Connect with us

Health

Research Links Social Support to Improved Contraceptive Decision-Making for Women

Published

on

Researchers at Makerere University School of Public Health (MakSPH) are urging the Ugandan government to boost healthcare funding to enhance reproductive health services. Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability.

Dr. Amongin notes that within just six months to a year of using contraception, some women encountered issues and switched methods. This highlights the need for the Ministry of Health to improve the availability of various contraceptive options. A rights-based approach to contraception ensures that women have access to a range of methods, preventing situations where desired options are unavailable at health facilities.

Performance Monitoring for Action's Phase 2 Survey Results by MakSPH (Sept-Nov 2021) reveals increased stockouts of injectables and erratic availability of pills at 225 public FP facilities, mainly due to supply issues. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Performance Monitoring for Action’s Phase 2 Survey Results by MakSPH (Sept-Nov 2021) reveals increased stockouts of injectables and erratic availability of pills at 225 public FP facilities, mainly due to supply issues.

“Stockouts are a significant issue, and this extends to parliamentary discussions on health sector budgets. As we focus on human capital development and improving maternal and newborn health outcomes, we must consider crucial components like preventing unwanted pregnancies through family planning. The budget allocation for the health sector directly impacts this issue. When women cannot access their preferred contraceptive methods due to stockouts, it reflects a failure in our legislative and budgeting processes. This situation forces women to switch to fewer desirable methods, which is not acceptable,” says Dr. Amongin.

Adding that; “These are things we need to continue discussing as a country but we must invest into family planning. We can talk about human capital development but until we step up and actually support women to prevent unwanted pregnancies, support them in their decisions of whether she wants to use a method for contraception or not. That is her choice. We must make sure access to the methods of her choice is actually addressed.”

Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Dr. Dinah Amongin, an obstetrics and gynecology expert at MakSPH, has expressed concern about the lack of access to family planning methods, which forces women to use less preferred options due to unavailability.

Dr. Amongin’s comments follow a recent study on the I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023. The study highlights that social support significantly improves women’s ability to make informed contraceptive choices, potentially leading to better reproductive health outcomes.

Part of the Innovations for Choice and Autonomy (ICAN) project, the study shows that self-injection with DMPA-SC (Sayana Press) could increase contraceptive use, especially among women with limited access to healthcare. Despite the rollout of this method in 2017, its use remains low in Uganda. Sayana Press as popularly known is a subcutaneous depot medroxyprogesterone acetate (DMPA-SC). It is a hormonal birth control shot, administered under the skin and is an all-in-one contraceptive that puts women in charge of their reproductive health.

Social support boosts self-efficacy, enhances privacy, and reduces access barriers, making self-management easier. Family planning helps manage the number and timing of children, lowering maternal and infant mortality rates and reducing complications from pregnancy. Conversely, unmet contraceptive needs can lead to unintended pregnancies and their associated risks.

A woman self-injecting while demonstrating to fellow women in Oyam district. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
A woman self-injecting while demonstrating to fellow women in Oyam district.

In Uganda, 52% of pregnancies are unwanted or mistimed, with over 43% due to unmet family planning needs. The country’s youthful population complicates the issue, with 50% under 17 years old, at least according to the recent National Population Census. Notably, 10% of girls, one in every 10 girls you encounter, has already had sex before she turns 15 years, and 20% of boys, two in 10 boys have engaged in sexual intercourse by the same age.

Uganda's population pyramid showing age and sex composition of the population as of 2024. Source UBOS, Census 2024. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Uganda’s population pyramid showing age and sex composition of the population as of 2024. Source UBOS, Census 2024.

Methods of contraception include oral contraceptive pills, implants, injectables, patches, vaginal rings, intra uterine devices, condoms, male and female sterilization, lactational amenorrhea methods, withdrawal and fertility awareness-based methods.

Global statistics show that 77.5% of women aged 15–49 had their family planning needs met with modern methods in 2022, up from 67% in 1990. In sub-Saharan Africa, the proportion of women who have their need for family planning satisfied with modern methods (SDG indicator 3.7.1) continues to be among the lowest in the world at 56 per cent. Nevertheless, it also increased faster than in any other region of the world, having more than doubled since 1990, when this proportion was only 24 per cent.

Among 1.9 billion women of reproductive age (15-49 years), an estimated 874 million women use a modern contraceptive method and 92 million, a traditional contraceptive method. The number of modern contraceptive users has nearly doubled worldwide since 1990 (from 467 million). Yet, there are still 164 million women who want to delay or avoid pregnancy and are not using any contraceptive method, and thus are considered to have an unmet need for family planning.

Number of women of reproductive age (15-49 years) using various contraceptive methods, world, 2020 (millions and percentage). Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Number of women of reproductive age (15-49 years) using various contraceptive methods, world, 2020 (millions and percentage)

Slow progress is due to factors like limited method choices, restricted access, fear of side effects, cultural opposition, and gender-based barriers.

Between 2015 and 2019, there were 121 million unintended pregnancies annually worldwide – 48 per cent of all pregnancies. Despite decreases in the rate of unintended pregnancy in all regions over the past three decades, nearly one in 10 women in sub-Saharan Africa, Western Asia and Northern Africa, and Oceania (excluding Australia and New Zealand) continue to experience an unintended pregnancy every year

Watercolor painted fetus illustration. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Watercolor painted fetus illustration.

In Uganda, where healthcare services are stretched thin and women juggle numerous responsibilities, accessing contraceptives can be challenging.

Dr. Amongin emphasizes that self-injection methods like DMPA-SC, also known as Sayana Press could ease the burden on women facing long queues and logistical challenges at health facilities. “This method allows for discretion and reduces the need for frequent visits, which is crucial for women with busy lives,” she says.

Researchers argue that the health sector’s budget should include substantial funding for family planning. The high cost of inaction is evident: neglecting family planning leads to unplanned pregnancies, which ultimately burdens families and the nation. Addressing this issue early in the life cycle is crucial to prevent these long-term consequences.

“This is the gist of the matter behind all our research, that a woman’s preference needs to be respected. The health facilities must stock commodities so that when a woman is in need, she actually gets it,” noted Dr. Amongin.

PMA researchers surveyed DMPA-SC (Sayana Press) users to find out if they self-administered the injection or received it from a healthcare provider. Results show a slight increase in self-injection among users between 2020-2021. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
PMA researchers surveyed DMPA-SC (Sayana Press) users to find out if they self-administered the injection or received it from a healthcare provider. Results show a slight increase in self-injection among users between 2020-2021.

Dr. Peter Waiswa, an Associate Professor at MakSPH, stresses the importance of informed choice in family planning. ICAN studies across Kenya, Malawi, Nigeria, and Uganda show that self-injection benefits all women, including young adolescents. “Supporting young people to make informed choices helps prevent unintended pregnancies,” says Prof. Waiswa.

“We spent four years trying to understand which women benefit from injecting themselves. And we found that all women benefit from it, including younger children. Because younger children in Uganda, whether we hide our heads in the sand or not, especially those 12 years and above are having sex and some of them using contraceptives,” Professor Waiswa says.

Dr. Peter Waiswa, an Associate Professor at MakSPH interacts with legislators Hon. Nancy Acora, the Lamwo District Woman MP and the Mbarara district woman MP Ayebare Margaret Rwebyambu. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Dr. Peter Waiswa, an Associate Professor at MakSPH interacts with legislators Hon. Nancy Acora, the Lamwo District Woman MP and the Mbarara district woman MP Ayebare Margaret Rwebyambu.

What is factually true is that by age 18, 60% of Ugandans have reported having sexual intercourse. Despite the benefits, dropout rates from family planning methods remain high due to side effects and lack of support. Dr. Waiswa also, a Public Health specialist, critique and dreamer for better health systems for mothers, newborns and children in Africa calls for better education and support to address these issues.

“As a way of being supported in a safe space whereby people are not asking questions, they are not fearing parents, they are not fearing other people, then they can use the methods. What we did in Mayuge and Oyam, we trained women who are users of family planning. To identify people who need to use family planning but are not currently using and then they go and see whether they can use or not. And we found that when people are supported, those groups which are currently not being reached can be reached by family planning,” argues Prof. Waiswa.

Women with most recent unintended pregnancies by age and residence. 2 in 5 women had their last pregnancy unintended in Uganda. 13% wanted no more while 33% wanted later. Source, PMA Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Women with most recent unintended pregnancies by age and residence. 2 in 5 women had their last pregnancy unintended in Uganda. 13% wanted no more while 33% wanted later. Source, PMA

A 2021 study found that contraceptive discontinuation significantly impacts the effectiveness of family planning services, leading to higher fertility rates, unwanted pregnancies, and induced abortions.

Analysis of data from PMA 2020 show that 6.8% of women discontinued contraceptive use, with discontinuation linked to factors such as age, marital status, method type, and health concerns. The study suggests prioritizing interventions to encourage contraceptive use among young people and promoting partner involvement and awareness, as many contraceptive methods are not discreet.

Prof. Waiswa is concerned of the high dropout rate from family planning methods, where many women discontinue use due to side effects, a need for better education and support.

“We need to see how to educate women so that they are informed when they are choosing a method to use. They need to have enough information because when they discontinue, the method can be ineffective, can cause side effects, but also these methods are expensive, so they waste money. There are a lot of those who change to other methods. We are learning a lot on the use of family planning why we still have a large unmet need,” says Prof. Waiswa.

Contraceptive methods used among women of reproductive age (15-49 years), world and by region, 1995 and 2020 (percentage) -Source: UN - World Family Planning 2022 Report Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Contraceptive methods used among women of reproductive age (15-49 years), world and by region, 1995 and 2020 (percentage) -Source: UN – World Family Planning 2022 Report

Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health, hailed the MakSPH study on self-injection contraception. She noted that the findings will help her enhance support for self-care initiatives. However, she expressed that only 29% of women willing to self-inject as indicated in the study is still low, highlighting a need to address barriers to increase acceptance as well as managing sexually active adolecents. “We must discuss how to handle minors seeking contraception to prevent unintended pregnancies,” she says.

On Friday August 23, 2024, the Daily Monitor reported, an increase in young girls adopting family planning to combat teenage pregnancies and school dropouts. Quoting data from the Uganda Health Information System, statistics show that between March 2023 and March 2024, 2,476 girls under 15 had their first antenatal care visit, and 1,755 gave birth. The highest number of pregnancies among this age group was in Oyam district.

In this period, Lango subregion saw 52 pregnancies among this age group, with Oyam district recording the highest at 10 cases. The 2021 UNFPA fact sheet indicates that Busoga region, particularly Kamuli and Mayuge districts, has the highest rates of teenage pregnancies, with 6,535 and 6,205 cases respectively.

Calculations based on United Nations, Department of Economic and Social Affairs, Population Division (2022). World Contraceptive Use 2022. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Calculations based on United Nations, Department of Economic and Social Affairs, Population Division (2022). World Contraceptive Use 2022.

“As the country, it’s clear that adolescents are limited to access to contraception because of so many reasons. For us as a Ministry, any woman between the age of 15 to 49 is a woman of reproductive age and that tells you that she is capable of getting pregnant and when such a girl of probably 15 years goes to a facility to seek for contraception, it rings a message that actually she is sexually active. So how do we handle her? So that is a matter of discussion for the country.

It is a matter that the nation needs to decide on, because we all know the girls are getting pregnant, the girls want to use contraception, but they have no access because of the fact that they are children,” wondered Achola.

Assoc. Prof. Lynn Atuyambe one of the researchers on post-abortion care shares a light moment with Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health during the ICAN Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Assoc. Prof. Lynn Atuyambe one of the researchers on post-abortion care shares a light moment with Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health during the ICAN Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala.

Unintended pregnancies and Uganda’s abortion paradox

Abortion in Uganda, is largely illegal except in specific circumstances. It contributes to maternal death due to unsafe practices. Between 2010 and 2014, WHO reported that 30.6million abortions conducted were safe and 25.1million were unsafe. 97% of these occurred in developing countries. In East Africa, the total number of abortions per year according to the Lancet are around 2.65million.

The Ministry of Health’s HMIS data show a rise in abortion cases, with 96,620 reported between July 2020 and June 2021in both government and private health facilities.

Another recent study on the quality of post-abortion care by MakSPH researchers Assoc. Prof. Lynn Atuyambe, Dr. Justine Bukenya, Dr. Arthur Bagonza and Mr. Sam Etajak highlights the need for accurate post-abortion care data to improve healthcare planning and policymaking.

Dr. Arthur Bagonza, a Public Health Consultant and Research fellow with specialization in health systems at MakSPH and one of the uality of post-abortion care has called for accurate abortion data to improve healthcare planning and policymaking. He notes that health workers often avoid documenting abortion data due to legal fears and calls for reforms to restrictive laws to ensure accurate reporting without legal repercussions.

“All assessed health facilities reviewed in our study achieved a 100% timeliness rate for report submissions. However, significant disparities were observed in data accuracy between different levels of health facilities, with lower-level facilities (HC IIs and HC IIIs) showing higher rates of data discrepancies,” says Dr. Bagonza.

Dr. Arthur Bagonza., a Public Health Consultant and Research fellow at MakSPH presenting results of the quality of post abortion care. He calls for accurate abortion data to improve healthcare planning and policymaking. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Dr. Arthur Bagonza., a Public Health Consultant and Research fellow at MakSPH presenting results of the quality of post abortion care. He calls for accurate abortion data to improve healthcare planning and policymaking.

According to Dr. Amongin, the high incidence of early sexual activity among Uganda’s youth is a pressing public health issue.

“We know as a country many women continue to die following unsafe abortions; abortions for pregnancies that they did not want. And these abortions are highest among adolescents and also other women categories.

We would want to ensure that we actually enhance access to contraceptives, but making it easier for them to have it and putting the power in the hands of a woman to as much extent as we can. So that a woman can practice what we call self-care, but of course she also will need the support of the healthcare system. But we want this power in women’s hands because of all the challenges that the women actually can encounter in accessing these methods,” she said.

On her part, Achola insists that abortion should not be a last resort for women and urges them to abstain or use protective means in order to avoid unwanted pregnancies. She notes that as long as abortion remains illegal in Uganda, many health workers will avoid addressing it, leading people to unsafe alternatives.

“I can’t be happy because abortion means we have failed to give people a method of their choice to prevent that pregnancy. Or the people are not able to access contraception to prevent unintended pregnancies. Abortion is not the last resort, it’s not a solution because it has its own complications as well,” says Achola.

Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health listens through during one of the dissemination sessions organised by MakSPH. Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Ms. Roseline Achola, Technical Specialist for Sexual and Reproductive Health and Self-Care at the Ministry of Health listens through during one of the dissemination sessions organised by MakSPH.

Despite this, Achola, notes most of the women who walk in health facilities with post-abortion complications must be attended to. “Whereas we don’t encourage people to do abortions, as Ministry of Health we are mandated to handle all complications for anyone who walks in our facilities because our priority is to save life. We want to urge women to avoid certain things. Why should you wait for unintended pregnancy to occur and then abort?”

Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services – Curative in the Ministry of Health highlights the financial burden on individuals seeking health services and suggests exploring private sector opportunities and community-based approaches to improve access. “We need to balance values and rights while addressing access barriers,” he notes.

According to Dr. Olaro, the autonomy and agency of women in sexual and reproductive health, particularly in African cultures remain a challenge where social norms may require women to defer decisions to their partners.

Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services - Curative in the Ministry of Health (MoH). Makerere University School of Public Health (MakSPH) Innovations for Choice and Autonomy (ICAN) project study I-CAN/Nsobola/An atwero social support intervention, piloted in Mayuge and Oyam districts in 2023, Dissemination on July 31, 2024 at Golden Tulip Hotel, Kampala Uganda, East Africa.
Dr. Charles Olaro, a Senior Consultant Surgeon and the Director Health services – Curative in the Ministry of Health (MoH).

He notes that there is a high burden of abortion and self-harm, with a significant portion of maternal mortality attributed to sepsis, which is often a result of unsafe abortions in Uganda.

“We still need evidence to ensure that access barriers are addressed. And this is a question I keep on asking Makerere University, yes, we have a young population but how are these people accessing contraceptives. Other issue we have to deal with is complex. I know we have to do a balance between values and rights, but we will be able to look at that when they gain the success to do it.”

Dr. Olaro points out that individuals often face a financial burden in health services, spending more on prescriptions than on the medications themselves. He suggests exploring private sector opportunities and a community-based approach to improve access to healthcare.

NB: The PMA surveys are spearheaded by Associate Professor Fredrick Makumbi and Dr. Simon Kibira of MakSPH, with support from the Uganda Bureau of Statistics and the Ministry of Health. The initiative also receives funding from the Bill & Melinda Gates Foundation, The Children’s Investment Fund Foundation (CIFF), and is supported by the Bill & Melinda Gates Institute for Population and Reproductive Health at Johns Hopkins University and Jhpiego.

View on MakSPH

Davidson Ndyabahika

Health

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

Published

on

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.


Mak Editor

Continue Reading

Health

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

Published

on

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.

View on MakSPH

John Okeya

Continue Reading

Health

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

Published

on

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:

View on MakSPH

John Okeya

Continue Reading

Trending