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First-Ever Harmonized Health Facility Assessment by MakSPH and MoH Reveals Improvements in Uganda’s Overall Health Services

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By Julius Tukacungurwa & Davidson Ndyabahika

The first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by MakSPH and the Ministry of Health (MoH) has illuminated significant advancements in Uganda’s healthcare landscape. This ground-breaking survey, which serves as a robust benchmark for evaluating health services across the country, offers a comprehensive overview of service availability and readiness within Ugandan health facilities. 

The HHFA, a successor to the esteemed Service Availability and Readiness Assessment (SARA) tool endorsed by the WHO, probes into four critical modules: service availability, service readiness, quality of care and safety, and management and finance. 

Focusing initially on service availability and readiness, the HHFA embarked on a cross-sectional analysis of 642 facilities in April 2022, spanning National Referral Hospitals (NRHs), Regional Referral Hospitals (RRHs), General Hospitals (GHs), primary healthcare facilities at levels II, III, and IV.

The findings, while highlighting disparities in service availability and facility capacity across different healthcare sectors, underscore a promising trajectory towards enhancing overall health services nationwide.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH), led the team that conducted the survey. He presented the report which was subsequently launched by Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero on Tuesday 12th.March.2024 during the 10th Annual National Health Care Quality Improvement Conference at Imperial Resort Beach Hotel, Entebbe.

Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH) speaks to the press during the launch of the report in Entebbe.

The findings of the HHFA report indicate that Reproductive Maternal Newborn Care and Adolescent Health (RMNACH) services were available in most health care facilities across the country. In Uganda, healthcare facilities offer a wide range of essential services, including pediatric care, antenatal and postnatal care, malaria prevention during pregnancy, and newborn care, with over 95% providing these services according to the report. Findings also show that continuous antenatal care is available in about 79% of facilities, while skilled delivery services are offered in 89%. Additionally, family planning, emergency obstetric care, immunization, and adolescent health services are widely accessible, with percentages ranging from 77% to 91%.

During the launch event, Dr. Aceng underscored the significant steps made by the health sector in meeting crucial performance benchmarks. These include a notable 47% reduction in Maternal Mortality between 2016 and 2022, a commendable 12% decrease in Under 5 Mortality over the same period, and a promising 7% decline in Infant Mortality rates as highlighted in the Uganda Demographic Survey (UDHS) Report 2022.

“As you might know, overall, the health sector has made good progress towards achieving the key performance indicator targets. I wish to appreciate each one of you for the job well done,” said Dr. Aceng. 

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero speaks at the launch on March 12, 2024.

Adding that; “The Ministry of Health continues to make big investments in the national health system. Mulago National Referral Hospital, Mulago Specialised Women and Neonatal Hospital, and several Regional Referral Hospitals have received infrastructure development including installation of modern medical equipment.

There is also deliberate effort to improve access to health service, delivery to the community through purposeful upgrade of some HC IIs to corresponding equipping and general review of the human resource requirements in the health sector. There is also deliberate effort to improve access to health services, delivery to the community through purposeful upgrade of some HC lIs to HC Ills with corresponding equipping and general review of the human resource requirements in the health sector.”

Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Looking on is Professor Garimoi Orach Christopher.

The also study highlights a significant increase in Uganda’s general service index, rising from 48% in 2018 to 59% presently. Utilizing a similar survey methodology, researchers observed notable improvements in the availability of health interventions across various domains. Particularly in Reproductive Maternal Adolescent Health services, higher provision rates were evident, especially at higher-level health facilities. Moreover, delivery assistance at Health Centres IIIs and above by skilled attendants has become standard practice, with nine out of ten cases receiving skilled care. 

Immunization services have also witnessed widespread availability, notably in hospital settings. However, while all surveyed facilities now offer malaria treatment services, access to non-communicable disease management, such as cancer diagnosis and treatment, remains limited, and readiness to provide transportation services for community members in need is inadequate.

According to Professor Orach, the Ministry of Health should strengthen and improve diagnosis and treatment of cancers generally across the country, especially at the National and Regional Referral Hospitals so that many more people at community levels can access the services. He also notes that the Ministry needs to quickly do everything possible to strengthen the transportation systems for patients from communities to reach and access health services.

Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Professor Orach presenting findings of the Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero signs off the launch of the Harmonized Health Facility Assessment in Uganda Report, 2023.

The research noted that salary enhancement is a step in the right direction for improving how health workers perform. “We need to enhance that by ensuring that, ‘the health system, which is a complex system’, when we enhance salaries, we still need to continue to monitoring the health workers, we still need to continue to provide other requirements for the performance of health services, like drugs should be available,” noted Professor Orach. 

Adding that; “Transport should be available, other ways of ensuring that their performance can be up to the expected standard. So, in other words, that’s an important step and we must thank the government for what they’ve done here for we should still support them in other ways and monitor them closely to ensure, guidelines are available for services, that drugs are available, so that they can continue to provide good services.” 

“Our findings also show that for instance, the private health practitioners are not carrying out a lot of immunization, but government health facilities and private not for profit facilities are providing immunization services. This means that the private health practitioners don’t focus on immunization since it may not be bringing them money, they sought the ministry to engage with them to ensure that they’re brought on board so that they can provide their services in an integrated manner,” he noted. 

During the event, Associate Professor Peter Waiswa from the Health Policy, Planning and Management Department at MakSPH delivered a keynote address on ‘Understanding Health Systems Strengthening in a resource limited set-up.’  Professor Waiswa has had research work in maternal, new-born and child health in low and middle-income countries.

Stakeholders during the launch of the report in a group photo. Launch of the first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by the School of Public Health, Makerere University, Kampala UgandaH and the Ministry of Health during the 10th Annual National Health Care Quality Improvement Conference, 12th March 2024, Imperial Resort Beach Hotel, Entebbe Uganda, East Africa.
Stakeholders during the launch of the report in a group photo. 

According to Dr. Diana Atwiine, the Permanent Secretary of the Ministry of Health, this health facility assessment and report will significantly enhance MoH’s institutional capacity for strategic planning and policy development in Uganda’s health sector.

“The Makerere University School of Public Health (MakSPH) Team led by Prof. Christopher Garimoi Orach is appreciated for spearheading the entire process of undertaking the HHFA and developing the report. The MoH is very grateful for the diligent work well-done by the various actors that included the technical officers, research assistants and the administration staff to have the final report meticulously developed,” said Dr. Atwiine. 

Dr. Henry G. Mwebesa, Director General of Health Services, emphasizes the pivotal role of robust health systems in achieving lasting health advancements. He underscores that the findings will facilitate the country’s ability to track health service progress, advancing towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This data supports evidence-based decision-making, fortifying national health system planning and policy-making.

“This HHFA report is recommended for use by the various key stakeholders including health service managers, district leaders, ministry of health officials, both government, private sector, civil society organizations and development partners at different levels to inform and improve planning and implementation of effective health services delivery in Uganda,” says Dr. Mwebesa. 

Photos by Julius Tukacungurwa.

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Davidson Ndyabahika

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Holistic Retirement Planning includes Psychological, Emotional & Social well-being across all Career Stages

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The Chairperson MURBS Board of Trustees-Dr. Michael Kizito (8th Right) with Professor Seggane Musisi (7th Right) and Members after the session on 8th January 2026. Makerere University Retirement Benefits Scheme (MURBS) Member Sensitisation Session on "Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose", 8th January 2026, Yusuf Lule Central Teaching Facility Auditorium, Kampala Uganda, East Africa.

The Makerere University Retirement Benefits Scheme (MURBS) on Thursday, 8 January 2026 organised a Member Sensitisation Session on “Understanding Identity Shifts; Developing Routines; Sustaining Motivation and Purpose”. The session focused on holistic retirement planning, emphasising that readiness for life after work goes beyond finances to include psychological, emotional, and social well-being across all career stages—from early career to post-retirement.

The session featured a keynote presentation by Professor Seggane Musisi, who highlighted how work-related titles and roles often shape personal identity, and how retirement can trigger a sense of loss if individuals are unprepared to redefine themselves. Members were encouraged to consciously design a post-work identity grounded in values, purpose, and community contribution.

Participants learned practical strategies for:

  1. Preparing early for retirement at different career stages;
  2. Developing healthy, meaningful routines that support mental stability and productivity;
  3. Sustaining motivation and purpose beyond formal employment;
  4. Managing stress, maintaining physical and mental health, and nurturing social connections; and
  5. Balancing family responsibilities with personal well-being.

The discussion also addressed cultural realities of retirement in Uganda, including family expectations, social obligations, and financial pressures. Special attention was given to age-related challenges such as dementia, depression, and chronic illness, underscoring the importance of preventive health care, emotional resilience, and timely professional support.

Overall, the session reinforced the message that retirement is a lifelong transition, not a one-time event. Members were encouraged to plan early, adapt continuously, and intentionally design a fulfilling, purposeful life beyond work—psychologically, socially, and financially.

To view the session, please click the embedded video below. Further below is the presentation.


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Kampala at a Crossroads: What New Research Reveals About Mobility, Governance, and the City’s Public Health Risks

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Motorists navigate the Clock Tower Flyover intersection in Kampala. Uganda, East Africa

Every day in Kampala, millions of people inch through gridlock, dodge swarming boda-bodas threading through narrow gaps in traffic, inhale dangerously polluted air, and walk along streets rarely designed for pedestrians. These conditions, and more, are often dismissed as ordinary transport frustrations. Yet researchers at Makerere University School of Public Health (MakSPH) are examining how such everyday realities translate into public health outcomes, shaped not simply by congestion, but by governance, policy, and power. Their work forms part of a multi-country project investigating the political economy of urban mobility in three African cities.

A boda-boda rider navigates floodwaters alongside a car on a waterlogged road in Kampala’s Industrial Area in 2024, highlighting how rapid urban development, inadequate drainage, and car-oriented road design combine to heighten daily mobility risks for vulnerable road users. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
A boda-boda rider navigates floodwaters alongside a car on a waterlogged road in Kampala’s Industrial Area in 2024, highlighting how rapid urban development, inadequate drainage, and car-oriented road design combine to heighten daily mobility risks for vulnerable road users.

Co-led by Dr. Aloysius Ssennyonjo, the Principal Investigator and health systems and governance researcher at MakSPH, together with Uganda’s Country Principal Investigator, Dr. Esther Bayiga-Zziwa, a road safety and injury epidemiologist, and Co-Principal Investigator Dr. Jimmy Osuret, an injury prevention researcher, the project titled The Political Economy of Urban Mobility Policies and Their Health Implications in African Cities (PUMA) applies a political economy lens to understand how political interests, institutional arrangements, and power dynamics shape mobility systems and their consequences for public health in Kampala, Kigali, and Lilongwe.

To note, political economy analysis examines how public decisions are shaped by the interplay of politics, interests, institutions, and resources, in short, who has influence, who controls what, and how money and power circulate within a system. In Kampala, a capital of nearly two million residents whose daytime population swells with commuters, this lens helps explain why some transport options attract funding and enforcement while others are tolerated, neglected, or contested. These choices are not just technical, but reflect competing interests and priorities, with consequences for safety, equity, and the everyday well-being of those moving through the city.

Illustration of the Index of Sustainable Urban Mobility (I_SUM) in a planned city, highlighting how transport, accessibility, environmental, social, infrastructure, and political factors jointly shape mobility outcomes. Source: Internet.
Illustration of the Index of Sustainable Urban Mobility (I_SUM) in a planned city, highlighting how transport, accessibility, environmental, social, infrastructure, and political factors jointly shape mobility outcomes. Source: Internet.

Now, through the NIHR-funded project, the Ugandan team is currently working with colleagues from the University of Rwanda, led by Professor David Tumusiime, and Kamuzu University of Health Sciences in Malawi, led by Dr. Dominic Nkhoma. The research partnership aims to generate evidence that can strengthen mobility governance and improve public health outcomes across the three African cities above, with advisory support for the research consortium from the University of Antwerp in Belgium and Canterbury Christ Church University in the UK.

Explaining the project’s rationale for the Politics of Urban Mobility, or PUMA, during the 2025 Universal Health Coverage Day webinar held on December 12 under the theme “Mobility, Costs, and Politics: How Urban Systems Shape Access and Progress Towards Universal Health Coverage in African Cities,” Principal Investigator Dr. Ssennyonjo said Africa is urbanising at an unprecedented pace. Projections show that by 2050, nearly 60% of the continent’s population will live in cities, a shift that is intensifying transport pressures and increasingly turning everyday mobility into a public health risk.

Participants at the PUMA Stakeholder Analysis Workshop held on November 21, 2025, where policymakers, practitioners, and researchers examined how political and governance dynamics shape urban mobility and public health outcomes in Kampala. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Participants at the PUMA Stakeholder Analysis Workshop held on November 21, 2025, where policymakers, practitioners, and researchers examined how political and governance dynamics shape urban mobility and public health outcomes in Kampala.

“Rapid urbanisation has created multiple challenges: transport systems are under strain, risks and vulnerabilities are rising, and opportunities for healthy behaviours such as walking are often limited. Access to livelihoods is also affected, with broad implications for health,” Ssennyonjo noted, adding: “Crucially, these issues are shaped by political and governance dynamics, yet few initiatives explicitly address them. This gap motivated our focus on the politics and governance of urban mobility.”

Dr. Aloysius Ssennyonjo, Principal Investigator of the PUMA project, speaks during the Stakeholder Analysis Workshop on November 21, 2025, highlighting the role of politics and governance in shaping urban mobility and public health outcomes in Kampala. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Dr. Aloysius Ssennyonjo, Principal Investigator of the PUMA project, speaks during the Stakeholder Analysis Workshop on November 21, 2025, highlighting the role of politics and governance in shaping urban mobility and public health outcomes in Kampala.

He mentioned that health outcomes are shaped by social, economic, and environmental factors, with transport costs, risks, and stress often posing greater barriers than medical fees alone to achieving affordable health for all. He noted that the PUMA project brings together multidisciplinary teams to study how governance and political dynamics shape urban mobility, public health, and development, a perspective reflected in Prof. Julius Kiiza’s observation that effective urban development relies on coordinated action by diverse stakeholders across sectors to improve health outcomes, though emphasising the primacy of politics.


“Uganda and Singapore had comparable levels of underdevelopment in the 1960s. Under Lee Kuan Yew, Singapore embarked on a deliberate nation-building project. Today, it is among the smartest cities globally, outperforming many Western cities in clean government, mobility, and liveability. Why are we lagging behind? The answer, I argue, lies largely in the nature of our politics,” Prof. Julius Kiiza cogently argued.


He intimated that the result has been cities that are “unreliable, unsafe, unsmart, and chaotic,” noting that claims of inclusive urban development often ring hollow. “I have argued, and repeat here, that boda bodas as a symbol of inclusivity represent a false model of inclusion. We must interrogate this and invest in better urban transport systems and wider, well-planned highways,” he affirmed.


Prof. Julius Kiiza, Professor of Political Science, speaking during a PUMA team–organised Universal Health Coverage Day webinar, highlighted how politics and governance shape urban mobility and public health outcomes. December 12, 2025. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Prof. Julius Kiiza, Professor of Political Science, speaking during a PUMA team–organised Universal Health Coverage Day webinar, highlighted how politics and governance shape urban mobility and public health outcomes. December 12, 2025.

Prof. Kiiza urged policymakers and practitioners to move beyond piecemeal technical fixes and instead treat urban mobility as a governance challenge requiring coordinated, cross-sector action. He stressed the importance of aligning transport planning with public health, housing, employment, and skills development, arguing that safer, more liveable cities depend on institutions that work together and are accountable to the public. Such reforms, he noted, demand sustained political commitment and inclusive dialogue across government, academia, civil society, and the private sector, precisely the terrain the PUMA project is engaging, by convening stakeholders and shaping a shared research agenda around Uganda and the continent’s urban mobility challenge.

Students cross a busy road in Kampala, Uganda, navigating traffic dominated by cars and motorcycles—an everyday reality that highlights the public health and safety risks shaping urban mobility in the city. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Students cross a busy road in Kampala, Uganda, navigating traffic dominated by cars and motorcycles—an everyday reality that highlights the public health and safety risks shaping urban mobility in the city. 2024.

Indeed, on November 21, 2025, the Ugandan team convened a national stakeholder workshop in Kampala, bringing together a wide range of stakeholders. Opening the workshop, Assoc. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management (HPPM) at MakSPH, commended the team for highlighting what she described as a long-underexplored dimension of Uganda’s urban health landscape: mobility and its governance.

Reflecting on her own experience, she noted how boda-bodas have become increasingly indispensable for millions seeking quick, flexible transport, but also carry complex health, safety, and economic implications that demand multisectoral attention, calling for a balanced, evidence-driven dialogue that recognises their value while also addressing the infrastructural and policy gaps that shape mobility systems in Uganda’s rapidly growing cities.


“I sometimes use boda-bodas,” Assoc. Prof. Suzanne Kiwanuka said. “They are necessary when you need to move quickly during heavy traffic. Yet we all know how unsafe they can be. This PUMA initiative is timely to generate evidence not only on the politics of urban mobility and its health implications, but also its economic consequences.”


Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management, addresses participants during a PUMA stakeholder workshop, emphasising the need for evidence-informed, multisectoral approaches to urban mobility and public health governance in Kampala.
Prof. Suzanne Kiwanuka, Head of the Department of Health Policy, Planning and Management, addresses participants during a PUMA stakeholder workshop, emphasising the need for evidence-informed, multisectoral approaches to urban mobility and public health governance in Kampala.

Notably, road traffic crashes remain one of Uganda’s most urgent public health threats today. The recent Uganda Police Force Annual Crime Report 2024 recorded 5,144 road deaths, a seven per cent rise from 2023, with motorcyclists accounting for nearly half of all fatalities. In Kampala, pedestrians, cyclists, and motorcycle riders constitute 94 per cent of all fatal crashes, according to the Kampala Capital City Authority. Thousands more suffer life-altering injuries each year.

Still, evidence from MakSPH, through its Centre for Trauma, Injury and Disability Prevention (C-TRIAD) and the Johns Hopkins International Injury Research Unit (JH-IIRU) under the Bloomberg Philanthropies Initiative for Global Road Safety (BIGRS), shows that the design and use of city roads are worsening the risk environment. Between 2021 and 2023, the team conducted more than one million roadside observations across Kampala, finding that while only five per cent of vehicles are officially recorded as speeding, those that do travel at an average of 57 km/h, well above safe limits for dense urban corridors, making city roads increasingly unsafe.

Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. The motorcycle rider at the centre of the image is travelling against the flow of traffic in Kampala, highlighting everyday road-use practices that increase safety risks in the city. 2024.
The motorcycle rider at the centre of the image is travelling against the flow of traffic in Kampala, highlighting everyday road-use practices that increase safety risks in the city. 2024.

The World Health Organization (WHO) guidelines, cited in the report, recommend speed limits of 30 km/h on community roads and in urban areas where pedestrians, cyclists, and other vulnerable road users share space with motorised traffic, and 50 km/h on major urban roads. Yet the findings show that six in ten vehicles on community roads exceed these limits, heightening risks for those least protected and underscoring the need for lower-speed zones, traffic-calming measures such as speed humps and raised crossings, and consistent enforcement of traffic regulations.

For the PUMA team in Uganda, the writing on the wall shows that these rising injuries coincide with worsening congestion and rapid urbanisation, yet city mobility policies within Kampala remain heavily oriented toward road expansion and vehicular flow, with limited attention to safety, health protection, or non-motorised transport. This policy imbalance, then, explains why daily commuting remains hazardous and why progress on safer streets has been slow.

Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa. A designated non-motorised transport corridor on Namirembe Road, Kampala, intended for pedestrians, is partially occupied by parked motorcycles and roadside trading. The scene highlights how everyday encroachment weakens urban mobility interventions aimed at improving safety and walkability. November 2025.
A designated non-motorised transport corridor on Namirembe Road, Kampala, intended for pedestrians, is partially occupied by parked motorcycles and roadside trading. The scene highlights how everyday encroachment weakens urban mobility interventions aimed at improving safety and walkability. November 2025.

The study uses a three-tiered approach that combines policy analysis, regional evidence, and local experiences to examine how mobility decisions are made in Kampala, Kigali, and Lilongwe, who holds authority, and how these processes affect public health and equity. This is strengthened by structured co-creation workshops with practitioners, policymakers, and community actors, which reveal how governance functions in practice, often diverging from what is written on paper.

In parallel, the research team is conducting a continent-wide review of academic and grey literature to map regional trends, gaps, and the broader forces shaping African mobility systems. Together, these streams enable the researchers to compare cities, identify shared challenges, and build a grounded analytical framework for improving mobility governance across Africa.

In Kampala, preliminary findings by the MakSPH PUMA research team show a city governed by many mobility policies but marked by weak mobility governance. The team shared that Kampala operates under a dense mix of frameworks, from the National Integrated Transport Master Plan and National Urban Policy to road safety, climate, and KCCA development plans. While these documents acknowledge congestion, urbanisation, and road injury risks, they also reveal overlapping mandates, blurred institutional roles, and limited coordination authority.

Minibuses crowd a busy transport hub in Kampala, reflecting the scale and intensity of the city’s paratransit-based transport system and the planning challenges shaping everyday mobility. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Minibuses crowd a busy transport hub in Kampala, reflecting the scale and intensity of the city’s paratransit-based transport system and the planning challenges shaping everyday mobility. 2024.

Key government Ministries, Departments, and Agencies (MDAs) actors include the Ministry of Works and Transport, KCCA, the Ministry of Lands, the Office of the Prime Minister, and the Ministry of Finance, with the Ministry of Health conspicuously absent despite clear health implications. Policy attention, according to the early findings, remains heavily skewed toward road transport, leaving non-motorised mobility and major health pathways, noise exposure, psychosocial stress, community severance, heat, and mobility independence largely unaddressed.

Governance realities are further shaped by political processes, including electoral cycles, informal negotiations with transport unions, selective regulation of boda-bodas, and heavy reliance on development partners that often influence what is prioritised and implemented. Together, these dynamics help explain stalled master plans, inconsistent enforcement, and resistance to progressive interventions. While the PUMA research remains at a preliminary stage currently, the emerging findings underscore the need for an integrated, multisectoral mobility agenda that places health at the centre of Kampala’s transport policy and practice.

Motorcycle riders travel alongside a heavy truck emitting exhaust fumes on a road in Kampala, illustrating how daily urban transport exposes road users to air pollution and related public health risks. 2024. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa.
Motorcycle riders travel alongside a heavy truck emitting exhaust fumes on a road in Kampala, illustrating how daily urban transport exposes road users to air pollution and related public health risks. 2024.

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John Okeya

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How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds

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How People Earn a Living is Contributing to Malaria Risk in Uganda, Study Finds. Photo: ImageFX

Livelihood activities such as farming, livestock keeping, construction, and night-time work significantly increase malaria risk in Uganda, according to new research by Dr Kevin Deane, a development economist at The Open University, UK, and Dr Edwinah Atusingwize and Dr David Musoke, a Research Associate and Associate Professor of Environmental Health at Makerere University School of Public Health, respectively.

The study, Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda, published on December 2, 2025, in the journal Global Public Health, examines how everyday economic activities shape exposure to malaria, often undermining conventional prevention measures such as insecticide-treated nets and indoor residual spraying. The findings are based on qualitative fieldwork conducted in June 2024 in Busiro County, Wakiso District, a peri-urban area with persistently high malaria transmission in Uganda.

Using a qualitative design, the researchers conducted 14 key informant interviews, 10 focus group discussions, and 11 in-depth interviews with households recently affected by malaria, engaging 100 participants from communities, health services, local government, and civil society across Kajjansi, Kasanje, and Katabi Town Councils, as well as Bussi Sub-County, in Busiro South. Their analysis, guided by the Dahlgren–Whitehead social determinants of health model, enabled the researchers to situate malaria risk within the broader social, economic, and environmental conditions shaping how people live and work.

Dahlgren and Whitehead model of the social determinants of health. Source: internet.
Dahlgren and Whitehead model of the social determinants of health. Source: internet.

In their findings, participants linked malaria exposure to agricultural practices, among which is maize cultivation near homes, which was associated with increased mosquito density during the rainy season. “One of the most common crops cultivated in Uganda, which many rely on as staple foods, creates environments in which mosquitoes are attracted to and thrive, often in settings where maize is grown near homes in rural areas and urban areas. This increases mosquito density around homes and contributes to increased outdoor biting and the number of mosquitoes entering houses,” the study argues.

Its authors say this poses a difficult policy challenge because maize is central to household food security, leaving few practical options for reducing exposure. They argue that proposals to keep maize away from homes are often unrealistic for families with limited land or those farming in urban areas, while targeted control during flowering periods may have limited impact given mosquitoes’ ability to travel beyond cultivation sites.

Screenshot of the open-access research article “Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda,” published in Global Public Health on December 2, 2025.
Screenshot of the open-access research article “Livelihoods as a key social determinant of malaria: Qualitative evidence from Uganda,” published in Global Public Health on December 2, 2025.

Beyond crop farming, the study reports that livestock rearing, especially zero-grazing cattle kept close to houses, attracts mosquitoes into household compounds. Other livelihood activities, including construction and brick-making, created stagnant water-filled pits that served as breeding sites, while night-time livelihoods, such as street vending, guarding, fishing, bar work, and brick burning, among others, prolonged outdoor exposure during peak mosquito biting hours. Gender further shaped risk, with women’s livelihoods and caregiving responsibilities frequently exposing young children alongside them.

“The evidence we present illustrates the unintended health consequences of development strategies intended to promote key livelihood activities, food security, and poverty reduction. There are no straightforward solutions given the complexity of these relationships and the importance of these livelihoods for many households,” the authors assert.

They conclude that malaria elimination efforts will fall short unless livelihoods and development activities are explicitly integrated into malaria prevention strategies, calling for stronger alignment between public health, agriculture, urban development, and economic policy.

Please see below for the study:

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John Okeya

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