Health
Inside Uganda’s National Health Adaptation Plan to Combat Climate Change
By John Okeya
On August 22, 2024, Uganda made history as the first African nation to launch a National Health Adaptation Plan (H-NAP), fulfilling the country’s global commitments at the UN Conference of Parties (COP) 26 and 28 summits in Glasgow (2021), and Dubai (2023), respectively, in response to the growing global climate change risks and challenges.
The National Health Adaptation Plan 2025-2030, dubbed H-NAP, which was launched by the health ministry yesterday in Kampala, seeks to fortify the country’s healthcare system against the current mounting health challenges driven by climate fluctuations, to safeguard public well-being amid the rising temperatures, erratic weather patterns, and associated health risks.
Officiating the H-NAP launch, Uganda’s Prime Minister, Rt. Hon. Robinah Nabbanja, represented by the third Deputy Prime Minister and Minister without Portfolio, Rt. Hon. Lukia Isanga Nakadama, commended the fruitful collaborative initiative of the government, development, and civil society partners in delivering the Health National Adaptation Plan.
“The government of Uganda has created an enabling policy and legal environment to tackle the climate change challenges,” she noted emphatically, revealing that: “In the Parish Development Model (PDM), we need to integrate climate change interventions. I was recently talking to my people (constituents in Mayuge district) about the PDM programme, I told them; ‘we gave you money and we know you are doing well. They said no, all our crops were washed away by the heavy rains, we did not get anything.’ So, it’s not all that easy.”
She said the current five-year term National Development Plan (NDP) III which is bound to expire and the new NDP IV underscore climate change as a cross-cutting issue requiring mainstreaming across all sectors, assuring that the Office of the Prime Minister (OPM) will coordinate multisectoral engagements for Ministries, Departments, and Agencies (MDAs) and support awareness raising for the new Health National Adaptation Plan.
“I congratulate the Ministry of Health and all sectoral partners for developing the Health National Adaptation Plan that we are launching today. This Plan is based on evidence from the Climate Change Health Vulnerability and Adaptation Assessment and should provide a systematic guide to building a resilient health system for Uganda,” the Prime Minister observed, urging the different multi-stakeholders to support the implementation of the Plan to harness its full potential in guiding the country’s climate change adaptation action.
Climate change adaptation, commonly used, means the steps taken to help both natural and human environmental systems adjust to the impacts of climate change, whether those changes are happening now or expected in the future. Such interventions may include actions, policies, and strategies designed to specifically reduce the negative effects of climate change while making the most of any potential benefits that may arise.
On the other hand, climate change refers to the long-term shifts in temperatures and weather patterns, mostly caused by human activities like burning fossil fuels, which release greenhouse gases (also known as GHGs) into the atmosphere. These changes lead to more extreme weather events, rising sea levels, and ecosystem disruptions, impacting everything, from agriculture to human health.
One of the key successes arising out of the two weeks deliberation between 120 world leaders and over 40,000 registered participants, including 22,274 party delegates, 14,124 observers, and 3,886 media representatives at COP26 summit in Glasgow, from Sun, Oct 31, 2021 – Fri, Nov 12, 2021, was the compromise to step up support for climate change adaptation, reflected in the Glasgow Pact calling for the doubling of finance to support developing countries like Uganda in adapting to the adverse weather impacts and build resilient health systems.
A key highlight during the Glasgow negotiations, was the realisation by the global actors of the critical linkage between climate change and health, as the discussions culminated in the consensus that the worsening climate crisis directly threatens global health through increased extreme weather events, the spread of diseases, and the increased strain on healthcare systems, thus necessitating urgent integrated action to protect public health.
Subsequently, nation states committed to developing national climate change health vulnerability and adaptation assessments and the health national adaptation plans, both documents that Uganda has now concluded, to emerge as a regional and global leader in the charge towards adaptation to combat climate change effects and build resilience.
The November 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) for Sound Management of Climate Change-related Health Risks in Uganda and the Health – National Adaptation Plan (H-NAP) 2025- 2030, were conducted through a collaboration led by Uganda’s Ministry of Health, with partners including Rockefeller Foundation, Makerere University, World Health Organization, Ministry of Water and Environment, Amref Health Africa, Reproductive Health Uganda, Pathfinder Uganda, Tree Adoption Uganda, Seed Global Health Uganda, Clinton Health Access Initiative and Regenerate Africa.
Makerere University School of Public Health’s Dr. John Bosco Isunju, who led the teams in the development of both the VAA and H-NAP, was honoured by the Ministry of Health with the 2024 Climate and Health Champions Award during the Health National Adaptation Plan Launch, for his significant contributions to building a climate-resilient health system in Uganda.
The Rockefeller Foundation’s investment played a pivotal role in funding the development of these two strategic documents. Mr. William Asiko, Vice President and head of The Rockefeller Foundation’s Africa Regional Office, emphasised, “Climate change is now the gravest threat to the health and well-being of billions of African people. Initiatives like Uganda’s Health National Adaptation Plan demonstrate how African countries are rising to the challenge by scaling the necessary climate solutions and setting an example for the world.”
Makerere University Vice Chancellor, Prof. Barnabas Nawangwe, in his remarks delivered by the University Secretary, Mr. Yusuf Kiranda commended the role played by the partners in the development of the Plan, noting that: “Our academics from the Makerere University School of Public Health played a vital role in leading the Climate Change Vulnerability and Adaptation Assessment (VAA), which has been instrumental in shaping the development of the H-NAP.”
“This is just one example of Makerere University’s strategic commitment to research, innovation, and capacity-building. We are dedicated to generating evidence and human resources capabilities that guide decision-making and contribute to the development and implementation of climate-resilient strategies in health, agriculture, and other sectors,” the Makerere University Vice Chancellor observed.
He stated that the success of the National Adaptation Plan depends on the strength of our collaborations, which requires concerted efforts of government ministries, health agencies, civil society organisations, the private sector, development partners, and the academic community, as he reiterated University’s commitment to being a key partner in the endeavour.
Today, Uganda, like the rest of the region and the globe, continues to grapple with the adverse effects of climate change. Subsequently, the Health National Adaptation Plan’s overarching goal is to enhance the resilience of Uganda’s health sector against climate-related impacts by incorporating climate adaptation into health strategies and planning, ensuring sustainable and continuous healthcare services during climatic challenges;
“Uganda is already experiencing severe climate change effects, such as floods, droughts, and temperature changes, which contribute to health issues like waterborne diseases, vector-borne diseases, malnutrition, and mental health problems.” The H-NAP report reads in part.
Its precursor, the 2023 Climate Change Health Vulnerability and Adaptation Assessment (VAA) survey, conducted across 716 selected health facilities in Uganda, highlighted the significant risks and challenges that climate change poses to public health.
The Vulnerability Assessment revealed that many healthcare facilities in Uganda are highly vulnerable to climate change-related hazards, due to unpreparedness across several critical components. In terms of energy, healthcare facilities were found to lack secure locations to protect emergency energy sources from hazards, had inadequate coverage for critical service areas, and failed to consistently check alternative energy sources.
The health workforce was also underprepared, with gaps in participation in climate adaptation plans, insufficient readiness for outdoor work during extreme conditions, and limited capacity to identify and manage health conditions, worsened by climate impacts.
Significant weaknesses were apparent in water, sanitation and hygiene, and healthcare waste management, including inadequate strategies to monitor and reduce water contamination, limited preparedness to prevent vector breeding in facility water systems, and a lack of comprehensive water safety and contingency plans. Post-hazard recovery plans were insufficient, with no safe locations for critical equipment during emergencies, inadequate safety measures for vital supplies, and inconsistent evacuation mechanisms for health workers and patients.
“These findings highlight a need for implementation of climate change adaptation plans and policies, building capacity of the health workers, and strengthening WASH management systems and water safety plans. There’s also a need for improvement of the reliability of energy infrastructure, development of contingency plans and enhancement of infrastructure resilience, evacuation plans, and post-disaster recovery,” the VAA report reads in part.
Today, Uganda has established a robust policy and legal framework to address climate change, including the National Climate Change Policy of 2015, the Climate Change Act of 2021, and the updated Nationally Determined Contribution of 2022. These frameworks aim to transform Uganda into a climate-resilient, low-carbon society by 2050.
The Uganda National Health Adaptation Plan (H-NAP) aligns with these policies, emphasising the integration of climate change adaptation into health sector plans and policies.
“A key recommendation to tackle climate change issues in Uganda is the integration of climate services for health. These services involve the provision of climate data, tools, and information tailored to the health sector’s needs, enabling health professionals to better anticipate, prepare for, and respond to climate-related health risks. Climate services for health include forecasting climate variables, monitoring and predicting the spread of climate-sensitive diseases and issuing early warnings for heatwaves and air pollution episodes,” The H-NAP reads in part.
According to the Plan, by integrating these services into health planning and operations, Uganda can enhance its public health resilience against the impacts of climate change. Furthermore, the H-NAP proposes a range of short-term and long-term interventions across ten components that include climate-transformative leadership, climate-smart health workforce, integrated risk monitoring, and sustainable financing.
From the H-NAP, specific actions identified include developing guidelines for mainstreaming climate and health, training health workers, enhancing disease surveillance systems, and revising infrastructure standards for climate-proofing. Also, the plan presents a financing framework to mobilise resources for implementing the identified interventions. This includes developing a comprehensive resource mobilisation plan, increasing national budgets for health and climate change policies, and advocating for health issues in climate funding streams.
Uganda is all too familiar with the harsh realities of climate change, having continuously experienced rising temperatures, prolonged droughts, and increasingly severe rainy seasons—each intensifying public health challenges. This National Health Adaptation Plan marks a critical step in the country’s climate action efforts, standing as the first of its kind. It serves as a crucial component of Uganda’s broader strategy to mitigate climate impacts and safeguard public health in the face of growing environmental threats.
At a ceremony held on 30th May 2025, themed ‘They taught us without saying a word’, the Makerere University College of Health Sciences (MakCHS) commemorated the silent teacher which are the cadavers (bodies) used in anatomy classes for medical students. In addition to a commemoration service, the event was used to create awareness and sensitise the public about the the importance of whole body donation.
The chief guest at the commemoration was Professor Mukadasi Buyinza, Deputy Vice Chancellor – Academic Affairs representing the Vice Chancellor, Professor Barnabas Nawangwe. The event attended by MakCHS students, staff and alumni was organised by students under Anatomy Society of MakCHS supported by Department of Anatomy and MakCHS leadership.
Welcoming guests to the event, Waziwu Mordecai–final year student of medicine and surgery who serves as President of the Anatomy Society, MakCHS explained that the reason for the gathering is three-pronged: to commemorate the silent teachers who make a profound contribution to medical education; to instill knowledge, compassion, and professionalism in future healthcare providers; and call on the community to support this noble act through awareness, advocacy, or future donation. ‘May the memory of our silent teachers live on in every life we will one day save’, he said.
The Anatomy society was founded in 2013 with aim of students providing peer mentorship to fellow students in lower years, such mentorship sessions help students appreciate better the anatomy of the human body. The society has supported:enhanced learning and mentorship; promoted academic participation including internal and external quizzes; and fostered connections including strengthen relationships between students across classes and with alumni.
Professor Elisa Mwaka, Head – Department of Human Anatomy welcomed all present for attending the ceremony. He thanked the College management led by the Principal, Professor Bruce Kirenga for the support provided in organizing the ceremony. He also expressed utmost appreciation to the Vice Chancellor for attending despite the competing priorities requiring his attention.
Professor Mwaka highlighted that we are here today, to pay our respect to the individuals whose bodies have been used for medical examination and research at MakCHS through offering prayers as well as sensitize people about willful/consented whole body donation.
Professor Mwaka explained that globally, sources of whole bodies for medical education and research are got through willed whole-body donation, unclaimed bodies in hospitals, imported bodies, executed persons among other means. In Uganda, unclaimed bodies in hospitals are used for medical as determined by the Uganda National Rules in the Penal Code Act of 1957.
In 2012 International Federation of Anatomy Associations (IFAA) recommended voluntary donation as the desirable and the only acceptable source for acquiring bodies. Almost all Africa countries and some European countries lack national body donation programs.
Speaking at the event, Professor Bruce Kirenga, Principal – MakCHS thanked Professor Mwaka for the insightful presentation. He welcomed Professor Buyinza to MakCHS and for accepting to attend despite the late invitation. He recognized the presence of the staff present and support towards the college activities.
Professor Kirenga underlined the importance of biomedical science under which human anatomy falls in medical education. ‘Biomedical sciences play a key role, once someone in grounded in the area, then he will be a good doctor’, he said.
The Principal also stressed that during his term of office operation efficiency will remain key ingredient for service delivery as well as rebuilding and rehabilitation of teaching and learning facilities. ‘Works to make the Biochemistry laboratory a model lab has commenced with a contract awarded to service provider; the refurbishment will be in phases’.
Professor Buyinza Mukadasi thanked the College, Human Anatomy department and the students for organizing the commemoration. ‘The amount of joy I have this morning, we should have done this a long time ago’, he said.
He expressed happiness at this commemoration for the silent teachers who unknowingly give so much to medical education and therefore mankind. He advised that community engagement to create awareness about the need for whole-body donation, regulatory compliance, and alignment to best practices.
He noted that disciplines like medicine is more like charity because medical practitioners give so much of themselves. ‘The number of people attending this ceremony is show of love for the discipline and commitment to the calling’ he said.
Professor Buyinza reiterated the commitment of Makerere University management to support MakCHS endeavours including this culture of commemorating the silent teacher. ‘Well-trained and season doctors are a result of the process explained here and the absence of bodies affects the quality of education provided and therefore the doctors produced’, he added.
Candles for the cadavers were lit and services representative of Anglican, Catholics and Muslims were conducted to remember the souls of the departed and wish them a peaceful rest. Ordinand Cosmas Ddembe for Anglican, Father Valentine Amuneke for Catholic and Dr. Haruna Kiryowa for Muslim preached the importance of respect for the dead and sacrifices of the dead for advancement of research and education in the medical field and health services.
Giving closing remarks, Professor Mwaka noted that setting up whole-body donation programs in Africa requires a holistic approach involving education, cultural sensitivity, legal structures, and partnerships with medical institutions.
Reasons why Africa has failed to establish body donation programs:
- Low awareness and willingness to donate bodies.
- Cultural and traditional beliefs
- Religious beliefs
- Fear of mishanding bodies
- Lack of legislation/ ambiguous regulations
- Lack of institutional policies and standard operating procedures
- Institutions should be encouraged to hold Services of thanksgiving or commemoration for those who have donated their bodies for medical education and research.
The following is required to change the current status:
- Cultural sensitivity and awareness
- Community engagement and awareness creation
- Educational campaigns
- Developing legal and ethical frameworks
- Building partnerships between hospitals and medical institutions
- Establishing local body donation systems i.e.,
- donation registration process,
- consent documentation,
- Logistical infrastructure necessary for the
- donation process.
- Effective communication, public trust,transparency.
- Training and professional development of healthcare providers.
- Global collaboration and funding: to share knowledge, best practices, and resources.
- Government support
- Funding and incentives
- Inclusion of body donation in national health strategies.
In a decisive step toward ending HIV as a public health threat by 2030, Uganda on Thursday, May 29, 2025, officially launched the third Uganda Population-based HIV Impact Assessment (UPHIA 2025) survey, a nationally representative household study expected to provide updated measurements on the status of the HIV epidemic by the end of the year.
The effort is led by Uganda’s Ministry of Health (MoH), with technical assistance from Makerere University School of Public Health (MakSPH), Uganda Bureau of Statistics (UBOS), Uganda Virus Research Institute (UVRI), and the U.S. Centers for Disease Control and Prevention (U.S. CDC), funded by the U.S. government through PEPFAR.
The Population-based HIV Impact Assessment (PHIA) surveys were first launched in 2014 as a global initiative at the International Center for AIDS Care and Treatment Programs (ICAP), based at Columbia University’s Mailman School of Public Health. Supported by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), through the U.S. CDC, the surveys have been conducted in at least 15 high-burden countries globally, including Uganda.
Led by national Ministries of Health, the PHIA surveys provide robust, population-level data on HIV prevalence, incidence, and viral suppression, offering a clear picture of epidemic trends and the effectiveness of national responses. They are designed to track progress, identify persistent gaps, and inform strategies to reach epidemic control, in line with global targets, including the fast-approaching goal of ending AIDS as a public health threat by 2030.
In Uganda, this survey was first rolled out between August 2016 and March 2017. The second followed in February 2020 but was disrupted by the COVID-19 outbreak, continuing through to March 2021. Both rounds were supported by ICAP at Columbia University, which provided technical assistance to strengthen data collection systems, improve laboratory infrastructure, and build national capacity to design, implement, and analyse the two national HIV surveys.
What sets UPHIA 2025 apart is the shift in technical leadership to Ugandan institutions for this third survey, reflecting local capacity to lead rigorous, high-quality public health research. For UPHIA 2025, Makerere University School of Public Health, in partnership with the Uganda Bureau of Statistics and the Uganda Virus Research Institute, is providing technical leadership to the Ministry of Health, alongside U.S. CDC. Implementation began with initial recruitment and training of over 300 field teams that begun on May 19, 2025, ahead of their nationwide deployment for data collection starting this June.
The first survey (UPHIA 2016) was an important milestone in informing Uganda’s national HIV response. This survey, concluded in 2017, measured, among things, the viral load suppression at the population level and provided household-based HIV testing and counselling, with results returned to participants and those who tested positive referred to care. The survey also assessed HIV incidence, HIV and syphilis prevalence, as well as hepatitis B infection rates. These findings would offer nationally representative data to track Uganda’s progress in controlling the HIV epidemic at both national and regional levels.
The next survey, UPHIA 2020, building on past success, was again executed with technical leadership from Columbia University’s ICAP, working with Uganda’s Ministry of Health alongside UVRI, UBOS, regional referral hospitals, local governments, and the U.S. CDC. It offered useful insights that showed encouraging progress, indicating that up to 88% of people living with HIV in Uganda at the time knew their status, 98% of them were on treatment, and 90% had achieved viral suppression. These results reflected momentum toward the UNAIDS global 95-95-95 targets, ensuring that most people living with HIV are diagnosed, treated, and have the virus under control, and advancing the broader goal of ending the epidemic by 2030.
Since the release of these findings nearly five years ago, which helped shape national HIV programming in Uganda, the country has made notable progress, but challenges remain. The UPHIA 2020 findings reported major gaps in testing coverage, particularly among young people and men. The results were also instrumental in identifying service delivery shortfalls and guiding decisions on resource allocation, program design, and policy. Yet today, Uganda remains one of the most heavily burdened countries in the world, with over 1.5 million people living with HIV and over 50,000 preventable new infections recorded per year.
It is this trend that Uganda’s Ministry of Health is working urgently to reverse. Launching UPHIA 2025 at the Ministry’s headquarters in Kampala on May 29, 2025, amidst great hope and expectation among the participants, Uganda’s Minister of Health, Dr. Jane Ruth Aceng Ocero, noted that the long-anticipated and previously delayed survey had arrived at such a critical moment. She welcomed UPHIA 2025 as both a measure of the country’s resilience and a guide for the final stretch toward ending AIDS by 2030, now just a few years away.
“The UPHIA 2025 survey comes at a strategic time to help us recalibrate and refocus our efforts,” the Health Minister said, underscoring the importance of its outcomes. “This will be Uganda’s final population-based HIV survey before 2030, the target year for ending AIDS as a public health threat. The findings will serve as a baseline for tracking our progress toward this national and global goal. They will also guide the next phase of strategic planning, ensuring that the final push toward 2030 is grounded in robust and reliable data.”
This third round of the survey will be carried out in 6,685 randomly selected households across the country. The exercise will involve interviews with approximately 15,000 individuals aged at least 15 and selected through a national household listing by UBOS. Of those, around 14,980 are expected to provide blood samples for HIV testing and analysis of viral suppression and other health indicators. The survey will also include interviews with 1,300 children and adolescents aged 10 to 14, though no blood draws will be taken from this group. Participation is voluntary, free of charge, and requires consent from the head of each household.
Dr. Aceng explained that beyond providing updated estimates of HIV prevalence, incidence, and viral load suppression, and examining regional and demographic disparities, the survey, which will cover the rest of the year, will include a qualitative post-survey assessment component to gather insights from people living with HIV, particularly those not virally suppressed, to understand their challenges and strengthen support services. Also, for the first time, this survey will assess the burden of non-communicable diseases among people living with HIV and include focused interviews with adolescents aged 10 to 14 in Mid-North and Mid-Eastern Uganda, where viral suppression was reported to be lowest in UPHIA 2020.
These activities are made possible thanks to the development support from the U.S. government, which invested $10 million (about UGX 37 billion) for this survey. Speaking at the UPHIA 2025 launch, U.S. Ambassador to Uganda William W. Popp noted that the United States has partnered with Uganda for over three decades to help people live longer, healthier lives;
“The bulk of our annual support, approximately $500 million this year, is dedicated to health programs, making the U.S. government the largest single provider of health assistance to Uganda,” the Ambassador said. He added, “Through PEPFAR, the United States has played a major role in Uganda’s progress toward ending HIV as a public health threat. Since 2003, when Uganda became one of the first countries to implement the program, we have invested nearly three billion dollars—almost 11 trillion Uganda shillings—in HIV prevention, care, and treatment services, saving millions of lives and making both our countries safer from HIV.”
With the benefit of hindsight, Uganda’s early encounter with HIV in the 1980s marked the beginning of one of the region’s most severe epidemics. But over the decades, a determined national response, driven by political leadership, community mobilisation, collaboration and global support, has delivered measurable progress. In the recent past, adult HIV prevalence fell from 7.2% in 2010 to 5.1% in 2023. Among women, it declined from 8.5% to 6.6%, and among men from 5.8% to 3.6%. AIDS-related deaths dropped from 53,000 to 20,000 over the same period, with female mortality declining by 66% and child deaths by 77%.
All these gains, amidst the challenge, go to show what is possible with sustained commitment. What is more, throughout this long journey of Uganda’s battle with eradicating HIV, Makerere University School of Public Health has played a pivotal role. From the early work of Prof. David Serwadda, whose ground-breaking research during the initial detection of HIV helped shape Uganda’s early response, to last year’s 2024 landmark Purpose 1 study on the twice-yearly injectable Lenacapavir that proved 100% efficacy in preventing HIV infection, MakSPH has remained at the forefront of innovation, evidence generation, and policy influence.
That legacy continues today, with the School providing technical leadership to the Ministry of Health in the implementation of UPHIA 2025. At the launch, MakSPH Dean Prof. Rhoda Wanyenze expressed pride in the School’s role as a trusted partner in Uganda’s fight against HIV and other public health challenges. She noted that for over 70 years, during which the School has existed, MakSPH has helped shape the country’s public health landscape through rigorous research, training, and policy support, anchored by a strong, long-standing partnership with the Ministry of Health and partners.
She also noted that the collaboration between Makerere University and the U.S. CDC has helped build national capacity in surveillance and epidemiology, while also strengthening Uganda’s ability to lead high-quality, large-scale national surveys, asserting that:
“The partnership between Makerere University and CDC has not only helped build national capacity in surveillance and epidemiology, but has also strengthened our ability to lead high-quality, large-scale national surveys. After two decades of joint work, we are proud that UPHIA 2024–2025 is now a fully Ugandan-led effort. This is critical to the sustainability of the skills and knowledge generation to inform our local response.”
The survey builds on MakSPH’s experience conducting similar national studies, including those on tuberculosis, prison health, family planning, schistosomiasis, and non-communicable diseases such as the STEPS survey. It will leverage the School’s strong capacity in research and impact evaluation, both in Uganda and across the African region, with a firm commitment to delivering high-quality data guided by the same rigour and integrity that have defined our work over the years, Prof. Wanyenze affirmed.
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