

Various cadres of health professions trainees and faculty have visited MakCHS over the years. A larger number of MakCHS students and postgraduate students interact with their counterparts from YSM in training, patient care, exchange of ideas, and use of evidence in clinical practice as well as social interactions.

This has over time contributed to de-mystifying the concept of High-Income Country (HIC) health care services and systems, where MakCHS students have learnt the importance of empathy, communication, and evidence-based health care which are critical in all socioeconomic settings.

3 Development of infrastructure to support applied research focusing on training of health care workers and patient care:

3.1 Rainer Arnold Senior House Officers Teaching Support (RASHOTS) Project

Through independent funding from the Mulago Foundation in California, the project supports educational activities of Senior House officers (SHOs), the postgraduate trainees of the MakCHS Internal Medicine Department. The project has yielded improved well-being of the trainees, improved competence in patient care and research through its mentorship program and has bridged the gap between the faculty and the learners through the creation of a Chief Resident position. Several trainees received funding for their Masters’ degree training from RASHOTS. See Bibliography below, which includes examples of publications related to RASHOTS

3.2 Quality Improvement

MUYU sponsored a competitive grant application process in 2013-2014 for SHOs to obtain funds to conduct a Quality Improvement (QI) project at MakCHS-MNRH. This was awarded to an SHO who was jointly mentored by faculty at MakCHS and YSM. She successfully examined ways to improve medication administration on the inpatient wards of MNRH and published the work in the International Journal for Quality in Health Care (see Bibliography below). Additionally, two MakCHS faculty have traveled to Yale as part of the MUYU exchange program for the purpose of learning about quality improvement education and practice.

4. Scholarship

Like in other fields, research is used in health care to answer questions that are geared towards improvement of services. In 2015, the MUYU team published a paper examining the effectiveness of the exchange program (refer to Bibliography below). The conclusion was that the exchange program benefitted those who participated as well as MakCHS as an institution, even though the benefits remain difficult to quantify.  The study supported the assertion that resource –poor to resource- rich exchanges have the potential to provide significant benefits to the resource – poor partner, through which MUYU continues to invest in the exchange program as a method to achieve its objective. Two subsequent manuscripts have been published which speak to the MUYU collaboration as a model of ethical and equitable partnership focused on capacity building for clinical education and care (see Bibliography below).

4.1 Patient-centered education

In 2014-15, a YSM junior faculty member received funding from the Fulbright U.S. Scholar Program to investigate the acceptability and feasibility of a patient-centered health education tool for outpatients with congestive heart failure. He was mentored by faculty from both YSM and MakCHS, and worked together with a MakCHS SHO on evaluating the tool for use with an inpatient population as well. The outpatient project was successfully published in 2016 and is being further investigated as a key intervention in the Center of Excellence for Patient-Centered Care project (see Bibliography below).

4.2 Uganda Initiative for Integrated Management of Non-Communicable Diseases (UINCD)

UINCD is a multidimensional partnership focused on building capacity in the realms of prevention, care, training, and research to enable the provision of effective and integrated care along the NCD management spectrum. Although the initial concept was generated by former MUYU trainees, UINCD came about in 2013 through the collaborative work of a leaders from Ministry of Health Uganda, MakCHS, Uganda NCD Alliance, and MNRH, joined by colleagues from YSM. UINCD has evolved into an organization engaged in community-based research and training, as well as stakeholder-engaged policy and advocacy activities. UINCD recently co-led the Uganda NCDI Poverty Commission and is leading the implementation of PEN-Plus, a WHO-endorsed approach for NCD integration, in Uganda(https://www.uincd.org/implementation/).Visit the UINCD website (https://www.uincd.org/) to learn more about specific activities and to view UINCD publications.

4.3 Balamu Project: Center of Excellence for Non-Communicable Disease Research, Education, and Care

The Balamu Project is funded by Else-Kröner Fresenius Stiftung, a German foundation, and is a collaborative project between Charité Universitaetsmedizin Berlin, YSM, Johns Hopkins University, and ACCESS-Uganda. The core physician leaders of this team were participants in the MUYU exchange program during their clinical training, based either at MakCHS or YSM. This connection and desire to improve the care of individuals living with NCDs in rural Uganda led to the development of this project focused on developing models of patient-centered care and clinician education, and investigating unique risk factors, barriers, and facilitators of NCD care in the rural setting. Visit the Balamu Project website (https://balamu.org/) to view an overview of the project objectives, accomplishments, and publications.

4.4 Health Professional Education Partnership Initiative (HEPI)

The five-year, NIH-funded HEPI-Strengthening the Health System and Services in Uganda (SHSSU) project focused on scaling up the training of health professionals through a partnership between MakCHS, YSM/YSN, Busitema University, Clarke International University, Kabale University, Mulago School of Nursing and Midwifery, and the African Centre for Global Health and Social Transformation. Under this umbrella, Yale and Makerere faculty collaborated to support advanced midwifery education, clinical excellence, and the midwifery model of care to improve maternal and newborn health outcomes in Uganda. Additional efforts were made to support local efforts to promote inter-professional education and collaborative practice through training of undergraduate students and faculty. https://hepi.mak.ac.ug

5. Material supportIn addition to the capacity building efforts described above, MUYU has facilitated material contributions such as: a mobile mammography van and two ultrasound machines to the Uganda Cancer Institute, renal biopsy needles and library materials to the MNRH Nephrology unit, support for lab supplies in the 4A side lab at MNRH, bronchoscope for the Pulmonary unit, and CPAP and BiPAP machines to the MNRH Intensive Care Unit at Mulago.

In addition to sharing evolving COVID management protocols throughout the early years of the pandemic, counterparts at Yale were able to mobilize U.S.-based MUYU alumni to donate funds that resulted in the direct donation of equipment to assist with the COVID response at MNRH during the difficult times of the second wave of Covid-19 pandemic in Uganda.

6. Bibliography

Section 3.1: Rainer Arnold Senior House Officers Teaching Support (RASHOTS) Project

1. Kalyesubula R, Mutyaba I, Rabin TL, Andia I, Alupo P, Kimuli I, Nabirye S, Kagimu M, Mayanja-Kizza H, Rastegar A, and Kamya MR. Trends of admissions and case fatality rates among medical in-patients at a tertiary hospital in Uganda: A four-year retrospective study. PLoS ONE 14(5): e0216060. https://doi.org/10.1371/journal. pone.0216060  
2. Mulindwa F, Andia I, McLaughlin K, Kabata P, Baluku J, Kalyesubula R, Kagimu M, and Ocama P. A quality improvement project assessing a new mode of lecture delivery to improve postgraduate clinical exposure time in the Department of Internal Medicine, Makerere University, Uganda. BMJ Open Quality 2022;11: e001101. doi:10.1136/ bmjoq-2020-001101  

Section 3.2: Quality Improvement

1. Alupo P, Ssekitoleko R, Rabin T, Kalyesubula R, Kimuli I, and Bodnar BE. Improving inpatient medication adherence using attendant education in a tertiary care hospital in Uganda. International Journal of Quality in Health Care. 2017 Aug 1; 29(4):587-592. doi: 10.1093/intqhc/mzx075.

Section 3.3.0: Scholarship

1. Bodnar BE, Claassen CW, Solomon J, Mayanja-Kizza H, Rastegar A (2015) The Effect of a Bidirectional Exchange on Faculty and Institutional Development in a Global Health Collaboration. PLoS ONE 10(3): e0119798. doi:10.1371/journal. pone.0119798
2. Rabin TL, Mayanja-Kizza H, Rastegar A. Medical education capacity-building partnerships for health care systems development. AMA Journal of Ethics. 2016; 18:710-717.
3. Rabin TL, Mayanja-Kizza H, Barry M. Global Health Education in the Time of COVID-19: An Opportunity to Restructure Relationships and Address Supremacy. Academic Medicine 2021 Jun 1;96(6):795-797. doi: 10.1097/ACM.0000000000003911.

Section 4.1: Patient-centered education

1. Siddharthan T, Rabin T, Canavan ME, Nasal F, Kirchhoff P, Kalyesubula R, Coca S, Rastegar A, and Knauf F. Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study. PLoS ONE (2016). 11(11): e0166411. doi: 10.1371/journal.pone.0166411.