Health
Makerere & Johns Hopkins Universities Release Report on Speed and Helmet Use in Kampala
Makerere University School of Public Health (MakSPH) and the Johns Hopkins International Injury Research Unit (JH-IIRU) have launched the status summary report 2023; Road Risk Factors for Kampala, Uganda, in partnership with Kampala Capital City Authority (KCCA) and Vital Strategies.
The report was launched at Hotel Africana in Kampala on January 16, 2024. It delineates key findings, including the average speed of speeding vehicles at a high average of 57km/hr, higher speeds on roads partially accessible to pedestrians compared to roads freely accessible to pedestrians. Also, helmet usage remains low among motorcyclists and is almost non-existent among passengers, contributing to a rise in accidents and fatalities since 2020.
There has been a variable trend in the reported numbers of deaths and serious injuries since 2018. Specifically, in 2022, there was a 1% increase in reported deaths compared to 2021, while serious injuries witnessed a 4% decrease during the same period.
In 2018, a total of 294 death were recorded, 315 recorded in 2019 while 236 were recorded in 2020. In 2021, there were 419 road traffic death and 425 recorded in 2022. Motorcyclists accounted for nearly half (49%) of the reported deaths followed by pedestrians made up 44% of deaths. In a bid to improve road safety by providing quality data, the research the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS) made roadside observations on speed and helmet use in Kampala City.
The researchers made six observation rounds citing 500,000 for speed and 600,000 cyclists to determine helmet use. The results, based on data collected between February 2021 and October 2023 indicate that the mean speed among speeding vehicles was high mostly among sport utility vehicles (SUVs) at 10%, sedans/saloons at 9%, minibuses/minivans at 8), and pickup/light trucks at 7%. Five percent of the observed vehicles were exceeding the posted speed limit.
Speeding in Kampala
Presenting findings, Mr. Bonny Balugaba, a Researcher based at the Trauma, Injuries and Trauma Unit of MakSPH noted that the international best practices for speed management recommend a safe speed of 30 km/h on roads where conflicts between cars and unprotected users are possible. Also, 50 km/h speed is recommended at intersections where side-on conflicts between cars may occur. This is particularly applicable in urban areas.
“If in Kampala we are seeing 57km/h speed, it means that we are way above the recommended speed limits and we know that beyond 40km/h, the chances of survival of someone that has been knocked are very minimal,” says Balugaba.
The researchers recommend enforcing a 50 km/h speed limit in metropolitan areas and a 30 km/h limit in places where motorized traffic interacts with bikes and pedestrians. In order to safeguard vulnerable road users, particularly the Ministry of Works and Transport and the Kampala Capital City Authority, it suggests implementing speed-calming techniques including bumps and signage as well as designating low-speed areas.
Investigators further advise the Kampala Metropolitan Traffic Police to increase enforcement, especially on local roads and on vehicles such as SUVs, sedans, pickup trucks, minibuses on routes with limited pedestrian access. It is recommended that public awareness campaigns and enforcement measures regarding the dangers of speeding be regularly monitored and evaluated to ensure continued efficacy.
Balugaba noted; “Mass media is good but if you are telling me the dangers of speed but am not apprehended on speed then it tends to entertainment. You come, entertain me with your campaign and adverts and go away but you are not enforcing.”
Helmet Use in Kampala
Helmet use compliance among motorcyclists was notably low at 39%, and even lower for passengers at 2%. This trend persisted on both local and collector roads (39%) and arterial roads (40%). During weekends, helmet use dropped by 20%. Ride-share motorcycle drivers, particularly Safe Boda, exhibited the highest compliance at 84%, surpassing commercial motorcycle drivers (50%), taxi drivers (55%), and private/government motorcycle users (55%).
From 2020 to 2022, 210 motorcycle occupants and 185 pedestrians lost their lives. Notably, 40% of pedestrian fatalities resulted from collisions with cars, SUVs, or pickups, whereas 36% of motorcycle deaths were attributed to accidents involving other motorcycles.
“We saw that only 2% of the motorcycles are using helmets. This really means that the situation is still bad. We need to put in place measures knowing that helmets save those that are wearing them,” says Balugaba.
Adding that while four of every 10 riders are wearing a helmet but less than one in every 10 passengers has a helmet. “is it that passengers have harder heads than riders? That in case they are involved in a crash, they don’t get affected? These are issues we need to work on.”
While sharing the data outcomes, Dr Raphael Awuah, the African Regional Advisor on Data and Surveillance for Vital Strategies notes that while many of the cities in Africa, pedestrians constitute the majority fatalities, this is different for Kampala. “For most parts of Africa, we see that pedestrians account for most fatalities. However, in Kampala, this is not the case. We see that majority of the deaths are among the motorcyclists and this trend has been observed since 2018. So clearly this emphasizes the need to prioritize the vulnerable road users in Kampala particularly motorcyclists and pedestrians.”
The top five locations for pedestrian fatalities and serious injuries from 2019 to 2022 are high-capacity roads: Kampala Road, Jinja Road, Bombo Road, Entebbe Road, and Masaka Road.
The distribution of motorcycle fatal crash locations does not exhibit any clear pattern, but there is a noticeable concentration on high-capacity highways. Kampala Road, Masaka Road, Bombo Road, Kisaasi Road, and the Northern Bypass are the top five places.
“While it is true that these are high capacity roads, speeding is probably one of the causes of fatalities. I hope we will use this data to inform the discussions, actions, plans, strategies to reduce the outcomes that I have just shared,” observed Dr Raphael Awuah.
The Kampala Metropolitan Traffic Police has been urged to increase the enforcement of proper helmet use, with a focus on passengers, taxis, and commercial motorbikes on arterial, local, and collector roads all week round. Also, KCCA and the Ministry of Works and Transport may want to start public awareness programs promoting the appropriate use of helmets and advocate for sanctions and fines for improper helmet wear in conjunction with coordinated increased enforcement.
“This is about behavioral change. It is extremely difficult. We are all humans. All of us know that speeding is bad for us but when we get behind the wheel, we will still try to speed. All of us know that wearing a helmet will protect our heads, but only 2% of us wear helmets when we are riding on a motorcycle. So what else is needed? Yes, knowledge is important, it is important to tell people why they should be putting on these helmets and the consequences they will face if they don’t wear them but it is also important to have reinforcing mechanism. Yes, mass media campaigns are important but equally important is visible and widespread enforcement,” explained Dr. Abdulgafoor Bachani, Director of JH-IIRU.
On his part, Dr. Fredrick Oporia said “Road safety is an issue of concern to everyone. To improve this safety, we must have high-quality data on the risk factors and share it with our stakeholders. Most importantly, we need local stakeholders who are charged with making laws and policies for the country because this is a systems issue that calls for systems thinking. We must involve the local to get the attention of the international.”
SP. Michael Kananura, spokesperson, Traffic and Road Safety Directorate, Uganda Police Force says there is a regulation on helmet use targeting not only riders but also passengers, although he acknowledges challenges with enforcement. He calls on the public support these public health and road safety measures.
“We really appreciate our colleagues from MakSPH and the rest for this work and the academia generally for the work you are doing in as far as research is concerned and also being able to share with us this data. We also use this data to improve in our enforcements. It guides us on areas of improvement and prioritization. The data really is so helpful to us and we also continue to work to see how we can improve in that area. We have a unit in traffic directorate that is for enforcement basically,” SP Kananura.
Comments from KCCA leadership
Hon. Kizza Hakim Sawula, the lord councilor from Lubaga and Executive Secretary and a Minister for Works and Physical Planning –KCCA noted that one of the causes of this these accidents in the capital city is the poor-quality roads that wear out easily with numerous potholes and the meagre maintenance budget appropriated by parliament to the city authority.
“Can you imagine that each kilometer of the road within Kampala is constructed at an average cost of 14 billion shillings. For the last three budgets, we were getting 78bn but but in the current budget, we received only 43 billion shillings for the entire capital, for the entire financial year for roads, drainages and traffic lights. How many kilometers are we looking at? 3 kilometers for a financial year, 43 billion shillings?
We used to get Shs26 billion from the national road fund, for road maintenance every financial year. You can confirm from the mayors and load counselors here. This time around, we received only 11 billion for all the maintenance. Now, what do we expect out of that money? So, the task is upon the members of the Parliament to improve on the budget. We have 2,110 kilometers of roads within Kampala. Only 654 kilometers are paved, when shall we complete the entire balance? So, we need a budget, enough budget from the members of parliament. When we talk to MPs they only talk about loans we get from development partners which is usually for new roads,” explained Hon. Sawula.
Concerned, Nakawa Division Mayor, Paul Mugambe said it was disheartening that many people continue to lose their lives prematurely. He cited that not every death is predetermined by the Lord. “Driving at excessively high speeds, and resulting in a crash is not the Lord’s decision. Many individuals lose their lives prematurely due to reckless behavior, and it’s truly regrettable.”
Mr. Mugambe urged Police to use the evidence provided to improve on the enforcement of road traffic laws and regulations.
Prof. Elizeus Rutebemberwa, the Deputy Dean, MakSPH thanked the Bloomberg Philanthilopies “for supporting us to help ourselves” and the JH-IIRU for the technical support to the TRIAD unit, the university and many partners. He also noted that the urban population in Uganda is steadily increasing and called for proactive and inclusive urban planning.
“From 2012, the urban population was 20%. In 2022, which is one year and a half ago, it was 26%. So, one in four people in Uganda were in urban areas. Now in 2040 it is estimated that 33 million would be living in urban areas and that would be 46%. So, it’s not getting better, it’s getting worse. So, we need to manage our urban areas so that people don’t shift from the rural areas to come to die in urban areas,” said Prof. Rutebemberwa.
He called on government and the city authority to fast-track mass transport systems to reduce congestion on the roads. “Look at the traffic that come to Kampala. They are in private cars and each one is carrying one person. In very few cases, two people. Now, if you have all those cars for one kilometre stretch, you could actually park all those people in one bus. And you have all space and you reduce the pollution, why should this be difficult for people to know that. For you to have an organized urban area, you need mass transport. You don’t need to research to know that. So why don’t we have them? Some of these things, some of them we talked about in the national drive, dedicated walk lanes.
According to Becky Bavinger, from the public health area of Bloomberg Philanthropies, road traffic injuries are the leading cause of death for people aged 5 to 29. She mentioned that the fatalities from road traffic are at a crisis level in Uganda.
“I want to say this again. This is the leading cause of death. It’s not HIV. It’s not tuberculosis. It’s real traffic injuries for people aged 5 to 29. Those are the young people. We had the mayor talking about the economic impact as well. These are young people going to school, getting trained, coming back into your workforce, starting out in the workforce, and you’re losing their lives. There’s a forthcoming research from the Road Safety Coalition Uganda looking at the loss of GDP from road traffic injuries. In 2017, your government reported 3,500 deaths. The WHO estimated it was double that at about 6,000. It has gone up. In 2021, your government reported 4,159 deaths. Again, the WHO estimated it was about double that at 7,300. This is not good. This is a crisis and we need everyone working together on it,” Ms. Bavinger said.
She noted that Bloomberg Philanthropies will be working over these next two years with KCCA and with the government of Uganda to institutionalize data collection and the surveillance of road traffic injuries and deaths to improve its accuracy.
“These data are critical to forming your decision making. I just want to conclude by saying congratulations to Makerere University, to Johns Hopkins University, but ultimately to KCCA for launching this report, for conducting this research and this is not easy research to conduct. To the stakeholders, use these data. Please, please do not go home and put this report on your shelf. Look through it. Talk to the journalist. Get the media to write stories about this, let everyone know what is happening,” said Bavinger.
Makerere’s School of Public Health (MakSPH) is expanding faster than it can house itself. It now hosts more than 1,000 students, runs programmes across multiple countries, and anchors a large share of the University’s research output. Yet parts of its operation still spill into rented space, costing over $113,000 a year, because the infrastructure has not kept pace with its growth.
That constraint sits uneasily with the School’s economic weight. Health research accounts for more than half of Makerere University’s academic output, making it one of the University’s most productive engines. As Vice Chancellor Barnabas Nawangwe put it, “An educated population is a healthy population, and an educated and healthy population is a prosperous population.”
Beyond the university, health is not just a social outcome but a driver of economic performance. Healthier populations are more productive, more resilient, and less costly to sustain. Investments in public health, whether in prevention, systems, or infrastructure, raise an economy’s productive capacity, not just improve outcomes.
Institutions that generate public health knowledge and train professionals are not peripheral to growth; they are part of its foundation.
It is this logic that is shaping how Makerere’s School of Public Health is positioning itself. At its centre is a new, unfinished complex on the University’s main campus, intended to anchor the School’s next phase as a regional hub for research, training, and policy support. But like much of the system it supports, it is being built gradually, in a “build-as-you-go” approach constrained as much by funding realities as by design.
Construction of Phase II of the MakSPH complex is now at an advanced stage, with progress recorded across all sections of the site. As of March 2026, Phase 2B is nearing completion at 98%, while Phase 2A stands at 89%, and Phase 2C at 69%, each tracking close to or slightly ahead of planned targets. Current works are concentrated on interior finishes—including tiling, terrazzo installation, and external rendering—as well as preparations for lift installation, signaling a transition from structural works to final detailing. The project team is working toward a practical completion date of August 31, 2026, with timelines calibrated to align with broader resource flows and implementation considerations.
Six years ago, in February 2020, construction began on what will be the new home of the School of Public Health. The building, a permanent, purpose-built public health facility on Makerere’s main campus, will accommodate a growing student body, provide space for doctoral and postdoctoral fellows, and strengthen the University’s ability to respond to Africa’s most pressing public health challenges.
Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, said the construction journey reflects the School’s “ambition, intent, and courage”—a bold step despite limited resources. He was speaking at a public lecture on health financing held at Makerere University on April 9, 2026.
But the ambition behind the project is not modest. “We are not building for today—we are building for the future,” said Professor David Serwadda, reflecting on a decision that shaped the entire construction effort. “We need to build for the next 100 years.”
That long view helps explain both the scale of the project and the risks taken to start it. When construction began, the School did not have the full funding. “We started with about a third of the required budget,” Serwadda said.
The approach was not without setbacks. A major grant from USAID, worth over a million dollars, was later withdrawn, midway through the construction, due to the closure of USAID. “We received what is called a ‘Dear John letter,’” he recalled. “At that moment, we felt the situation was a major blow, almost terminal for the project.”
But the project did not stop. It adjusted. “We said, let us continue, piecemeal,’” he said. “Finish the auditorium first, use it, and keep building the rest.”
“We have come a long way as the School of Public Health,” said Professor Rhoda Wanyenze, the Dean. “We are proud of that history, but we also recognize that it comes with responsibility.”
She argued that responsibility is no longer confined to Uganda. With ongoing collaborative work in more than 25 African countries currently, the Dean says this is “a responsibility to provide leadership in public health not only in Uganda but across the continent.”
The scale of that growth has been visible from what was once a small training unit in the Faculty of Medicine in the 1950s, which has expanded into 12 academic programmes and more than 1,000 students.
“When I came back for my public health training, we were about 40 students,” she said. “Now, we have more than 1,000.” “Public health is growing and evolving,” Wanyenze said. “And we are doing our best to develop the skills needed for this changing landscape.”
That includes new areas such as health informatics and data science, driven by the digitisation of health systems and the growing role of data in decision-making and AI. The School is already coordinating regional platforms on digital health, linking multiple countries in shared learning and practice.
But this growth has outpaced the physical systems needed to sustain it. For the University leadership, the implications extend beyond infrastructure.
“One of the most effective ways to invest in health in Uganda is to invest properly in Makerere University,” said Vice Chancellor Barnabas Nawangwe. “We must recognize Makerere as a research-led university with a special national role—not fund it like any other institution or department. Makerere is one of the government’s greatest assets. Invest in her, and the returns will exceed expectations.”
Professor Nawangwe hailed Dr. Ramathan Ggoobi, the Permanent Secretary to the Treasury, who delivered a keynote on investing in health for Uganda’s future in view of Vision 2040. “I wish to thank Dr. Ramathan Ggoobi and his team for their personal intervention in allocating resources in next year’s budget to complete the new School of Public Health building. That support is deeply appreciated,” he said.
Uganda’s progress in health outcomes is evident, but uneven. Life expectancy has risen significantly from about 50 years in 2000 to roughly 68.8 years in 2024, according to the Permanent Secretary to the Treasury, Ramathan Ggoobi. Yet the gains sit alongside persistent financial strain on households. About 4% of Ugandans still spend more than a quarter of their consumption on healthcare, pushing many into poverty as a result of illness.
For Ggoobi, this points to a structural gap that recurrent government spending alone cannot close. “We must mobilise long-term domestic capital without adding fiscal risk,” he argued, pointing to the need for more sustainable financing mechanisms. Central to this is the gradual design and rollout of a national health insurance scheme. Evidence from countries such as Rwanda, Kenya, and Ghana suggests that well-structured contributory models can expand coverage while reducing catastrophic out-of-pocket spending.
“My Ministry and the School of Public Health must be partners. … Evidence framed in fiscal terms drives policy,” said Ggoobi, stressing the need for locally grounded solutions. “What works in Ghana might not work here. We need a model that fits Uganda.”
Uganda’s current macroeconomic conditions, relatively low inflation, currency stability, and expanding private credit may provide a window to move in that direction.
Uganda’s health system is entering a new phase—one where the biggest challenge is no longer building it, but sustaining it. External funding is tightening. Domestic resources are under pressure. Demand for care is rising faster than both.
In this new reality, health is no longer just a social priority but a financing problem and a test of economic strategy.
For years, the system expanded on government investment, backed by strong external support. Infrastructure grew. Services followed. But that model is now under strain. Expectations are rising. Citizens want better care, closer to where they live, and without the financial shock that so often comes with illness.
Uganda is already investing in health. The real question is whether that investment is sustainable and whether it is delivering value.
It was against this backdrop that policymakers, academics, and practitioners gathered at Makerere University on April 9 for a public lecture and high-level dialogue on health financing. At the centre of the discussion was a keynote by Dr. Ramathan Ggoobi, the Permanent Secretary to the Treasury under the theme “Investing in Health for Uganda’s Future: Delivering Vision 2040 through Smart and Sustainable Health Financing.”
The event was organised by Makerere University School of Public Health (MakSPH) in collaboration with the Ministry of Health and the Ministry of Finance, Planning, and Economic Development.
Dr. Ggoobi does not think about health the way most people in government do. He is not persuaded by the language of welfare. When he speaks about health, he reaches for the language of growth, productivity, and national wealth. In his view, the sector is not a cost centre. It is an economic engine.
“Health is not merely a social sector issue. It is an economic transformation issue, a productivity issue, and a national competitiveness issue,” he said, arguing that no country has achieved sustained growth without investing in human capital. Globally, human capital accounts for nearly 70% of national wealth. The World Health Organization (2021) estimates that every dollar invested in health can return four to nine dollars in productivity gains.
“Investment in health is not charity. It is growth finance. So, my first message is to treat health spending as an investment, not as consumption. Every shilling must buy measurable economic and social returns,” he emphases.
His views reveal a shift in how Uganda’s Treasury thinks about health financing. Spending must justify itself. Investments must deliver returns. And inefficiency is no longer just a technical issue but a fiscal problem.
Ggoobi’s worldview is shaped by the idea that Uganda’s long-term growth ambitions under Vision 2040, which is 13 years away, to achieve what he describes as a tenfold expansion to a $500 billion economy, will be decided not just by infrastructure or industry but by the quality of its human capital.
Globally, he notes, human capital accounts for the bulk of national wealth. Health, therefore, is not peripheral to development. It is central to it.
If health is an investment, then it must generate returns. If it does not, then something in the system is not working. “Every shilling must buy measurable economic and social returns,” he said.
This is where the optimism gives way to unease. Countries that have achieved and sustained middle-income status did so through deliberate, sustained, evidence-driven investments in human capital.
Uganda is working within tight fiscal limits. The national budget for 2025/26 stands at Shs 72.38 trillion, with about Shs 5.87 trillion going to health.
Government spending on health has increased over time, rising from about Shs 2.8 trillion a few years ago to Shs 4.4 trillion today. But even with this growth, spending per person is still low, around $50 a year, less than half of what is often needed to provide basic health services.
Not all the money is used efficiently. Global estimates suggest that weak systems, poor coordination, and procurement challenges can cause up to a third of health spending to be lost.
According to Dr. Ggoobi, Uganda has made notable progress in strengthening its health system, driven by sustained public investment. Life expectancy has risen from about 50 years in 2000 to approximately 68.8 years in 2024, an increase of over 18 years. Access to services has also improved significantly, with about 91 percent of Ugandans now living within five kilometres of a health facility, while income poverty has declined from 24.5 percent in 2010 to 16 percent.
On the service delivery side, the government has introduced the malaria vaccine for children under five and rolled out electronic medical records across national and regional referral hospitals. Strategic investments have also been made, including 16 high-capacity oxygen plants, three regional blood banks, CT scan equipment in 14 of 16 regional referral hospitals, and 20 digital X-ray machines in general hospitals, with remaining gaps expected to be closed in the next budget. Together, he noted, these efforts demonstrate that sustained investment in health is yielding tangible results.
Beneath that progress, Dr. Ggoobi sees a health financing structure that is fundamentally unstable, noting that external partners still finance as much as 40–45 percent of health expenditure. Government contributes about 22 percent, household’s 31 percent, and insurance remains marginal at less than five percent. This balance, Ggoobi argues, is dangerous. It leaves the system exposed to shocks from outside while pushing risk onto those least able to bear it.
But the issue that troubles him most is government inefficiency. His priorities are to increase and protect domestic health financing, mobilise long-term capital, and improve efficiency.
“We are wasteful even with the little we have. Procurement is a major problem—many fights in government are not about mandate but about procurement. That is why we are moving all entities onto an electronic procurement system to improve transparency, reduce leakage, and ensure accountability,” said Dr. Ggoobi.
The government has enrolled 38 entities on the electronic procurement system. Full adoption is expected by mid-2026.
If you have good audits and we implement their recommendations, then we can expect positive outcomes. Number two is e-government, reducing human contact where it is not necessary. Unless you’re a doctor, you have to examine someone. Why do you have to sit in a hotel to discuss procurement? Humans must get out of discussing procurement. That’s why we are building the eGP and reviewing the procurement law. We are going back to the cabinet; we are going to remove human beings who are not necessary in the chain of procurement,” said Ggoobi.
Across the discussion, one issue drew near-unanimous agreement that prevention remains underfunded.
The Ministry of Health’s position, delivered through John Kauta, the Commissioner in charge of Health Information, Statistics, Monitoring, and Evaluation, is unequivocal that “the cheapest disease to treat is the one we prevent.”
Yet Uganda still spends more on treating illness than preventing it. Freddie Ssengooba, a Professor of Health Economics and Health Systems Management, MakSPH, highlighted malaria as a case study, both costly and preventable, while others pointed to rising non-communicable diseases driven by lifestyle factors.
This imbalance has fiscal consequences. Preventable diseases generate recurrent costs, crowding out other investments and reinforcing the cycle of inefficiency.
Mak Chancellor Hon. Dr. Crispus Kiyonga pushed the debate toward geography and access, citing that while Uganda’s health system was originally designed to follow administrative structures, the ambition to reach every village was never fully realised.
“We must plan based on what we can sustainably afford. We cannot import another country’s system. But where shall we save the majority of our people? It is in the villages. That is where children miss school due to illness. Where young girls drop out due to a lack of basic support, like pads. So, we must choose: given limited resources, what system gives the greatest impact? When the Minister of Health asks for a CT scan—something people travel to Nairobi for—that is important. But in the village, a child needs an antimalarial. The choice is between a CT scan and basic treatment. These are tough decisions,” says Dr. Kiyonga.
While the country is “highly indebted” and resources are limited, the level of care that Uganda can realistically provide to its citizens should borrow from China’s early pragmatic reforms of universal access first and quality later, according to the Chancellor.
“You cannot deliver health from a distance,” he said, arguing for a renewed focus on community-level access.
The Chancellor also strongly supported a shift from tertiary care to primary care. From Mulago National Referral and reducing its congestion to the village by investing in lower health facilities.
He urged the government ministries of Finance and Health to strongly collaborate with academic institutions to improve their work. “This dialogue should not be a one-off. It must be continuous. Makerere must engage the government with well-costed, risk-weighted proposals. We should build structured collaboration between universities and government so that research informs policy, and we reduce reliance on expensive foreign consultants. There is valuable research here,” said Dr. Kiyonga.
Taken together, the dialogue revealed a country’s health system in transition, from scarcity to expansion but not yet to performance.
As Ms. Jane Kyarisiima Mwesiga, Deputy Head of Public Service (Service Delivery), Office of the Prime Minister, framed it, the next phase must move “from expansion to performance, from inputs to outcomes, from financing to public value.”
But the path forward remains contested. Should Uganda prioritise insurance or direct public provision? Prevention or specialised care? Infrastructure or functionality?
The answers lie not in choosing but in sequencing, something Uganda has historically struggled to do.
Dr. Ian Clarke, a Physician, philanthropist, entrepreneur, and Chairman of Clarke Group Companies, speaking while representing the Private Sector during the dialogue, spoke emotionally on national health insurance, whose discussion has been ongoing for close to 20 years, but with minimal progress.
“We have had studies and proposals, but many were rightly rejected because they were not practical. You cannot design a National Health Insurance scheme that looks like private insurance. There is simply not enough money in Uganda—or anywhere—to sustain that. We still think in silos: public sector and private sector. Then we ask, how do we support the private sector? There are many ways—but as has been emphasized, we must focus on prevention and equity, especially in rural areas.”
For Ssengooba, while insurance is important and long-term, its implementation needs to be phased. He called for more investments in the health sector as the first line of insurance for citizens. He also called on the government to partner with institutions such as the National Social Security Fund (NSSF), which already have systems, capacity, and reach in place to support health investments. “If we leverage institutions like NSSF—for collection, for pooling resources—we can make progress. During COVID, they demonstrated that they can support national priorities. So, we should think about how to leverage what already exists,” he says.
Stephen Omojong of the National Social Security Fund highlighted an untapped opportunity. The Fund currently manages about Shs 30 trillion in assets, with millions of contributors.
This pool, he argued, could support health financing either through insurance-linked products or long-term investment vehicles. His example of a voluntary savings scheme now has 68,000 participants and Shs. 114 billion mobilised in a year, suggesting that behavioural barriers may be less rigid than often assumed.
Makerere University Vice Chancellor, Professor Barnabas Nawangwe, framed the dialogue as more than an academic exercise, describing it as a call to action. He urged the government to tap into the University’s research capacity to inform strategic investments, noting that “health research constitutes more than 50% of all research at Makerere University,” with institutions like the School of Public Health and the Infectious Diseases Institute playing a central role.
He referred to their national impact—from supporting over 20% of Uganda’s HIV patients to operating in more than 90 districts—and emphasised that Makerere brings in over one trillion shillings annually in research income. “When you fund Makerere University,” he said, “you should understand that we are not a net consumer—we are a net producer for the country.”
Taken together, the dialogue revealed a system in transition from expansion to performance, from spending to results. Uganda is no longer short of ideas, nor entirely short of resources. The real test is execution.
Whether the country can turn health spending into measurable outcomes will determine not just the future of its health system but the credibility of its economic ambitions.
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