On October 15, 2021, the beep of a glucose monitor flatlined in our living room. My mother, Rebecca Nabiteeko (R.I.P.), took her last labored breath as her veins, swollen, burning, and numb, finally surrendered to a decade-long siege by diabetes. Her final days were a cruel liturgy: mornings began with insulin injections, and nights ended with prayers to a God who never answered. “Nsaba Yezu, mpone obulwadde bwa sukaali,” she prayed for deliverance from the sugar sickness. The same sickness that caused numbness of her feet, then her sleep, and finally her life. I miss her.
In our little cramped Kyebando-Kisalosalo home, medication such as pregabalin, Metformin, and Insulin Mixtard—became part of the day’s meals and everyday companions as relatives. We memorized their shapes: the amber vials crowding the dining table, the syringes tucked like shrapnel in drawer corners. Her body was a battleground. Her faith, a fragile ceasefire.
Her story is not unique. It is now becoming every household’s and a Ugandan story. Our country is under attack! While HIV, cholera, and malaria dominate headlines, a quieter killer stalks Uganda: non-communicable diseases (NCDs) like diabetes, hypertension, and cancer now claim 1 in 3 lives, eclipsing infections as the nation’s grim reaper.
“Our clinics are grappling with constant drug stockouts. For hypertension, diabetes, and asthma medications, funding covers just 2% of the actual needs,” reveals Dr. Freddie Ssengooba, a professor of health economics at Makerere University School of Public Health (MakSPH).
Dr. Freddie Ssengooba, a professor of health economics at Makerere University School of Public Health (MakSPH)
In one of the Health Policy Advisory Committee (HIPAC) meetings of Uganda’s Ministry of Health, where key stakeholders gather, a concerning reality about medicine availability was shared.
In schools, teenagers trade 500-shilling cigarettes like sweets. In markets, soda and unregulated sweetened juices flow cheaper than clean water. Uganda’s health system, already strained by several public health issues, is buckling under the NCD surge. “80% of the early 335 COVID-19 deaths in Uganda had NCD comorbidities as an underlying condition,” stated Dr. Eric Segujja, a public health systems researcher, while coronary heart disease, once rare in Africa, now claims 12% of Uganda’s disease burden.
This is a plague of policy, profit, and paralysis, a war where lobbyists outgun public health advocates and sugar drowns out science. My mother didn’t just die of diabetes. She died in a system that incentivizes manufactured epidemics while pushing back on public health responses.
Dr. Eric Segujja, a public health systems researcher at Makerere University School of Public Health (MakSPH) presents results of the political economy analysis of health taxes on unhealthy commodities in Uganda research.
At a dissemination meeting on the political economy analysis of health taxes on unhealthy commodities in Uganda at Kabira Country Club in Kampala in late January this year, Dr. Ssengooba emphasized that, “When discussing NCDs, we need to be very practical.”
Adding that, “Currently, we rely heavily on a few donors and pharmaceutical companies, who provide us with a set of donated drugs each year. If these donors begin to reduce their support, similar to what we’re seeing with the US in the coming days, we will face even greater challenges. This is a critical issue: as we talk about NCDs, there’s no provision within the national budget to address medicine shortages. While there are healthcare professionals trained to manage these diseases, they may end up advising patients to purchase medicines from pharmacies—something that’s not affordable for many, especially those without financial means.”
The culprits? Cheap, sophisticated distribution channels and aggressively marketed unhealthy commodities. For instance, between 2015 and 2023, beer production rose by 42%, soft drinks by 67%, and cigarette sales surged despite taxes.
A presentation titled “Impact of Taxation on the Production, Sales, Revenue, and Consumption of Selected Unhealthy Commodities in Uganda: A Nine-Year Analysis” reveals a significant increase in the production of non-alcoholic beverages, particularly sugar-sweetened drinks, over the years. The highest production levels in the country were recorded during the 2022/2023 financial year. Richard Ssempala a Makerere University lecturer at the School of Economics and a current PhD candidate at Osaka Metropolitan University in Japan, who is also one of the researchers, attributes this growth to the rise in the number of factories and small-scale firms entering the market, coupled with low tax rates on these commodities.
Are Health Taxes, a “Best Buy,” Stalled by Competing Interests?
The World Health Organization (WHO) ranks health taxes on tobacco, alcohol, and sugary drinks among its top “Best Buys” to curb NCDs. Yet in Uganda, implementation faces fierce resistance. Dr. Henry Zakumumpa, a health systems and NCDs researcher at Makerere University, says industry lobbyists have impressed upon government technocrats, people, and commissioners at the Uganda Revenue Authority that when you increase taxes, then there will be distortion of the economy due to low consumption and the government won’t get those taxes, which he says is not true.
Tough speaking Dr. Henry Zakumumpa, a health systems and NCDs researcher at Makerere University.
“When the taxes remain low, we as public health advocates realize that we shall not achieve our objective of reducing consumption of cigarettes and tobacco because they become affordable. Young people in secondary schools can afford cigarettes, which, of course, as we know, lead to cancer and heart disease. The tobacco industry is interested in maintaining taxes at a level where they’re ineffective, where they are so low that the prices are so low and young people can afford them,” said Dr. Zakumumpa.
But do health taxes work?
Studies that have been conducted elsewhere have shown that, when you increase taxes, the government increases revenue, and also the population reduces consumption of harmful products.
While the industry argues that taxes generate government revenue, a 2017 report by the Center for Tobacco Control in Africa (CTCA), based on a World Bank study, revealed that for every dollar the Ugandan government receives in tobacco taxes, it spends four dollars treating tobacco-related diseases. The government incurs costs at the Cancer Institute, Lung Institute, and Heart Institute, treating individuals with lung cancer, throat cancer, and heart disease linked to smoking in their youth.
“The industry has been successful in misinforming the public, even government officials, by scaring them that if they increase taxes, the economy will suffer and the government will lose revenue, which we have found is actually misinformation,” argues Dr. Zakumumpa.
Dr. Segujja explains, “Health taxes collide with national priorities like the industrialization growth trajectory that the government is pursuing and getting a bulk of the population from the subsistence to a cash economy. Manufacturers of alcohol, tobacco products, and sodas advance this as the rationale for their businesses and, along the way, were attracted to the country with tax incentives to contribute to this objective. Now, they argue new levies will kill jobs and take them out of business.” Industry lobbying has kept Uganda’s tobacco taxes at 30% of retail prices, far below WHO’s 70% recommendation.
The Chemical Hook
A young man smokes cigarettes in Makerere Kikoni, a neighborhood bordered by Bwaise to the north, Makerere University to the east, Naakulabye to the southwest. Formerly a slum in semi permanent structures, it is now most developed with student hostels.
For the smokers, every puff injects their veins with 70 cancer-causing chemicals. Smoking doubles their risk of diabetes or that 90% of lung cancers trace back to this habit. But they know one thing: they can’t stop and this is how big tobacco engineers addiction in Uganda’s backyard
“Tobacco is one of the most addictive products,” explains Dr. Zakumumpa. “But do you know why? Manufacturers lace it with nicotine—a chemical trap designed to hook you for life.”
The irony is as bitter as the smoke. In rural Uganda, farmers have chewed raw tobacco leaves for generations without addiction. But in the hands of multinationals like British American Tobacco (BAT) and Marlboro, those same leaves are chemically altered. Nicotine, absent in natural foliage, is added like a sinister seasoning, transforming a plant into a predator.
Profitability of their businesses thrives through repeated consumption by a bulk of consumers.
“They want you as a tenant for life,” Dr. Zakumumpa says. “Even when your lungs scream, your wallet empties, or your blood sugar spikes. When the poor can’t afford cigarettes, they smoke less. The rich? They fund their own demise,” he adds notes.
But isn’t this the science of slavery?
Science demonstrates that nicotine is not only addictive, but also a master manipulator. It rewires brains to crave more, while tar and formaldehyde, some of the 7,000 chemical substances, carve silent graves in lungs. Yet Uganda’s tobacco taxes remain among the lowest globally, keeping packs accessible to teens.
“This isn’t commerce,” Dr. Zakumumpa argues. “Its chemical warfare, and the casualties are in our wards, gasping for air.”
He advises those who are addicted to enroll in nicotine reduction therapies and healthcare treatment at centers designated to help people with tobacco addiction.
“There is something called the National Care Centre (NACARE); we have Serenity Centre Uganda. We have about five centers which treat people who have tobacco addiction and who want to leave tobacco because it’s a chemical addiction, so they should approach the School of Public Health, they can approach us researchers, we can link them to these centers and they will leave and drop this habit,” says Dr. Zakumumpa
Revenue vs. Health, the Fiscal Tightrope
Uganda’s dilemma mirrors a global challenge. While health taxes could reduce NCD risks and fund healthcare, policymakers fear economic fallout usually advanced by opponents of tax increases. “Taxes on unhealthy commodities are sensitive, fought against by companies”—acknowledges Ssempala. Yet data from his nine-year analysis demystified this: Production and sales of taxed goods like beer and sodas keep rising, even as revenues plateau. During COVID-19, sales dipped briefly but rebounded sharply.
The Ministry of Health’s Dr. Oyoo Charles Akiya remains pragmatic:
“We need compromise. If manufacturers won’t accept higher taxes, let’s mandate health warnings or limit marketing to children.”
Dr. Akiya is the Commissioner of Health Services-Non-Communicable Diseases, and he hopes there can be a path forward through coalitions, evidence, and political will. Despite hurdles, advocates see hope. South Africa’s success in taxing sugary drinks and Kenya’s tobacco levies offer blueprints.
Dr. Oyoo Charles Akiya, Commissioner of Health Services-Non-Communicable Diseases MoH as a panelist at a dissemination meeting at Kabira Country Club in Kampala in late January this year.
Regionally, a coalition of East African NCD managers is advocating for unified policies. The 4th Global NCD Alliance Forum, held at the Convention Centre in Kigali, Rwanda, on February 13, 2025, was the first of its kind in Sub-Saharan Africa. The event brought together 700 advocates, experts, and ministerial representatives from over 66 countries working in NCD prevention and care. This forum is a key global health forum as we race to the 4th UN High-level Meeting on NCDs, scheduled for September 2025 in New York.
“Change requires top-down pressure,” says Dr. Akiya.
With multinationals at the centre of manufacturing these commodities, exerting enormous pressure sometimes may prove difficult to confront as individual countries.
“We’re engaging the AU and UN to put NCDs on presidential agendas.” Locally, the Ministry of Health is mobilizing patients with lived experience: “They matter the most. The media plays a crucial role in this endeavor and holds significant importance for us. We cannot leave them out in these efforts. The leadership at the Ministry of Health, the minister, and the PS [Permanent Secretary] are all passionate about NCDs,” he added.
Is it a race against time or a behavioral issue?
As Uganda’s youth embrace processed snacks and tobacco, the clock ticks. “Every day without action, we lose more people to preventable diseases,” warns Professor Ssengooba.
The other day, Mubiru (not his real name) was jogging on the street, and a motorcycle taxi called Boda Boda knocked him, and he has just come out of the cast. He’s trying to manage NCDs; he got injured. At a Kampala hotel buffet, 28-year-old Miriam (not her real name) stares at her plate—a mountain of matoke, fried rice, boiled rice, vegetable rice, roasted gonja (plantain), and three golden potato wedges. “Finish it all,” her aunt insists. “Food is a blessing!” But Professor Ssengooba sees a different truth in these heaping portions: “Our plates have become battlegrounds. We pile carbohydrates like trophies—fried, boiled, mashed—while our bodies crumble.”
Uganda’s love affair with carbohydrates has turned toxic. Meals once centered on balanced staples like beans and greens now drown in oil and starch. “We’ve confused ‘tasty’ with ‘excessive,’” he says, adding that “at weddings, funerals, and even home dinners, its six carbohydrates competing on one plate. Why? Tradition says ‘more is generous.’ Science says, ‘more is deadly.’”
High angle woman checking glucose levels. Photo courtesy of Freepik
At what cost? Surging diabetes and hypertension rates. “We’re eating our way into clinics,” he warns. Yet change faces cultural roadblocks: How do you convince a nation that less on the plate isn’t disrespect—but survival? In this high-stakes battle between public health and profit, Uganda’s choices will shape a generation’s survival.
Davidson Ndyabahika is the Communications Officer, Makerere University School of Public Health.
I am pleased to present our annual report. Throughout the past year, MakSPH-METS Program has remained steadfast in its mission to strengthen Uganda’s capacity for HIV and TB programming through strengthening robust health information systems, surveillance, and quality improvement initiatives.
MakSPH leverages its team of expertise in public health to guide program strategies, strengthen national capacity for data collection, analysis, and use. The innovations developed are solutions for health system challenges and they generate evidence that can be used to inform policy and practice.
MakSPH-METS provides technical support to MoH, RRHs, implementing partners at different health system levels.
Our collaborative approach, working closely with the Government of Uganda and various stakeholders, has enabled us to make significant strides in building sustainable health information systems and improvingthe quality of healthcare delivery. The achievements highlighted in this report reflect our commitment to strengthen health systems through development and implementation of innovative and impactful evidence- based solutions.
As we look to the future, I am confident that the METS Program will continue to play a pivotal role in strengthening Uganda’s health systems through several initiatives.
Operationalising a sustainability plan through transitioning of the developed innovations to the Ministry of Health for ownership.
Disease outbreak management will be strengthened through continued capacity building for emergency response and optimization of existing integrated disease surveillance systems. The field teams will facilitate seamless coordination across health system levels to build sustainable and resilient health systems capable of effectively responding to public health emergencies.
Lastly, we continue to strengthen collaboration with government, enhance coordination with implementing partners and promoting integration of health services.
Our dedicated team of professionals, combined with the unwavering support from our partners and stakeholders, positions us well to address emerging health challenges and advance our nation’s public health goals. The innovative solutions and capacity-building initiatives highlighted in this report demonstrate not only our progress but also our potential for greater impact in the years ahead.
Makerere University Biomedical Engineering Unit under the Department of Physiology is glad to advertise for positions under its new Project ‘KeyScope Project: The Key to Sustainable Cancer Diagnosis and Treatment in Uganda.”
Laparoscopic surgery is considered as the standard of care for cancer treatment in high-income countries. However, this technology is rarely accessible to LMICs due to the high cost of installment, lack of maintenance personnel, unreliable electricity, and shortage of consumable supplies. To address these concerns, a unique multidisciplinary collaboration between engineers, surgeons, oncologists, and business experts from Duke University, Makerere University, Uganda Cancer Institute and University of Maryland joined efforts to develop a low-cost, durable laparoscopic system (KeySuite) for use in resource- constrained environments.
Our aims are aligned to demonstrating the local capacity to manufacture, acquire local and international regulatory approval, determine clinical performance and distribute/sell the KeyScope to the local market. Specifically, we shall improve the current design and determine the local capacity to manufacture the device, establish the clinical safety and acceptability of the product, and obtain regulatory approval from local and international accredited bodies.
Position: Junior Research Fellow
Reports to: Project Coordinator
Engagement: Full time
Duration: 1 year renewable upon satisfactory performance
Duty Station: Kampala
Roles and responsibilities
As a trainee, a Junior Research Fellow will closely work with a research team to undergo training design, manufacturing and validation of the KeyScope. This is a non-degree/no-credit training opportunity that will prepare the successful candidate for advanced studies and future industry work in an upcoming medical technology sector of Uganda and Africa at large.
Specifically the Fellow will;
Participate in the local construction of the KeyScope through material assessment and selection, developing a product manufacturing plan, and carrying out an impact assessment.
Aid in the establishment of clinical safety and acceptability of the KeyScope through the use of a feasibility study to secure approvals, recruit patients and surgeons.
Contribute to the process of attaining regulatory approval from a certified body for the KeyScope.
Contribute to the development of a commercialization plan under training and mentorship of a Business Developer.
Actively engage in project documentation, questionnaire and ethics protocol development, journal article writing and publication, report writing.
Conduct key informant interviews, administer questionnaires, and verbatim transcription of interview recordings.
Participate in data collection and analysis using digital and paper-based tools.
Participate and contribute to teaching and student mentorship.
Engage with the research partners and stakeholders.
Any other activities as assigned by the Principal Investigator, and Project Coordinator (Immediate Supervisor) from time to time.
Qualifications:
Completed a Bachelor’s Degree in Biomedical Engineering or any closely related field and at least awaiting graduation in not more than 6 months from an accredited University in Uganda.
If completed, candidate must not have graduated more than 1 year ago.
Academic qualifications of having attained or expecting at least expecting a second-class upper division degree.
Experience in Human-Centered Design skills and Design Thinking will be highly considered.
Prior experience in working with international multidisciplinary teams and organizations.
Experience of previous work on laparoscopy is a plus.
Evidence of prior interest for research, design, innovation and medical device manufacturing.
Applicant should have a desire to work with different fabrication techniques.
Ability to multitask and perform duties in learning environment with minimum supervision
Excellent scientific writing skills and a good command of communication skills.
How to Apply:
All suitably qualified and interested candidates should submit a one-page cover letter, one-page writing sample, CV (maximum 3 pages) with relevant certificates, transcripts & two reference letters as a single digitally signed PDF file addressed to the Project PI and emailed to keyscopeu01@gmail.com by 17:00hours on 18th April 2025. Indicate, “KeyScope Project” in the subject line. Those awaiting graduation should send their most recent testimonials. Only shortlisted applicants will be contacted.
Makerere University School of Public Health (MakSPH) is honored to host a distinguished delegation from Karolinska Institutet (KI) for a two-day administrative exchange, part of our 25 years of a flourishing partnership between Makerere University (Mak) and Karolinska Institutet.
Fostering Administrative Synergies
The visiting team, led by Therese Lind, head of administration at KI’s Department of Global Public Health, comprising HR specialist Sofia Öhlund-Fingal, Sonia Hammi, project manager, Kseniya Hartvigsson, communications officer CESH, and Anna Hansson, project manager, Grants Office—engaged in:
Discussions on research administration and financial management
Knowledge sharing on operational challenges and best practices
Exploring funding opportunities with major donors
The visit covered grants management, procurement, financial systems, and joint application strategies to enhance efficiency and academic exchanges. The team also toured key university facilities, including the historic Main Building, the state-of-the-art MakSPH auditorium, and the construction site, to witness the institution’s growth.
A Legacy of Collaboration
Since 2000, this partnership, Mak-KI, has yielded:
49 PhD graduates through the Sida-supported doctoral program
Reciprocal exchanges benefiting 254 students and 153 faculty members
The Centre of Excellence for Sustainable Health, established during the pandemic
This visit reinforces our commitment to strengthening institutional capacity and driving impactful research. We extend our sincere appreciation to the KI team and look forward to continued collaboration.