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Cancer Patients Spend an Average of Shs 300,000 on a Single Visit at UCI

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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 University Research and Innovation fund (Mak-RiF).

Figure1; Out of pocket expenditure by Cancer stage.
Figure1; Out of pocket expenditure by Cancer stage.

Conducted in 2021 during the Covid-19 pandemic lockdown, this study titled “Impoverishing and Catastrophic Health Expenditure on Cancer Care among Persons affected by Cancer in Uganda” 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. “Overall, 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. “This money is spent on buying missing drugs, imaging services, and tests among others,” 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.
Participants attending the Blended presentation at Uganda Cancer Institute, Mulago.

The Assistant Commissioner – 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.”  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.”

Dr. Gerald Mutungi, Assistant Commissioner for Health Services – NCDs prevention and Control Department at Ministry of Health, Uganda.
Dr. Gerald Mutungi, Assistant Commissioner for Health Services – 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.”

Dr. Jackson Orem, Executive Director, Uganda Cancer Institute (UCI).
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 University’s strategic planning framework for the 2020–2030 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 – 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. 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).
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 University Research 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.

Mak Editor

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Public Investment Management Centre Concludes 4th Cohort Training on Financial Implications Guidelines

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Group photo of participants. Public Investment Management Centre of Excellence (PIMCoE), hosted by the College of Business and Management Sciences, Makerere University, Kampala Uganda, East Africa, training of its 4th cohort of public officers on User Acceptance Training on Guidelines for Clearance of Financial Implications, November 15, 2024.

The Public Investment Management Centre of Excellence (PIMCoE), hosted by the College of Business and Management Sciences at Makerere University, successfully concluded the training of its 4th cohort of public officers on November 15, 2024. This capacity-building program focused on the User Acceptance Training on Guidelines for Clearance of Financial Implications, a critical process mandated by Section 76 of the Public Finance Management Act (PFMA), 2015.

Under the PFMA, every bill presented to Parliament must include a Certificate of Financial Implications (CFI) issued by the Ministry of Finance, Planning and Economic Development (MoFPED). The preparation of the Statement of Financial Implications (SFI), which forms the basis for the CFI, is the responsibility of Ministries, Departments, and Agencies (MDAs). This statement provides detailed revenue and expenditure estimates and projected savings over a minimum of two years’ post-enactment.

Empowering MDAs with Essential Skills

The training sessions, which began last week and will continue into the following week, aim to equip MDAs with the skills required to prepare robust SFIs. These competencies are essential for MoFPED Budget Analysts to review and draft CFIs or Letters of Financial Clearance effectively.

A section of participants. Public Investment Management Centre of Excellence (PIMCoE), hosted by the College of Business and Management Sciences, Makerere University, Kampala Uganda, East Africa, training of its 4th cohort of public officers on User Acceptance Training on Guidelines for Clearance of Financial Implications, November 15, 2024.

The 4th cohort comprised officers from key institutions, including the Ministry of Lands, Ministry of Agriculture, National Environmental Management Authority (NEMA), Uganda Land Commission, Ministry of Local Government, National Agricultural Research Organization (NARO), and the Ministry of Kampala, among others.

A Step Toward Transparent and Accountable Governance

Speaking at the closing ceremony, Mr. Moses Sonko, Principal Economist at MoFPED, commended the initiative and acknowledged the value it brings to Uganda’s public policy and legislative processes. Representing the Permanent Secretary of MoFPED, Mr. Sonko highlighted the importance of the training in strengthening governance frameworks.

“This training was developed to equip us with tools and knowledge essential for our roles in ensuring that Uganda’s policy and legislative proposals are financially sound, transparent, and align with national priorities,” Mr. Sonko remarked. He encouraged participants to apply their newly acquired skills to enhance policy preparation and implementation.

Mr Sonko addresses trainees at the close of the training. Public Investment Management Centre of Excellence (PIMCoE), hosted by the College of Business and Management Sciences, Makerere University, Kampala Uganda, East Africa, training of its 4th cohort of public officers on User Acceptance Training on Guidelines for Clearance of Financial Implications, November 15, 2024.
Mr Sonko addresses trainees at the close of the training.

He also emphasized the multi-dimensional nature of the training, which enables officers to identify the financial, social, environmental, and economic impacts of proposed bills and policies.

Participant Feedback

Participants expressed their enthusiasm and gratitude for the training. Mr. Davis Kwizera from the National Animal Genetic Resources Centre and Data Bank (NAGRC&DB) shared his positive experience, stating: “This training has offered a wealth of knowledge and an in-depth understanding of policy processes. It will significantly enhance our ability to prepare relevant policy documents. If you’ve taken the courses on Financial and Risk Analysis as well as Investment Appraisal and Risk Analysis, this program completes the package.”

The new guidelines for the clearance of financial implications will officially take effect in July 2025. PIMCoE remains committed to building the capacity of public officers to ensure that Uganda’s legislative and policy frameworks are underpinned by sound financial and risk analyses, fostering a culture of accountability and sustainable development.

For more updates on PIMCoE programs and upcoming training sessions, visit PIMCoE’s official website.

Betty Kyakuwa
Betty Kyakuwa

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CoBAMS Hosts Workshop to Review Parish Development Model

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Participants pose for a group photo after the workshop. Stakeholders, researchers, and policymakers workshop to discuss the progress and emerging issues in the implementation of Uganda’s Parish Development Model (PDM), 12th November 2024, Council Room, Main Building, Makerere University, Kampala Uganda, East Africa.

In a pivotal workshop held at Makerere University on November 12, stakeholders, researchers, and policymakers gathered to discuss the progress and emerging issues in the implementation of Uganda’s Parish Development Model (PDM). This transformative model, conceptualized by Prof. Ezra Suruma, aims to tackle some of Uganda’s most pressing socio-economic challenges: poverty, unemployment, and limited access to essential services, particularly in healthcare and agriculture.

Prof. Suruma, the architect of PDM, underscored the crucial role of researchers in creating wealth-empowering strategies for Ugandans. “The PDM is designed to eradicate poverty, promote economic inclusion, improve service delivery, and modernize agriculture,” Prof. Suruma stated. He highlighted that the model not only provides a pathway for Uganda’s rural households to participate in the economy but also aims to address the underlying issues that leave many citizens unable to afford basic needs.

Prof. Ezra Suruma (Right) and Prof. Barnabas Nawangwe (Left) at the event. Stakeholders, researchers, and policymakers workshop to discuss the progress and emerging issues in the implementation of Uganda’s Parish Development Model (PDM), 12th November 2024, Council Room, Main Building, Makerere University, Kampala Uganda, East Africa.

The Vice Chancellor of Makerere University, Prof. Barnabas Nawangwe, commended Prof. Suruma’s visionary leadership and the significant impact PDM is expected to have on communities across Uganda. “The PDM stands as one of the largest government interventions aimed at eradicating poverty and uplifting communities,” he remarked. Prof. Nawangwe also emphasized Makerere University’s commitment to supporting PDM through the PDM Lab hosted by the College of Business and Management Sciences (CoBAMS), which serves as a hub for real-time data analysis to guide the implementation of PDM activities across the country.

The PDM Lab at CoBAMS, led by Prof. Eria Hisali and funded by the United Nations Development Programme (UNDP), is instrumental in collecting, analyzing, and interpreting data that can shape PDM policies at the grassroots level. During the workshop, Dr. Suruma extended his appreciation to UNDP for their support and acknowledged the researchers for their efforts in generating valuable insights into the effectiveness of PDM.

Part of the audience at the event. Stakeholders, researchers, and policymakers workshop to discuss the progress and emerging issues in the implementation of Uganda’s Parish Development Model (PDM), 12th November 2024, Council Room, Main Building, Makerere University, Kampala Uganda, East Africa.

Despite Uganda’s notable economic growth in recent years, poverty remains a persistent challenge, with a significant portion of the population struggling to meet basic needs. Unemployment rates, especially among youth, are high, limiting economic opportunities for the country’s largest demographic. Access to healthcare, particularly in rural areas, is another critical issue, with many Ugandans unable to afford or reach essential medical services. These challenges underscore the need for initiatives like the PDM that are designed to create sustainable economic opportunities, improve household incomes, and ensure equitable access to services.

“PDM seeks to empower households to create wealth, ultimately reducing dependence on subsistence farming and encouraging local economic development,” Prof. Suruma emphasized. He believes that the model’s holistic approach will foster greater self-sufficiency among Uganda’s communities by addressing poverty from multiple angles, including agricultural modernization, financial literacy, and service accessibility.

Part of the audience at the event. Stakeholders, researchers, and policymakers workshop to discuss the progress and emerging issues in the implementation of Uganda’s Parish Development Model (PDM), 12th November 2024, Council Room, Main Building, Makerere University, Kampala Uganda, East Africa.

As the workshop concluded, participants expressed optimism about PDM’s potential to drive sustainable change. Prof. Nawangwe reiterated Makerere University’s dedication to supporting this national initiative, affirming that the PDM Lab will continue to play a key role in assessing and enhancing the model’s effectiveness.

The Parish Development Model offers a beacon of hope for millions of Ugandans striving for a better quality of life, aligning with Uganda’s broader aspirations for economic growth, social equity, and sustainable development.

Betty Kyakuwa
Betty Kyakuwa

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Study Explores PPPs for Sustainable Development in Uganda’s Tourism and Health Sectors

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Prof. Akileng addresses the participants of the workshop. Research dissemination workshop by Dr. Jude Thaddeo Mugarura, lecturer and researcher, study "Managing the Public Private Partnership (PPP) Operating Environment for Sustainable Service Delivery in Uganda’s Tourism Sector" and Simon Peter Kyomuhendo, findings on “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector.” 11th November 2024, Conference Room, Room 2.2B, Level 2, School of Business, College of Business and Management Sciences (CoBAMS), Makerere University, Kampala Uganda, East Africa.

On November 11, 2024 the School of Business held a research dissemination workshop led by Dr. Jude Thaddeo Mugarura, a lecturer and researcher whose study focused on “Managing the Public Private Partnership (PPP) Operating Environment for Sustainable Service Delivery in Uganda’s Tourism Sector.” The event also featured research by his student, Simon Peter Kyomuhendo, who presented findings on “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector.”

Both studies, which delve into the role of PPPs in two crucial sectors—tourism and health—aim to provide insights into how strategic partnerships between public and private entities can address pressing service delivery challenges in Uganda. Dr. Mugarura’s study in the tourism sector emphasized the importance of a stable operating environment for PPPs, highlighting the need for clear policies, regulatory support, and sustainable practices that allow both public and private stakeholders to thrive. His research suggests that a conducive PPP environment is essential for Uganda’s tourism sector to achieve sustainability, attract international visitors, and create job opportunities, while preserving the country’s cultural and natural heritage.

Dr. Jude making his presentation. Research dissemination workshop by Dr. Jude Thaddeo Mugarura, lecturer and researcher, study "Managing the Public Private Partnership (PPP) Operating Environment for Sustainable Service Delivery in Uganda’s Tourism Sector" and Simon Peter Kyomuhendo, findings on “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector.” 11th November 2024, Conference Room, Room 2.2B, Level 2, School of Business, College of Business and Management Sciences (CoBAMS), Makerere University, Kampala Uganda, East Africa.
Dr. Jude making his presentation.

Kyomuhendo’s research, titled “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector,” explored how PPPs can improve value for money (VFM) in healthcare delivery by encouraging local content utilization. His findings revealed a positive correlation between PPP adoption and VFM in healthcare, suggesting that well-structured partnerships can enhance efficiency and service quality. However, he noted that while PPPs support infrastructure development and resource allocation, local content utilization does not always have a strong moderating effect on VFM, indicating potential areas for policy improvement to ensure meaningful local engagement.

Dean of the School of Business, Prof. Godfrey Akileng, lauded the researchers for their dedication to tackling critical issues in Uganda’s development sectors. “These studies bring much-needed evidence to the table, demonstrating the potential of PPPs to transform our tourism and health sectors,” Prof. Akileng remarked. He emphasized that such research is pivotal to Makerere University’s commitment to producing actionable knowledge that aligns with Uganda’s national development goals.

Group photo of the participants. Research dissemination workshop by Dr. Jude Thaddeo Mugarura, lecturer and researcher, study "Managing the Public Private Partnership (PPP) Operating Environment for Sustainable Service Delivery in Uganda’s Tourism Sector" and Simon Peter Kyomuhendo, findings on “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector.” 11th November 2024, Conference Room, Room 2.2B, Level 2, School of Business, College of Business and Management Sciences (CoBAMS), Makerere University, Kampala Uganda, East Africa.
Group photo of the participants.

Prof. Akileng extended his gratitude to the Carnegie Corporation of New York for supporting these projects, acknowledging that their funding was instrumental in advancing impactful research. “The generosity of our donor has enabled us to conduct thorough research and share insights that will inform policy and guide sustainable development efforts in Uganda,” he added.

The workshop encouraged discussion among participants, including policymakers, private sector representatives, and university staff, on the importance of PPPs in creating a resilient service delivery model. Dr. Mugarura highlighted the need for continual assessment of the PPP framework to adapt to evolving economic and social demands. He recommended that the government prioritize regulatory improvements and capacity building for local firms to enhance their role in PPP projects.

Participants listen to the presentation. Research dissemination workshop by Dr. Jude Thaddeo Mugarura, lecturer and researcher, study "Managing the Public Private Partnership (PPP) Operating Environment for Sustainable Service Delivery in Uganda’s Tourism Sector" and Simon Peter Kyomuhendo, findings on “Public Private Partnership Adoption, Local Content Utilization, and Value for Money in the Ugandan Health Sector.” 11th November 2024, Conference Room, Room 2.2B, Level 2, School of Business, College of Business and Management Sciences (CoBAMS), Makerere University, Kampala Uganda, East Africa.
Participants listen to the presentation.

The dissemination workshop concluded with a collective call for increased collaboration between the public and private sectors. Both researchers emphasized that strategic partnerships hold the key to addressing Uganda’s service delivery challenges and achieving sustainable growth in tourism and healthcare.

Betty Kyakuwa
Betty Kyakuwa

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