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We Are Pushing Nature to the Edge—But Solutions Are Within Reach: Global Conversations on Sustainable Health

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By Davidson Ndyabahika and Johanna Blomgren

We’ve all done it—tossed leftovers, ignored wilted greens, or shrugged at a half-eaten meal. Food waste is a quiet guilt we all share, a reflex in a world of abundance and scarcity. But what if this small act connects to a larger global issue? On February 26, 2025, experts from Uganda, Sweden, and beyond gathered in a virtual seminar, asking, “How can we nourish ourselves without harming the planet?” Hosted by the Centre of Excellence for Sustainable Health (CESH), the discussion revealed a harsh truth—our food habits are draining the Earth.

The discussion on sustainable food systems marked the beginning of the annual four-part global conversation on sustainable health, organized through a collaboration between Sweden’s Karolinska Institutet and Uganda’s Makerere University under the auspices of CESH.

In Kampala, the paradox is stark. Every day, 750 tons of food waste fill the city’s landfills, enough to feed thousands. Rotten mangoes spill from crates in Nakasero Market, and half-eaten Rolex wraps pile behind street stalls. Uganda’s Food Rights Alliance shows 37.8% of this waste comes from plates and markets. Across East Africa, organic waste, like spoiled vegetables and discarded tubers, makes up 79% of urban trash—a grim reflection of broken systems. Beyond this is a city stuck with piles and piles of organic trash, which has previously been fatal with a slide in one of Kampala’s major landfills. Meanwhile, 26% of Uganda’s children remain stunted.

At the heart of this week’s global conversation was the WWF’s Living Planet Report 2024, a sobering revelation of a 73% decline in global wildlife populations since 1970. Freshwater ecosystems have hemorrhaged 85% of biodiversity, Latin America’s species richness has plummeted by 95%, and Africa—home to smallholder farmers who feed millions—has lost 76%. “Nature is disappearing at an alarming rate,” warned Harold Turinawe, WWF Uganda’s Forest Markets Transformation Manager, his voice weighted with urgency.

“We are pushing Earth’s systems to irreversible tipping points, and despite the increase in food production and land use and the destruction of habitats, the world is still hungry; we have over 735 million people going to bed hungry every other night. The contradiction is striking,” Turinawe added.

Mr. Harold Turinawe, Forest Markets Transformation Manager, World Wide Fund for Nature, Uganda Country Office. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa-Karolinska Institutet, Sweden, Centre of Excellence for Sustainable Health (CESH)-Global Conversations on Sustainable Health.

The report highlights the Amazon’s lush canopies that are felled for cattle ranches. The interplay of man’s unsustainable utilization of Mother Nature, leading to the food paradox, feast, famine, and ecological ruin, underscores the urgency of addressing global goals in a coordinated manner.

The report’s indictment of industrial food systems is clear: agriculture claims 40% of habitable land, 70% of freshwater, and drives 25% of greenhouse emissions. Yet, 735 million people still starve nightly. “Our obsession with monocultures and processed foods isn’t just destroying habitats—it’s failing humanity,” said Dr. Rawlance Ndejjo, the seminar’s moderator and a public health lecturer at Makerere University.

Florence Tushemerirwe, a Ugandan public health nutrition expert based at Makerere University’s School of Public Health, pointed out the irony: 26% of children are stunted, while obesity rises among adults in Uganda. “We grow nutrient-rich crops but export them, leaving people dependent on cheap, processed imports. In fact, many people do not appreciate their nutrient value,” she said. Uganda’s iodine-depleted soils now rely on fortified foods—a temporary fix for a growing crisis.

Ms. Florence Tushemerirwe, Public Health Nutritionist and Research Associate. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa-Karolinska Institutet, Sweden, Centre of Excellence for Sustainable Health (CESH)-Global Conversations on Sustainable Health.

All through the seminar, the message was clear: we are wasting abundance while ecosystems crumble and people go hungry. “Our salt is iodized because our soils no longer provide it. Biodiversity loss isn’t abstract—it’s stealing nutrients from our plates. But if we don’t maintain our nature’s health, or our environmental health, or our natural resources health, it means that whatever food we grow, we actually do not carry the nutrients we need to maintain a diverse diet,” said Tushemerirwe.

The panel dissected global food trade’s role. WWF’s Turinawe lamented, “90% of deforestation is for agriculture. In Uganda, the once-vibrant wetland ecosystems of Lwera at the shores of Lake Victoria now face severe degradation due to large-scale rice growers; in the Amazon, its cattle ranches.”

Dr. Rachel Marie Mazac of Stockholm Resilience Centre stressed Europe’s complicity: “Sweden’s ‘virtual biodiversity loss’—importing deforestation via beef and soy—shows how our diets export destruction.”

“From a Swedish perspective, we are highly dependent on imports, particularly raw materials, which contribute significantly to biodiversity loss in other regions. It’s difficult to pinpoint the exact impact, especially with biodiversity, but there’s a concept of “virtual impact,” says Dr. Mazac.

Dr. Rachel Mazac, Postdoctoral Researcher, Stockholm Resilience Centre, Stockholm University. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa-Karolinska Institutet, Sweden, Centre of Excellence for Sustainable Health (CESH)-Global Conversations on Sustainable Health.

Food consumed in Sweden, though produced elsewhere, contributes to biodiversity loss in those areas. The issue links to trade, food production, and distribution. It’s not just about production or waste but also equitable distribution.

Dr. Ndejjo added starkly, “You could be eating a burger from a cow grazed on razed Amazon forest. Guilt isn’t enough—we need systemic change.”

Amid the grim statistics, the panelists outlined a roadmap for redemption: nature-positive agriculture, subsidy policy reform, improved localized diets, global accountability, and honest discussions on the GMO dilemma.

Turinawe emphasized the need for agroecology in extension services—integrating trees, crops, and livestock to rebuild soil health and biodiversity. He stressed while critiquing Uganda’s Parish Development Extension Model for prioritizing enterprises for profit over sustainability. “We are saying get one million to a farmer. What are they producing? They are engaging in commodities that are predetermined. Nobody’s talking about Mother Nature. Who takes care of the soil? Who takes care of the water needs? Who takes care of the diversification we are talking about? But diversification in the diet begins with diversification on the farm. So my first issue is strengthening the agricultural extension services,” says Turinawe.

Adding that things like soil health management, land tenure system farmer-to-farmer network for peer learning, and fair farmer subsidies should be key to planning and agricultural extension.

“In Uganda, where I come from, and currently in Kampala, if you head north towards Zirobwe in Luweero District, you’ll find people we call Bibanja owners—essentially squatters who don’t own the land they occupy. These individuals cannot engage in sustainable agriculture as we’re discussing; their focus is survival. What we need are programs that give farmers secure land rights, which can motivate them to invest in soil health and environmental conservation—investments that take time. Improving soil is not a short-term effort; it requires long-term actions like planting trees, integrating practices, and using farmyard manure. None of this is realistic for someone who fears being displaced tomorrow. We need to approach this challenge collectively.”

Subsidies must reward sustainable practices, not industrial giants.

“Why not tax breaks for farmers using organic manure?” Turinawe challenged. “I would love to hear that a farmer that is engaged in sustainable cocoa production and coffee production gets a tax holiday rather than having a blanket of investors getting a holiday. Put subsidies and investment incentives in the right direction. We shall spur production, and of course, this will also bring in corporate partnerships, and we can make our supply chains safer, better, more green, and more sustainable,” Turinawe added.

Dr. Mazac noted that “nature-positive production can feed the world by optimizing crops, livestock, and wild fisheries, and supporting aquaculture that works with wetlands, not against them.” For Mazac, policy is key: She is also an advocate of subsidies and taxes that benefit farmers. Those that ensure incentives that improve soil health and maintain water quality as well as tackle climate change in order to make sustainability profitable.

“We must rethink trade to avoid widening the gap between food-producing areas and markets and instead support local farmers. Subsidies and taxes should empower these communities to nourish their populations before focusing on exports. While exports generate income, they also have significant impacts. A possible solution is changing production systems, but we must also shift dietary and consumption habits, making this a collective effort, not just an individual responsibility.”

Tushemerirwe is hungry for reviving indigenous crops and regulating predatory marketing. “Awareness is power. We must teach communities to value their traditional foods over processed substitutes.”

“There is good food grown in rural areas and available in markets, but people don’t recognize its value due to lack of guidance. We need food-based data guidelines to raise awareness. The Uganda Ministry of Health has a draft for this, along with draft policies to regulate unhealthy food marketing, especially to children. Junk food is advertised everywhere: hospitals, schools, and even street billboards, with fast food chains clustered together. We must regulate this and educate people on the nutritional benefits of eating what they grow over imported alternatives,” she stated.

Dr. Ndejjo believes these draft guidelines to regulate unhealthy food marketing should be finalized into policies and urges policymakers and implementers to prioritize the urgent need for these documents.

Dr. Rawlence Ndejjo, Lecturer, Department of Disease Control and Environmental Health. Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa-Karolinska Institutet, Sweden, Centre of Excellence for Sustainable Health (CESH)-Global Conversations on Sustainable Health.

The conversation also weighed in on the genetic engineering in agriculture for increased crop yields, popular for GMOs, a dilemma that panelists called for their democratization rather than demonizing them. While Dr. Mazac cautioned against corporate-controlled seeds, Turinawe acknowledged their potential: “If democratized, drought-resistant crops could save farms in a warming world.”

Dr. Mazac noted that while in Europe and the European Union, they are not allowed to grow or sell foods that have been genetically modified, the essence of them should not be overlooked, since they are a technology that seeks to solve the future food crisis.

 “GMOs aren’t inherently evil. Drought-resistant crops could save farms—but corporate patents trap farmers,” she said.

Turinawe added, “Our approach to GMO’s is a measure one bordering more on ethics and responsible use of GMOs; we see GMOs as a tool to promote resilience, especially since everything has changed—the food we once relied on can no longer grow in the same way. If GMOs help improve crop resilience, that’s a valuable tool. However, there are concerns that companies like Monsanto could use the GMO technology as a tool of exclusion, e.g., the fear of monopolizing future seed markets. This is where caution is needed.”

A Call for Radical Collaboration

The seminar’s resounding theme was unity: multi-sectoral collaboration is non-negotiable. From street food vendors to policymakers in the boardrooms, every actor must align. “Food systems aren’t siloed,” Dr. Mazac asserted. “They’re woven into climate, economy, and culture.”

“I think we need to sit and agree and engage quite regularly and find solutions for us to be able to produce food but sustainably,” concluded Tushemerirwe.

The Path Ahead

CESH’s global conversations on sustainable health are a microcosm of a global awakening, especially in tracking progress to meet our goals for 2030 and beyond: This seminar on food systems emphasizes the interconnectedness of food security and biodiversity. With the next UN Climate Summit (COP29) on the horizon, the panel’s message is clear—transformative change is possible, but only through courage, equity, and an unyielding reverence for nature.

To find more about this global conversation on sustainable health and more, visit CESH.health

Davidson Ndyabahika and Johanna Blomgren are the co-organisers of the global conversation on sustainable health

Makerere University School of Public Health (MakSPH), Kampala Uganda, East Africa-Karolinska Institutet, Sweden, Centre of Excellence for Sustainable Health (CESH)-Global Conversations on Sustainable Health.

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Research probes link between maize farming and malaria risk in Uganda

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Assoc. Prof. David Musoke, Dr. Paul Mulumba and Dr. Kevin Deane with participants at the Stakeholders' Workshop on 15th April 2026. Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.

A joint study between Makerere University School of Public Health (MakSPH) and The Open University, UK, is investigating a possible link between maize cultivation and malaria risk in Uganda, as evidence increasingly points to livelihoods and everyday economic activities as key drivers of transmission of the disease.

The research initiative was advanced during a stakeholders’ workshop held on April 15, 2026, at MakSPH’s Resilient Africa Network in Kololo, where a team led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings on the social determinants of malaria. The meeting brought together academics, policymakers, and practitioners to examine how agricultural practices, particularly maize farming, may be shaping malaria patterns in both rural and urban settings in Uganda.

The work builds on a growing body of research linking malaria to economic activity. One such study, led by the two researchers and published in Global Public Health in December 2025, found that livelihood activities such as farming, livestock keeping, and night-time work significantly influence malaria exposure. The study identified agriculture, especially maize cultivation near homes, as a key factor associated with increased mosquito density and heightened infection risk.

Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.
Assoc. Prof. David Musoke presents research findings on how livelihoods, including maize cultivation near homes, may influence malaria exposure during a stakeholder workshop at the Resilient Africa Network, Kololo, on April 15, 2026.

At the workshop, Dr. Musoke said the new inquiry reflects a broader shift in how malaria is understood, outlining how livelihoods, particularly agriculture, shape exposure through multiple pathways, from crop production and water use to the timing of daily activities that coincide with peak mosquito biting hours. These patterns, he argued, extend risk beyond what conventional interventions, such as insecticide-treated nets and indoor spraying, are designed to address.

Uganda remains one of the countries most affected by malaria, with the disease accounting for a significant share of outpatient visits, hospital admissions, and deaths. It is consistently ranked among the leading causes of illness and mortality, particularly among children under five and pregnant women. Despite sustained investment in prevention and treatment, including widespread distribution of insecticide-treated nets and indoor residual spraying, transmission remains high in many parts of the country. This persistence has increasingly drawn attention to factors beyond conventional interventions, including the role of livelihoods, environment, and everyday exposure to mosquitoes.

Maize grown close to homes, with damp ground conditions, may increase exposure to malaria in rural communities. Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.
Maize grown close to homes, with damp ground conditions, may increase exposure to malaria in rural communities.

“As researchers, our role is to generate evidence, and that evidence should inform decision-making,” Dr. Musoke said. “We do not work in isolation. What we hear from stakeholders matters. We are bringing together different sectors, disciplines, and institutions because this work is still in progress, and we intend to build it collaboratively. Increasingly, research requires not just academics, but policymakers, implementers, and communities to be part of the process.”

The collaboration with The Open University has been central. Dr. Deane said the idea of examining the relationship between maize and malaria emerged from several years of joint research on social determinants with MakSPH. He pointed to a gap in malaria research, which has largely focused on biomedical and indoor interventions, while overlooking the role of livelihoods and outdoor exposure.

Assoc. Prof. David Musoke (left), Dr. Paul Mulumba (centre), a Health Inspector in Wakiso District, and Dr. Kevin Deane (right) share insights during the workshop at the Resilient Africa Network, Kololo, on April 15, 2026. Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.
Assoc. Prof. David Musoke (left), Dr. Paul Mulumba (centre), a Health Inspector in Wakiso District, and Dr. Kevin Deane (right) share insights during the workshop at the Resilient Africa Network, Kololo, on April 15, 2026.

“We cannot continue relying solely on bed nets, spraying, and treatment,” Dr. Deane said. “These remain essential, but they are not sufficient for elimination. There is significant outdoor malaria transmission, particularly among adults, and that is linked to how people live and work.”

He added that maize presents a complex case. As one of Uganda’s most widely grown staple crops, it is central to both food security and household income, making it impractical to separate farming from living spaces. This, he said, underscores the need to better understand the relationship and develop responses grounded in evidence and local realities.

Evidence presented during the workshop drew on both community experiences and existing scientific literature. Prior qualitative research by the team found that mosquito populations increase during maize growing seasons, particularly in the evenings. Scientific studies also show that maize pollen can enhance mosquito survival and longevity, potentially increasing their capacity to transmit malaria.

Dr. Kevin Deane of The Open University emphasised the need to move beyond conventional malaria interventions to better understand how livelihoods and everyday activities shape exposure during the stakeholder workshop in Kololo, Kampala, on April 15, 2026. Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.
Dr. Kevin Deane of The Open University emphasised the need to move beyond conventional malaria interventions to better understand how livelihoods and everyday activities shape exposure during the stakeholder workshop in Kololo, Kampala, on April 15, 2026.

Previous work in Wakiso district further situates maize within a wider set of risk factors. Findings show that agriculture, including crop production and animal husbandry, can create conditions that support mosquito breeding through stagnant water, water storage practices, and environmental changes. These risks are compounded by outdoor activities in the early morning and evening, when exposure is highest. The research also points to the growing role of urban agriculture, which is bringing crop cultivation and potential mosquito habitats closer to residential spaces, altering traditional patterns of transmission.

Ms. Doreen Nabwire Wamboka, in-charge at Namayumba Epicentre Health Centre III in Wakiso District, said the discussions challenged long-held assumptions that malaria is a “well-understood” condition.

“I used to think malaria had been fully researched, that we already knew what we needed to know,” she noted. “I now see that what has been studied is the conventional side of it. There are emerging factors we have not paid attention to. This work is opening up new ways of thinking, even about things we take for granted, like the crops we grow around our homes. We treat malaria as ordinary, yet it is still one of the most common conditions. Understanding these connections could change how we approach the disease.”

Ms. Doreen Nabwire Wamboka, In-charge at Namayumba Epicentre Health Centre III in Wakiso District, engages in a co-creation session as a fellow participant looks on during the stakeholder workshop in Kololo on April 15, 2026, underscoring the need for collaborative approaches to design interventions to tackle malaria. Stakeholders’ workshop on the social determinants of malaria led by Assoc. Prof. David Musoke of Makerere University and Dr. Kevin Deane of The Open University presented ongoing and previous findings, April 15, 2026, at MakSPH’s Resilient Africa Network, Plot 30, Upper Kololo Terrace, Kampala Uganda, East Africa.
Ms. Doreen Nabwire Wamboka, In-charge at Namayumba Epicentre Health Centre III in Wakiso District, engages in a co-creation session as a fellow participant looks on during the stakeholder workshop in Kololo on April 15, 2026, underscoring the need for collaborative approaches to design interventions to tackle malaria.

The initiative will now combine spatial analysis, entomological studies, and community-based research to better understand how maize cultivation influences malaria risk. It will also involve farmers and other stakeholders in shaping potential interventions, reflecting a broader shift toward co-produced solutions.

The workshop, funded by The Open University, marked an important step in refining this research agenda. As the work progresses, its findings could inform policy and practice not only in Uganda, but also in other malaria-endemic countries where maize is widely cultivated. For now, the research signals a shift from isolated interventions to a more integrated understanding of how livelihoods and environments drive malaria transmission.

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John Okeya

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Course Announcement: Certificate in Water, Sanitation and Hygiene (CWASH) – 2026

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Graduands of the 2025 Certificate Course in Water, Sanitation and Hygiene (CWASH) pose for a group photo at the Makerere University School of Public Health, following the successful completion of the short course in July 2025. Makerere University School of Public Health, Mulago Hospital Complex, Kampala Uganda, East Africa.

Update: Application deadline extended to 30th April 2026

Makerere University School of Public Health (MakSPH) is pleased to announce the Certificate Course in Water, Sanitation and Hygiene (CWASH) – 2026.

This intensive and practical short course is designed to strengthen the knowledge, skills, and attitudes of professionals involved in the planning, implementation, and management of Water, Sanitation and Hygiene (WASH) services. The programme responds to the growing demand for competent WASH practitioners in local government, non-governmental organisations, and the private sector.

Course Highlights

  • Duration: 8 weeks (01 June – 24 July 2026)
  • Mode: Day programme (classroom-based learning and field attachment)
  • Fees:
    • UGX 900,000 (Ugandans / East African Community)
    • USD 500 (International participants)
  • Application deadline: Thursday, 30 April 2026

Who Should Apply?

  • Practising officers in the WASH sector
  • Environmental Health workers seeking Continuous Professional Development (CPD)
  • Applicants with at least UACE (or equivalent) and one year of WASH-related work experience

More Information

Additional details on course structure, modules, and delivery are available at: https://sph.mak.ac.ug/academics/water-sanitation-and-hygiene-wash

Important Note for Applicants

Attached to this announcement, interested persons will find:

  1. The course flier, providing comprehensive programme details, and
  2. The application form, which should be completed and returned to MakSPH together with the required supporting documents.

For full course details, application procedures, and contact information, please carefully review the attached documents. Eligible and interested applicants are strongly encouraged to apply before the deadline and take advantage of this opportunity to build practical competence in WASH service delivery.

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Makerere’s Quiet Case for Investment in Public Health Infrastructure

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Side elevation of the Makerere University School of Public Health (MakSPH) Phase II complex under construction on the Main Campus. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.

Makerere’s School of Public Health (MakSPH) is expanding faster than it can house itself. It now hosts more than 1,000 students, runs programmes across multiple countries, and anchors a large share of the University’s research output. Yet parts of its operation still spill into rented space, costing over $113,000 a year, because the infrastructure has not kept pace with its growth.

That constraint sits uneasily with the School’s economic weight. Health research accounts for more than half of Makerere University’s academic output, making it one of the University’s most productive engines. As Vice Chancellor Barnabas Nawangwe put it, “An educated population is a healthy population, and an educated and healthy population is a prosperous population.”

Beyond the university, health is not just a social outcome but a driver of economic performance. Healthier populations are more productive, more resilient, and less costly to sustain. Investments in public health, whether in prevention, systems, or infrastructure, raise an economy’s productive capacity, not just improve outcomes.

A construction worker undertakes metal fabrication works at the Makerere University School of Public Health (MakSPH) building site. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.
A construction worker undertakes metal fabrication works at the Makerere University School of Public Health (MakSPH) building site.

Institutions that generate public health knowledge and train professionals are not peripheral to growth; they are part of its foundation.

It is this logic that is shaping how Makerere’s School of Public Health is positioning itself. At its centre is a new, unfinished complex on the University’s main campus, intended to anchor the School’s next phase as a regional hub for research, training, and policy support. But like much of the system it supports, it is being built gradually, in a “build-as-you-go” approach constrained as much by funding realities as by design.


Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.

Construction of Phase II of the MakSPH complex is now at an advanced stage, with progress recorded across all sections of the site. As of March 2026, Phase 2B is nearing completion at 98%, while Phase 2A stands at 89%, and Phase 2C at 69%, each tracking close to or slightly ahead of planned targets. Current works are concentrated on interior finishes—including tiling, terrazzo installation, and external rendering—as well as preparations for lift installation, signaling a transition from structural works to final detailing. The project team is working toward a practical completion date of August 31, 2026, with timelines calibrated to align with broader resource flows and implementation considerations.

Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.

Six years ago, in February 2020, construction began on what will be the new home of the School of Public Health. The building, a permanent, purpose-built public health facility on Makerere’s main campus, will accommodate a growing student body, provide space for doctoral and postdoctoral fellows, and strengthen the University’s ability to respond to Africa’s most pressing public health challenges.

Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, said the construction journey reflects the School’s “ambition, intent, and courage”—a bold step despite limited resources. He was speaking at a public lecture on health financing held at Makerere University on April 9, 2026.

But the ambition behind the project is not modest. “We are not building for today—we are building for the future,” said Professor David Serwadda, reflecting on a decision that shaped the entire construction effort. “We need to build for the next 100 years.”

Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.
Professor David Serwadda, Professor Emeritus at Makerere University and Chair of the MakSPH Infrastructure Fundraising Committee, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026.

That long view helps explain both the scale of the project and the risks taken to start it. When construction began, the School did not have the full funding. “We started with about a third of the required budget,” Serwadda said.

The approach was not without setbacks. A major grant from USAID, worth over a million dollars, was later withdrawn, midway through the construction, due to the closure of USAID. “We received what is called a ‘Dear John letter,’” he recalled. “At that moment, we felt the situation was a major blow, almost terminal for the project.”

But the project did not stop. It adjusted. “We said, let us continue, piecemeal,’” he said. “Finish the auditorium first, use it, and keep building the rest.”

“We have come a long way as the School of Public Health,” said Professor Rhoda Wanyenze, the Dean. “We are proud of that history, but we also recognize that it comes with responsibility.”

Professor Rhoda Wanyenze, Dean of the Makerere University School of Public Health, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.
Professor Rhoda Wanyenze, Dean of the Makerere University School of Public Health, speaks at a public lecture on health financing for Uganda’s future, held on April 9, 2026.

She argued that responsibility is no longer confined to Uganda. With ongoing collaborative work in more than 25 African countries currently, the Dean says this is “a responsibility to provide leadership in public health not only in Uganda but across the continent.”

The scale of that growth has been visible from what was once a small training unit in the Faculty of Medicine in the 1950s, which has expanded into 12 academic programmes and more than 1,000 students.

“When I came back for my public health training, we were about 40 students,” she said. “Now, we have more than 1,000.” “Public health is growing and evolving,” Wanyenze said. “And we are doing our best to develop the skills needed for this changing landscape.”

That includes new areas such as health informatics and data science, driven by the digitisation of health systems and the growing role of data in decision-making and AI. The School is already coordinating regional platforms on digital health, linking multiple countries in shared learning and practice.

But this growth has outpaced the physical systems needed to sustain it. For the University leadership, the implications extend beyond infrastructure.

“One of the most effective ways to invest in health in Uganda is to invest properly in Makerere University,” said Vice Chancellor Barnabas Nawangwe. “We must recognize Makerere as a research-led university with a special national role—not fund it like any other institution or department. Makerere is one of the government’s greatest assets. Invest in her, and the returns will exceed expectations.”

Professor Nawangwe hailed Dr. Ramathan Ggoobi, the Permanent Secretary to the Treasury, who delivered a keynote on investing in health for Uganda’s future in view of Vision 2040. “I wish to thank Dr. Ramathan Ggoobi and his team for their personal intervention in allocating resources in next year’s budget to complete the new School of Public Health building. That support is deeply appreciated,” he said.

Vice Chancellor Professor Barnabas Nawangwe speaks at a public lecture on health financing for Uganda’s future on April 9, 2026. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.
Vice Chancellor Professor Barnabas Nawangwe speaks at a public lecture on health financing for Uganda’s future on April 9, 2026.

Uganda’s progress in health outcomes is evident, but uneven. Life expectancy has risen significantly from about 50 years in 2000 to roughly 68.8 years in 2024, according to the Permanent Secretary to the Treasury, Ramathan Ggoobi. Yet the gains sit alongside persistent financial strain on households. About 4% of Ugandans still spend more than a quarter of their consumption on healthcare, pushing many into poverty as a result of illness.

For Ggoobi, this points to a structural gap that recurrent government spending alone cannot close. “We must mobilise long-term domestic capital without adding fiscal risk,” he argued, pointing to the need for more sustainable financing mechanisms. Central to this is the gradual design and rollout of a national health insurance scheme. Evidence from countries such as Rwanda, Kenya, and Ghana suggests that well-structured contributory models can expand coverage while reducing catastrophic out-of-pocket spending.

Dr. Ramathan Ggoobi with Professors Serwadda, Wanyenze and Nawangwe. Construction of Phase II of the Makerere University School of Public Health (MakSPH) Complex, Eastern Gate, Main Campus, Kampala Uganda, East Africa.

“My Ministry and the School of Public Health must be partners. … Evidence framed in fiscal terms drives policy,” said Ggoobi, stressing the need for locally grounded solutions. “What works in Ghana might not work here. We need a model that fits Uganda.”

Uganda’s current macroeconomic conditions, relatively low inflation, currency stability, and expanding private credit may provide a window to move in that direction.

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Davidson Ndyabahika

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