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The 2020 COVID-19 Non-Pharmaceutical Containment Measures – Adherence and Impact on Livelihoods in Rural Uganda

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By Dr. Dan Kajungu and MUCHAP/IMHDSS Team

Uganda is currently experiencing a second wave of the COVID-19 pandemic with an upsurge of cases. The country registered an 81% increase in the number of COVID-19 cases between March and April 2021, which indicates resurgence or another wave in the pandemic. From 200 cases per day in April, now the country is recording over 500 cases per day. The vaccines uptake has improved only recently, and the population has ignored the Ministry of Health (MoH) Standard Operating Procedures (SOPs) meant to contain transmission. Since March 2021, when the COVID-19 AstraZeneca vaccine was introduced, about 541,569 persons have so far been vaccinated.

On 6th June, new control measures were announced to mitigate the transmission. The Makerere University Centre for Health and Population Research (MUCHAP) which runs a longitudinal population-based cohort of Iganga and Mayuge districts (Iganga Mayuge Health and Demographic Surveillance Site) conducted a community survey to understand how citizens responded to the non-pharmaceutical interventional measures, and the impact on their livelihood. This survey was part of the routine community surveys that a typical health and demographic surveillance site conducts to understand the population dynamics in population cohorts. The hybrid survey involved about 2,000 households in rural and peri-urban settings using a questionnaire that adopted some questions from the Wellcome Trust COVID-19 tool. It was a hybrid of on-phone and physical interviews conducted between July and August 2020 right after the relaxation of restriction in Uganda. Community based surveys provide information on what to expect when piloting and implementing interventions in populations. In addition to the demographic and household characteristics, questions sought to understand the extent of community adherence to COVID-19 control measures and probed about the impact on socio-economic and access to health services.

Adherence to preventive measures: The survey found that 94% of the respondents adhered to COVID-19 non-medical control measures that were enforceable by security personnel. It was different for non-pharmaceutical measures that were largely dependent on individual enforcement or discipline and this averaged at 43% of the respondents. Six in ten respondents reported doing most of their work from home and half (50%) avoided seeking medical care at health facilities during lockdown.

The non-pharmaceutical guidelines included using preventive actions like social-distancing, hand washing with soap, the use of alcohol-based hand sanitizing gels as well as wearing of face masks. Citizens were encouraged to stay at home with the exception of essential workers who rendered critical services. Some community members could not adhere, not because they do not take it as a priority but because of the cost implications.

Socio-economic impact: There was change in the living arrangement in 12% of the households mostly because someone moved out or into the household. Community members reported a reduction (64%) in the income for household members with some experiencing a complete stop in earnings (6%). Residents in rural settings reported more reduction in income compared to Peri-urban residents (78% vs 74%). There are seemingly unique circumstances that need to be considered as interventions and decisions are made. For instance, it should not be surprising that a household cannot afford to have a bar of soap, a face mask, an alcohol-based hand sanitizing gel and social distance because of the living structures. In some cases, even accessing water is a luxury for some homes. There are some homesteads that are unable to grow food or earn an income from selling cash crops because they leased their pieces of land for large scale sugarcane growing 3 or 4 years ago, with just a house and a few feet of compound to spare. Unfortunately, such individuals have no access to social media where they can express their predicament.

The survey further found out that during the 2020 lockdown period, there was a general increase in violence against men, children, and women. There were cases of child neglect as well as marital problems. The survey found that 53% of the respondents reported increase in marital problems, while violence against women during the lockdown was reported by 51% of the respondents and was more common among rural residents compared to their Peri-urban counterparts. Residents could not access what they considered essential needs like transport and education services, which were directly affected by government directives and other community services. Communication was the most affected essential service reported.

Access to Health Services: 26% of the interviewed community members who were on daily medication due to a chronic or long-term condition reported running out of drugs during lockdown. Non-affordability due to the cost was the main reason in 54% of respondents, while 19% reported cases of stock-outs at both public and private health facilities and 10% were restricted by lockdown measures.

In another review of the immunisation records at Busowubi Health Centre III in Iganga district, it was clear that during the lockdown, utilisation of immunization services was severely affected (manuscript is undergoing peer review). Children did not complete their scheduled vaccine doses which calls for catch up vaccination drives. People could not go to health facilities because of fear of acquiring infection and restricted movements of boda-boda.

Please see Downloads for the detailed report.

Mark Wamai

Business & Management

From risk to resilience: Increasing insurance uptake among farmers in rural Uganda

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Dr. Aisha Nanyiti presenting about the project. EfD-Uganda Fellows Co-creation workshop with representatives from Government, CSO and the private sector to generate a context-relevant Micro, Small and Medium Enterprise (MSMEs)-led model for supporting the transition to low-carbon ag-tech by smallholder farmers, 25th April 2024, Makerere University, Kampala Uganda, East Africa.

By Dr. Aisha Nanyiti

Poor households in low-income countries face numerous risks, from extreme weather events to illness and crop failure. With limited savings and assets, even small shocks can have devastating consequences on welfare. While formal insurance products can potentially help mitigate these risks, their uptake remains remarkably low among rural smallholder farmers, who instead primarily rely on informal risk-sharing networks. This pattern persists despite evidence suggesting that informal insurance mechanisms provide incomplete coverage against shocks. These shocks translate into shortfalls in income and consumption (Karlan et al. 2014, Morduch 1999).

Studying the impact of insurance on farmers’ economic behaviour

In Nanyiti and Pamuk (2025), we focus on smallholder farmers in rural Uganda and examine how different insurance arrangements affect their economic behaviour and decision-making. Uganda provides an ideal setting to explore these questions, as only 1% of adults have formal insurance coverage, despite 67% of households depending on agriculture for their livelihoods. By comparing behaviour under formal insurance (provided by registered companies) versus informal insurance (peer-to-peer transfers), we gain insights into why formal insurance uptake remains low and how farmers respond to different risk management options.

Using a real effort task experiment, we investigate whether the incentives created by these different insurance arrangements influence productivity and risk management decisions. Our findings reveal important behavioural responses that help explain observed patterns in insurance uptake and suggest potential approaches for improving the design and adoption of formal insurance products. We find that farmers exerted less effort under informal insurance but not under formal insurance coverage, and increased their level of formal insurance coverage after experiencing a bad outcome.

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Dr. Aisha Nanyiti is a Lecturer at the School of Economics, College of Business and Management Sciences, Makerere University

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Directorate of Graduate Equips Schools and Colleges with Training in Philosophy of Methods

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By Moses Lutaaya

The Directorate of Graduate Training at Makerere University has equipped several Senior ranking lecturers with expert knowledge in a Training of Trainers’ workshop on “Philosophy of Methods”.

In his remarks at the opening of a 3-day training workshop at Level4 Conference Hall – Senate Building, the Director of Graduate Training Prof. Julius Kikooma said, “The teaching of Philosophy of Methods gives all participants the fundamentals to extend knowledge to other learners, hence its importance in upholding the Makerere University values.”

Kikooma urged and challenged the participants to also attend and actively participate in the follow up of learners’ training of students, stating that the PhD students need support as the directorate continues to coordinate the curriculum of PhD by-research that was approved by the senate recently.

“To holistically implement the senate approved PhD curriculum, we are coordinating capacity building trainings of all stake holders in a structured approach with the different units of the University. Many more trainings including Training of Trainers in advanced research methods course are on the way.”

He further urged the participants to be intentional in their teaching profession and in whatever they were doing, adding “Apart from focusing on practices as teachers and researchers, we can engage in wider philosophical debates in our research areas so that we are relevant in the society and in the empowerment of PhD research students.”

 The participants for the Philosophy of Methods training were from College of Humanities and Social Sciences, College of Education and External Studies, Makerere University Business School among others.

During the same training, Dr. Dickson Kanakulya stressed the need to train senior lecturers in the Philosophy of Methods, saying, “The biggest connection is that societal problems require concrete research to find solutions. Our challenge in Africa is that we employ a short barrow approach to find solutions to problems. This cannot work. We need consistent researchers to solve problems. Lasting solutions to societal issues can only be got through training such as Philosophy of Methods, where researchers come up with new models for societal solutions.”

Prof. Julius Kikooma pose for a photo with participants and facilitators.

Dr. Kanakulya said that Makerere University remains the biggest research University in Africa and philosophy of Methods helps to come up with good research tools that produce good research outputs. “Research has shown that the higher the number of PhD researchers in any given country, the higher the levels of development of that country e.g. the USA, China etc., adding that research is not limited to only medicinal or agricultural related issues.”

He said philosophy of methods, encourages philosophical creativity in research, “It is meant to bring out philosophical generation of concepts, theories and ideas. It is meant to encourage students to question the existing philosophical assumptions and status quo in a given field of knowledge such that new philosophical concepts are created.”

 For successful rollout of government programs like the National Development Plan 4, Dr. Kanakulya said that Philosophy of Methods training needs to be integrated into such systems. “Philosophy of Methods focuses on ethical thinking aspects. For example, for a better rollout of the Parish Development Model, we need implementers to be ethical.” He added.

 Prof. Sulait Tumwiine, the associate Dean of Faculty of Graduate Studies and Research at MUBS said, “This is a discussion where new ideas are shared to guide and gauge applicability in the current knowledge diversity coupled with lots of technological development including Artificial Intelligence and Chat GPT.”

He added, “As professors of Universities, we need to understand how we leverage on what comes up so that it does not take our space, but also appreciate how we can support growth of knowledge. The Philosophy of Methods training is the answer.”

 Dr. Jim Spire Ssentongo highlighted that Philosophy uses more of the critical mind than Science. He added that philosophy is more of speculation of the mind.

“Sustainability of philosophy Education encourages us to continue training. Philosophy being the oldest discipline retained special status in the academia as a pinnacle of pursuit of knowledge. All disciplines have major elements of philosophy citing examples in the philosophy of Mathematics and Physics.

Dr. Spire added, “If you do not understand philosophy, you cannot deeply investigate anything because philosophy is the reality of understanding everything. Philosophy is the basis of understanding what knowledge is and how it is arrived at.”

Also participating in the workshop was Prof. Joseph Ntaayi from MUBS, in his remarks he said PhD students need the philosophy of methods training to understand how to best to create knowledge. He added that ontological and epistemological questions that lead to good research design methods can only be answered by this training.

Dr. Robert Kakuru, a Lecturer in the College of Humanities and Social Sciences said that the Philosophy of Methods training is needed by every graduate student as well as supervisors to critically determine the choice of methods to use in academic research. For example, “If one wants to use a questionnaire as an interview approach, one should understand, why that approach and yet without this training, the why cannot be answered.” He added.

The Philosophy of Methods training was organized by Directorate of Graduate Training with funding support from the Consortium for Advanced Research Training in Africa (CARTA).

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Uganda’s National ID Delivers $1.35 for Every $1 Invested

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A man reaches for the Uganda National ID from his wallet. New study, “Understanding the Benefits, Costs, and Challenges of the National Identification System in Uganda,” published in Digital Society, for every US$1 invested in the NID system, the return on investment is US$1.35, led by Roy William Mayega from Makerere University School of Public Health’s Resilient Africa Network (MakSPH-RAN), Kampala, Uganda, East Africa.

KAMPALA – The National Digital ID (NID) has significantly transformed Stella Nakazibwe’s role as a SACCO Administrator. “In my day-to-day work, I use my National ID to carry out financial transactions in the bank. Without it, I can’t access funds,” she says, her voice filled with a quiet confidence. “Now, I also use it to register for my school. You can’t sit for ICPAU papers without registering, and a National ID is essential.”

Nakazibwe’s story represents the promise of Uganda’s ambitious National ID system, launched in 2014 with the aim of streamlining government services, enhancing security, and boosting financial inclusion, with 97 percent believing it is essential.

A sound national ID system should meet key principles of inclusion, design, and governance, according to the World Bank. However, a 2017 study by the US government’s Center for Digital Development, formerly USAID, found that many digital ID systems are fragmented and focused on short-term goals, lacking clear evidence of their long-term social and economic benefits.

Ugandan law requires all citizens aged 16 and above to obtain a National ID linked to their demographic and biometric data. To support this, the National Identification and Registration Authority (NIRA) launched a mass registration campaign nationwide, followed by smaller drives to capture more people. The requirement for SIM card registration further boosted this effort, making telecom companies major users of the National ID database.

But a new study, “Understanding the Benefits, Costs, and Challenges of the National Identification System in Uganda,” published in Digital Society, reveals a more nuanced picture, stressing both the successes and the persistent challenges in ensuring that the National ID truly benefits all Ugandans.

The research, led by Roy William Mayega from Makerere University School of Public Health’s Resilient Africa Network (MakSPH-RAN), surveyed nearly 3,000 Ugandans and analyzed government data to assess the system’s impact. Other researchers were Dr. Dorothy Okello, Christine Muhumuza, Nathan Tumuhamye, Julius Ssentongo, Dr. Allen Kabagenyi Mulerwa, Brandon Kwesiga, Dr. Agnes Nyabigambo, Anthony Ssebagereka, and Professor William Bazeyo.

Dr. Roy William Mayega, a lead researcher on this work. File Photo. New study, “Understanding the Benefits, Costs, and Challenges of the National Identification System in Uganda,” published in Digital Society, for every US$1 invested in the NID system, the return on investment is US$1.35, led by Roy William Mayega from Makerere University School of Public Health’s Resilient Africa Network (MakSPH-RAN), Kampala, Uganda, East Africa.
Dr. Roy William Mayega, a lead researcher on this work. File Photo

The findings confirm that the National ID has been a worthwhile investment for the government. The study estimates that for every US$1 invested in the NID system, the return on investment is US$1.35. These savings stem from reduced fraud in social programs and more efficient management of public funds.

But beyond the numbers, the research also illuminates the human experiences behind the National ID. For many, like Nakazibwe, the ID has unlocked opportunities previously out of reach. It has become a key to accessing mobile money services, opening bank accounts, and participating more fully in the formal economy.

However, the research also shows that not everyone is benefiting equally. The study found that while 94% of Ugandans sought to register for an NID, nearly one in five still don’t have one. And those who are most likely to be left behind are often the most vulnerable.

“We found that reasons for not having a National ID were more prevalent in the lowest wealth quintile,” explains Mayega. “This suggests that the poorest Ugandans face greater hurdles in accessing the system, whether it’s due to challenges in navigating the registration process or the cost of transportation. Illiteracy was also a key contributor.”

The most common reasons for not having a National ID included incomplete registration (33.7%), not registering (21.2%), lost IDs (19.9%), failure to collect IDs (9.4%), and slow processing (7.7%). Women were more likely to mention long queues and registration costs, while men cited ID loss and non-citizenship. Urban residents more often pointed to lost IDs and slow processes, while rural participants highlighted limited registration time.

Joan Apio, Deputy RDC Apac, officiated over the unpacking, recipient, and handover of NIRA kits supplied for mass enrollment and renewal of National IDs at the NIRA Office Apac Branch on March 13, 2025.
Joan Apio, Deputy RDC Apac, officiated over the unpacking, recipient, and handover of NIRA kits supplied for mass enrollment and renewal of National IDs at the NIRA Office Apac Branch on March 13, 2025.

The study also uncovered concerns about data privacy and the potential for misuse of personal information. Many Ugandans express concerns about the potential use of their National IDs for surveillance or fraudulent activities. These anxieties point to the need for greater transparency and robust data protection measures.

From the study, the common National ID errors included misspelled names (45.0%), incorrect or missing dates of birth (16.6%), unclear fingerprints (8.9%), and improper signatures (3.6%). Of the 169 participants with errors, only 28.5% attempted corrections, and just a third succeeded, often after waiting an average of six months. Most (77.1%) described the correction process as difficult, with transport costs from 0 to 400,000 shillings and other related expenses around 525,000 shillings (US\$ 145.8).

To ensure that the National ID lives up to its full potential, the researchers recommend a series of concrete steps: launching targeted registration drives to reach those who have been left behind, simplifying the registration process, strengthening data protection measures, and expanding the use of National IDs in government programs.

“It’s crucial that the government addresses these concerns and builds trust in the system,” says the Executive Director of the Africa Freedom of Information Centre (AFIC), Gilbert Sendugwa.

In Uganda, a National ID is more than just identification—it’s a key to accessing rights and services, Sendugwa explains.

“However, the issue of data security persists. For example, a woman in Ntungamo District faced legal trouble after her stolen ID was misused to secure a Parish Development Model loan before tighter controls were in place. The government must do more to teach people to protect their IDs and reassure them that their data is used to empower, not control, them,” he says.

Gilbert Sendugwa, ED, AFIC.
Gilbert Sendugwa, ED, AFIC.

Of the participants with National IDs, 7.7% (186 people) reported they had lost them, with higher rates among women (9.1%), urban residents (9.7%), and those in the lowest wealth quintile (9.3%). However, only 28.5% of those who lost their IDs attempted to replace (8.6%) or recover (19.9%) them, with mixed success. While 75% of those seeking replacements succeeded, only 45.4% of those trying to recover lost IDs managed to do so. About half of those attempting replacements described the process as difficult, with some waiting over three months.

Millions of Ugandans risk being excluded from essential services without national digital IDs, according to the Collaboration on International ICT for East and Southern Africa (CIPESA). Vulnerable groups like older persons in poverty and those with disabilities, who often struggle to reach NIRA offices for enrollment, face the greatest challenges. Without IDs, they are unable to access senior citizens’ grants, healthcare, land titles, social security benefits, driving permits, SIM card registration, bank accounts, passports, and voter registration.

“Uganda’s digital ID system needs to ensure the necessary safeguards for both data protection and access to essential services; otherwise, it risks not only entrenching exclusion and inequality but also increasing concerns about personal data privacy and protections. Gaps in solid data protection can result in discrimination, profiling, surveillance of data subjects, and identity theft,” says Juliet Nanfuka, a digital rights advocate and communications officer at CIPESA.

Juliet Nanfuka, a digital rights advocate and communications officer at CIPESA.
Juliet Nanfuka, a digital rights advocate and communications officer at CIPESA.

Uganda’s experience with the National ID system provides helpful lessons for other African countries aiming to leverage the power of digital identification. As NIRA prepares for a nationwide mass ID renewal and registration campaign on May 27, 2025, the redesigned IDs are expected to feature enhanced security technologies like Multiple Laser Images (MLI), Machine-Readable Zones (MRZ), QR codes, and 2D barcodes. These upgrades are intended to improve identity verification and expand access to digital services.

Researchers argue that by addressing citizen concerns, ensuring equitable access, and genuinely listening to the voices of its people, Uganda can transform the National ID from a mere card into a critical lifeline for all.

Davidson Ndyabahika is a Health and Science Communication Specialist, School of Public Health, Makerere University

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