To access treatment and care services at the Uganda Cancer Institute (UCI), patients spend on average 300,000 Uganda shillings on a single visit although some spend to as high as 800,000 (Figure 1). This was revealed by a study done by Makerere University in collaboration with the Strengthening Institutional Capacity for Research Administration (SICRA) and Uganda Cancer Institute (UCI) with funding from the Government of the Republic of Uganda through Makerere UniversityResearch and Innovation fund (Mak-RiF).
Figure1; Out of pocket expenditure by Cancer stage.
Conducted in 2021 during the Covid-19 pandemic lockdown, this study titled āImpoverishing and Catastrophic Health Expenditure on Cancer Care among Persons affected by Cancer in Ugandaā is among the first few in the country to estimate the catastrophic health expenditure among cancer patients receiving care in Uganda.
The study revealed that patients suffering from Prostate and Colorectal Cancers were the most affected, with their out-of-pocket expenditure greater than 600,000 per visit. Out of pocket expenditure refers to all direct payments for healthcare or services from household income or savings that patients incur at the point they receive health services.
The study also highlighted that a considerable proportion of cancer patients experience catastrophic health expenditure. āOverall, at least half of all cancer patients experienced catastrophic health expenditure on Cancer Care and treatment. 5 out of 10 patients spent at least 40% of their household income on Cancer health care,” the study findings reveal in part. Further, “Cancer patients or households with patients are unable to solely meet costs associated with cancer care. Often they depend on family, relatives, and friends’ support. However, the continuity of support coming through is not guaranteed throughout the patient’s time of sickness.” Speaking during the Dissemination and Stakeholders Engagement at UCI, Dr. Allen Kabagenyi, the Principal Investigator, noted that unemployed patients, who constituted 86% in the study, were among those who spend at least 300,000 Uganda shillings whenever they visit UCI. āThis money is spent on buying missing drugs, imaging services, and tests among others,ā she added.
Besides digging deep into their pockets to meet the cancer treatment costs, the findings reveal that families often sell their household property like land, animals, homes among others, in order to raise money for treatment and any related care. “The Shs300,000 is for only one visit but remember a cancer patient who is on stage one and two has to visit regularly, translating to almost Shs. 3.6 million in a year,” Dr. Francis Kiweewa, the Director Strengthening Institutional Capacity for Research Administration (SICRA) said.
Participants attending the Blended presentation at Uganda Cancer Institute, Mulago.
The Assistant Commissioner ā Non communicable diseases (NCDs) prevention and control Department at Ministry of Health, Uganda, Dr. Gerald Mutungi said; “At the ministry, we have adopted the approach of evidence-based policy decision making. Therefore, the policy recommendations of this study are well received.ā He further said that as the Ministry waits for the passing and implementation of the National Health Insurance Scheme, researchers need to investigate and come up with measures aimed at cancer prevention and control.ā
Dr. Gerald Mutungi, Assistant Commissioner for Health Services ā NCDs prevention and Control Department at Ministry of Health, Uganda.
Dr. Jackson Orem, the Executive Director of Uganda Cancer Institute, while responding to the study findings admitted to the growing cancer burden, which he said could only be managed through establishing regional Cancer management centers. He said “currently when you look at the statistics of the number of cancer patients we receive at UCI, 15% are from central region while 85% come from up country. What I can say is that we need to decentralize our services so that these people are able to access them with ease in their respective areas.ā
Dr. Jackson Orem, Executive Director, Uganda Cancer Institute (UCI).
Dr. Nixon Niyonzima, the Head of Research at UCI, said government should have focused interventions of increasing household income so that the patients are able meet the cancer care and treatment related expenses.
Speaking to journalists, Prof. Bruno Yawe, the Ag. Principal College of Business and Management Sciences (CoBAMS) noted that the study speaks to the objectives of Makerere Universityās strategic planning framework for the 2020ā2030 period, which seeks to enhance a research-led university. He commended the multidisciplinary study team led by Dr. Allen Kabagenyi, saying that the findings were timely especially when Uganda is registering rising cancer related morbidity and mortality. He thanked the Mak-RIF Grants Management Committee representative Dr. Mercy Amiyo, for insights and continued support to researchers at Makerere University.
In Uganda, over 56,238 are living with cancer and more than 21,000 deaths were registered in 2020, according to the Globocan Cancer Statistics report. Further the report shows the top seven cancers in Uganda including; cervical cancer, Kaposis Sarcoma, breast, prostate, Non-Hodgikin Lymphoma, cancer of the liver and esophageal ā account for 70% of new cancer cases. Knowing the catastrophic health expenditure on cancer care is crucially important to design strategies of providing financial protection against the rising medical expenditure by households with cancer patients.
Meet the study team
Left to Right: Dr. Allen Kabagenyi (MAK, SSP); Dr. Francis Kiweewa (SICRA); Dr. Nixon Niyonzima (UCI).Left to Right: Dr. Lydia Nakiyingi (MAK, CHS); Prof. Elizeus Rutebemberwa (MAK, SPH); Dr. Roy Mubuuke (MAK, CHS); Prof. Fred Matovu (MAK, CoBAMS).
Acknowledgements
This study was funded by the Government of the Republic of Uganda through Makerere UniversityResearch and Innovation Fund (MAK-RiF). Special thanks to all the patients, Care Givers and Key informants who participated in this study. Graduate Assistants Mr. Ronald Wasswa and Mr. Kayemba, Makerere University.
The Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, has officially opened a one-week training for Ministry of Kampala Capital City and Metropolitan Affairs (MoKCC&MA) officials on Integrating and Managing Environmental, Social, Health and Safety (ESHS) Safeguards in Procurement.
The training, conducted by the Public Investment Management (PIM) Centre of Excellence, is funded by the World Bank and brings together officials from KCCA, metropolitan and municipal authorities under the Greater Kampala Metropolitan Area (GKMA) programme, alongside officials from central government ministries and agencies.
Opening the training, Prof. Nawangwe emphasized that safeguarding is a critical pillar of sustainable development and accountable public service delivery.
āIf we get things wrong in Kampala, we affect the entire country. Everything done in this city must be well planned, socially responsible, and environmentally sound,ā Prof. Nawangwe said.
Drawing from his professional background as an architect, the Vice Chancellor underscored the importance of environmental, social, and safety safeguards, noting that failure to address these issues at planning and procurement stages can lead to loss of life, stalled projects, and massive financial waste. He cited international examples where projects were halted or countries faced global pressure due to neglect of environmental and social considerations.
Prof. Nawangwe commended the World Bank for its continued partnership with Makerere University, particularly in supporting the establishment and growth of the PIM Centre of Excellence, which he described as one of the Universityās flagship initiatives with visible national impact.
āI see the work of the PIM Centre in government processes, in reports, and even in Development Committee meetings. That is real impact,ā he noted, adding that strengthening in-country capacity through Makerere reduces reliance on costly external consultants.
He reaffirmed Makerere Universityās commitment to supporting government through research, training, and policy-relevant knowledge, stressing that continuous professional development is essential in a rapidly changing world.
The Under Secretary, Ministry of Kampala Capital City and Metropolitan Affairs, Ms. Monica Edemachu Ejua, welcomed the training, describing it as timely and necessary given the challenges faced during project implementation, particularly in road construction.
Ms. Ejua, revealed that the training was informed by real and painful experiences, including fatal accidents on construction sites, some of which could have been avoided with stronger environmental and social safeguards.
āEnvironmental, social, and health and safety issues must never be downplayed. These considerations must begin at procurement planning, not at implementation,ā she said.
She highlighted that procurement officers, engineers, planners, accountants, and administrators must all understand safeguards, noting that infrastructure development is inherently multidisciplinary.
āDevelopment must be a blessing to communitiesānot a burden,ā she added.
Ms. Ejua praised Makerere University for hosting the training and the World Bank for supporting government efforts to build institutional capacity, adding that learning does not end at graduation.
World Bank: Strong Country Systems Are Key to Development Impact
Presenting on behalf of the World Bank, Ms. Christine Kasedde, a Senior Environmental Specialist, explained that the training is part of a broader effort to strengthen country systems for managing environmental and social risks in development projects.
She noted that while the World Bank has committed over USD 4 billion to projects in Uganda, weak safeguards and capacity constraints have affected implementation and disbursement.
āEnvironmental and social safeguards are legally binding commitments. When they are not addressed properly, issues escalate to the highest levels of government,ā Ms. Kasedde explained.
She outlined how the collaboration with Makerere University has led to the development of several short professional courses across CoBAMS, the College of Agricultural and Environmental Sciences (CAES), and the College of Humanities and Social Sciences (CHUSS). These courses address gaps in social risk management, environmental sustainability, health and safety, climate risk, and procurement.
Ms. Kasedde also revealed that the partnership has culminated in the establishment of an Environmental and Social Sustainability Centre at Makerere University, which will serve as a hub for training, research, advisory services, and independent assessments.
Procurement as a Tool for Sustainable Development
Representing the Public Procurement and Disposal of Public Assets Authority (PPDA), Ms. Mercy Kyoshabire, Director for Procurement and Disposal Capacity Building, emphasized that public procurement accounts for over 60 percent of government expenditure and must therefore be leveraged as a tool for sustainable development.
She reminded participants that environmental, health, and social safeguards have been embedded in standard bidding documents since 2019, urging procurement professionals to integrate sustainability throughout the procurement cycle.
āSustainability is about the three PsāPeople, Profit, and Planet. Procurement decisions made today should not compromise future generations,ā she said.
Ms. Kyoshabire reaffirmed PPDAās commitment to collaboration and capacity building, particularly with centres of excellence such as Makerere University.
A Model of Interdisciplinary Collaboration
The training also drew strong support from the Principal of CAES, represented by Dr. Patrick Byakagaba and, Principal CHUSS, Prof. Helen Nkabala, who emphasized Makerere Universityās shift away from siloed approaches toward interdisciplinary collaboration in addressing national development challenges.
Prof. Edward Bbaale, Principal Investigator of the PIM Centre of Excellence, noted that the training responds to critical gaps identified at the pre-investment and procurement stages of public projects, particularly as Uganda pursues an ambitious growth agenda amid climate and social risks. Dr. John Sseruyange, the manager of PIM Centre of Excellence said, the week-long training is expected to strengthen the capacity of KCCA and GKMA implementing entities to integrate and manage environmental, social, health, and safety safeguards across the procurement and project implementation cycle, ultimately improving service delivery and protecting communities.
Away from the bustle of the city, in the calm setting of Mbarara, over 30 public service economists have gathered with a shared purpose: to strengthen the skills that shape how public resources are invested and how national development priorities are realised.
The two-week executive training on Economic Appraisal and Stakeholder Analysis, organised by the Public Investment Management (PIM) Centre of Excellence at Makerere University, officially commenced this week, bringing together public officers from across government, academia, state agencies, and civil society. At its core, the programme seeks to answer a fundamental questionāhow can Uganda ensure that every shilling invested in public projects delivers maximum economic and social value?
The training draws expertise from Makerere University, Cambridge Resources International (CRI), the Ministry of Finance, Planning and Economic Development (MoFPED), and the National Planning Authority (NPA), reflecting a strong partnership between academia, policy makers, and development practitioners. Participants represent a wide cross-section of institutions, including the Ministry of Internal Affairs, Uganda Tourism Board, MoFPED, Kiira Municipality, Wakiso Local Government, Kyambogo University, Makerere University, UEDCL, UNCST, UDC, the Uganda Police Force, Parliament of Uganda, and several civil society organisations.
Opening the programme on behalf of the Permanent Secretary and Secretary to the Treasury, Commissioner PAP, Ms. Gertrude Basiima, explained that the choice of venue was intentional. Holding the training away from the city, she noted, allows participants to concentrate fully and engage more deeply with the intensive content. Previous trainings held in similar settings, she added, had yielded positive results.
Ms. Basiima highlighted that the training is part of a long-standing strategic partnership between the Ministry of Finance and the PIM Centre of Excellence at Makerere University, housed in the School of Economics. Established in 2016, the collaboration was informed by diagnostic assessments that revealed persistent gaps in Ugandaās public investment management systemāparticularly in project identification, appraisal, selection, and implementation.
āThese gaps are not merely technical,ā she observed. āThey determine whether public investments truly transform communities or fall short of their promise.ā
The training builds on earlier modules in financial appraisal, equipping participants with advanced competencies in economic appraisal and stakeholder analysis. Through practical case studies and hands-on exercises, participants will explore demand forecasting, economic pricing, and sector-specific appraisal techniques applicable to energy, water, transport, and agriculture. By the end of the programme, participants are expected to competently conduct cost-benefit analyses and assess whether proposed projects merit inclusion in the national budget.
Ms. Basiima emphasised that while many feasibility studies are prepared by consultants, public officers must be able to interrogate, quality-assure, and defend these studies before decision-making bodies such as the Development Committee. The training, she said, is designed to position participants to do exactly that.
For Prof. Edward Bbaale, Director of the PIM Centre of Excellence, the training comes at a critical moment in Ugandaās development journey. With the country implementing ambitious programmes under the National Development Plan IV and the Ten-Fold Growth Strategy, public investment has become a central driver of socio-economic transformation.
Across the country, Uganda is investing heavily in transport infrastructure, energy generation and transmission, irrigation systems to respond to climate change, industrial parks, digital infrastructure, education, and health facilities. Yet, as Prof. Bbaale cautioned, the success of these investments depends less on the volume of funding mobilised and more on the quality of project preparation and appraisal.
āEconomic appraisal must be seen not as a box-ticking exercise, but as a strategic tool for national transformation,ā he said. āIt enables government to prioritise projects with the highest economic and social returns, minimise fiscal risks, and ensure value for money.ā
Prof. Bbaale also underscored the strength of the multi-institutional partnership supporting the programme, noting that it blends global best practices with Ugandaās policy realities. At the conclusion of the training, participants will receive a tripartite certificate jointly issued by Makerere University, the Ministry of Finance, and Queenās University, recognising their enhanced expertise in public investment management.
For the Manager of the PIM Centre of Excellence, Dr. John Sseruyange, the training is as much about mindset as it is about technical skills. He encouraged participants to remain disciplined, engage fully, and build professional networks that will endure long after the two weeks in Mbarara.
āThe skills you gain here will not only strengthen you as individuals,ā he noted, ābut will directly influence the quality of public investment decisions made across Uganda.ā
As the sessions unfold over the next two weeks, the training stands as a testament to Makerere Universityās enduring contribution to national developmentābuilding capacity, shaping policy, and preparing public servants to make decisions that drive sustainable growth, economic resilience, and shared prosperity for all Ugandans.
Beyond training, the PIM Centre of Excellence continues to play a broader national role through research and policy advisory services. The Centre has supported the review of Development Committee guidelines and convened national dialogue through its annual Public Investment Management Conference, including last yearās conference themed āOvercoming Implementation Barriers in Public Investment Management for Fiscal Sustainability.ā
Dr. Aisha Nanyiti is a Lecturer at Makerere Universityās School of Economics. She holds a PhD in Development Economics from Wageningen University, The Netherlands. Her research focuses on impact evaluation, causal inference, and behavioural economics, with expertise in Randomized Control Trials (RCTs), LabāinātheāField experiments, and survey-based causal analysis. Aisha studies labour and financial markets, gender and womenās empowerment, poverty, and clean energy adoption, bridging rigorous evidence with real-world policy impact. She is also a Research Fellow at the Environment for Development Initiative (EfDāMak Centre), contributing to inclusive development and evidence-based policy in East Africa. She is the International Economic Association (IEA)’s featured economist for January 2026.