Health
We Are Pushing Nature to the Edge—But Solutions Are Within Reach: Global Conversations on Sustainable Health
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.
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.
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.
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.
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
Health
Ekyaalo Diagnostics; Johns Hopkins University Partners with Makerere and MUST to Advance AI Innovation for Breast Cancer Diagnosis
By Joseph Odoi
Globally, Breast cancer remains a serious health challenge, with the World Health Organization (2022) reporting over 2.3 million new cases annually and nearly 670,000 deaths. In Uganda, breast cancer is one of the leading cancers among women, yet the majority of patients are diagnosed at late stages due to delays in accessing diagnostic services, most of which are centralized at the Uganda Cancer Institute (UCI) in Kampala. Since 72% of Uganda’s population lives in rural areas, women often face late diagnosis due to long travel distances. Even after accessing care, results can take 1–6 months due to the slow process of transporting samples to central laboratories. This delay directly impacts the timely start of treatment.
To address this gap, Johns Hopkins University in collaboration with Makerere University and Mbarara University of Science and Technology (MUST), is spearheading innovative solutions that leverage artificial intelligence (AI) and low-cost technologies to improve early diagnosis and treatment.
As part of this collaboration, the Centre for Maternal, Newborn, and Child Health Research at Makerere University School of Public Health led by Associate Professor Peter Waiswa in July hosted a team of graduate biomedical engineers from the Center for Bioengineering Innovation and Design (CBID) at John Hopkins University.
The team is developing a low-cost, AI-powered technology called Ekyaalo Diagnostics, aimed at reducing the turnaround time for breast cancer diagnosis, especially in hard-to-reach areas. As part of their work, they undertook a learning tour at the Ministry of Health, Uganda Cancer Institute, and regional cancer referral centres. The purpose was to map stakeholders in the breast cancer space, gather Ekyaalo diagnostic technology usability feedback, and understand the local innovation ecosystem in breast cancer care.
Ekyaalo Diagnostics and Bringing Pathology Closer to Communities
The flagship innovation, Ekyaalo Diagnostics, is a portable AI-powered whole-slide scanner (WSS) designed to digitize cytology samples at Health Centre IVs and General Hospitals. These digitized images are securely transmitted to pathologists at higher-level facilities for timely review, eliminating the need for physically transporting samples to Kampala.
This technology has the potential to reduce diagnosis delays from several months to just a few days, thereby improving survival outcomes for breast cancer patients.
Building Local Solutions to Global Challenges
In addition to Ekyaalo Diagnostics, Makerere researchers at the Department of Biomedical Engineering are also advancing other innovations such as development of artificial breast prototypes to be used in educating women on breast cancer symptoms while Research at Mbarara University led by Dr. William Waswa, are developing PapsAI, a low-cost automated tool that support whole slide scanning of slides for cervical cancer screening.
These initiatives are aligned with the National Cancer Control Plan (NCCP) of the Ministry of Health, which emphasizes prevention, early detection, timely diagnosis.
Design Challenges and Considerations
Despite the progress being made, challenges persist, according to the team’s findings from the tour,these technologies hold great promise however their success in Uganda will depend on addressing some critical barriers.
One of the biggest challenges is limited staffing. Many lower-level health facilities lack trained laboratory personnel to prepare slides. For this reason, new technologies must be designed to be simple, user-friendly, and capable of being adopted after short training sessions.
Another major barrier is equipment maintenance. Past medical innovations in Uganda have often struggled with frequent breakdowns and software failures. The team emphasized that new diagnostic tools must be affordable, durable, and resistant to common system crashes if they are to serve rural health facilities effectively.
Finally, high operational costs continue to undermine sustainability. Some innovations fail because their maintenance costs are too high or because they are incompatible with existing health systems. Ensuring cost-effectiveness and system integration will therefore be vital for the long-term success of breast cancer diagnostic technologies in Uganda.
MORE ABOUT THE PROJECT
The project is led by the Johns Hopkins Center for Bioengineering Innovation and Design (CBID) in collaboration with Makerere’s Department of Biomedical Engineering and MUST researchers. Field learning tours have already been conducted at Mulago National Referral Hospital, Jinja, Mbarara, and Fort Portal Regional Referral Hospitals, with input from clinicians, technologists, and innovators in Uganda’s health ecosystem.
The Johns Hopkins team has conducted usability interviews with clinicians, laboratory technologists, and surgeons at multiple hospitals including Mulago, Jinja, Mbarara, and Fort Portal. They have also engaged with Uganda’s innovation ecosystem, including makerspaces and industry partners. It has been noted that the Ministry of Health together with Partners working on treatment of cancer has drafted the National Cancer Control Plan (NCCP) that is aimed at reducing incidence, morbidity and mortality through prevention and early treatment and palliative care. The Plan will give guide on health education, early detection, and diagnosis among others Special thanks go to the Center for Bioengineering Innovation and Design (CIBID) Johns Hopkins University for funding this field learning tour, Centre for Maternal Newborn and Child Health Research at School of Public health (Makerere University) for hosting the team, Departments of Bioengineering at Makerere University and Mbarara University of Science and Technology, Mulago pathology department and the Uganda cancer institute, Regional Referral hospitals of Jinja, Mbarara and Fort Portal among other General hospitals and Health center IVs visited for technical input.
Health
VectorCam Project; Makerere, Johns Hopkins, and MoH to Scale Up AI-Powered Malaria Surveillance across Uganda
On August 20, 2025, Makerere University School of Public Health (MakSPH) convened a timely workshop on Strengthening Equitable Partnerships in International Research Collaboration in Uganda. Held at the MakSPH Auditorium, the event brought together researchers, policymakers, and institutional leaders to reflect on how Uganda, and indeed the wider region, can engage more effectively and derive greater benefit from global research collaborations.
Delivering the keynote address, Prof. David Musoke Serwadda, a Professor Emeritus at Makerere University and a globally recognised HIV researcher and epidemiologist, urged a rethinking of how international research partnerships are structured. A former head of the Institute of Public Health (IPH) and later Dean of the School, serving between 2003 and 2009, Serwadda is also the founding director of the Rakai Health Sciences Programme (RHSP), which is one of Uganda’s most influential research initiatives on HIV. While acknowledging the many benefits Uganda has gained from global research collaborations, he cautioned that too many times, these partnerships remain transactional, shaped by donor priorities, bound to project cycles, and offering limited long-term value to local institutions once projects close.
Prof. Serwadda, himself a globally recognised and well-accomplished researcher, with over four decades of experience and numerous awards for his contributions to science and global health, observed that Ugandan partners are many times included in research projects for visibility rather than substance, often excluded from core roles such as Principal Investigators or from influencing agenda-setting, budget control, and authorship. “Partnerships are not an end in themselves; they exist to help us achieve mutually agreed objectives built on shared responsibility and reciprocal obligations. Too often, Southern institutions are brought into projects late, simply for optics. That is not equitable collaboration,” he insisted.
During his talk, he stressed that this imbalance undermines both research quality and sustainability, noting that normally, when local researchers are sidelined, studies often fail to align with national priorities or build capacity that endures. By contrast, partnerships that are grounded in mutual respect, fair resource sharing, co-design, and shared decision-making have the impact of producing knowledge that is globally relevant and locally impactful.
“Equity in partnerships is about fairness, ensuring that all partners, regardless of context, can contribute meaningfully. This also requires responsibility on our part in the Global South. We must insist on involvement from project conception, negotiate fair terms, and strengthen our own systems to manage collaborations effectively,” Prof. Serwadda advised, emphasising that strong institutions, clear strategy, agenda and objectives are key for local institutions to engage in mutually fair and beneficial research collaborations at the global and continental stage.
As Director and later Dean of MakSPH, Prof. David Serwadda spearheaded numerous research collaborations and attracted substantial grants that elevated the School and the University’s global standing. Today, MakSPH is recognised as Makerere University’s flagship unit for its wide-ranging partnerships and robust research management systems. Since its beginnings as a small Department of Preventive Medicine in 1954, through its transformation into the first Institute of Public Health in sub-Saharan Africa in 1975, its elevation to School status in 2007, and most recently its reinstatement as a standalone School with college status within Makerere University in January 2025, a status first granted in 2001, MakSPH has built a 70-year legacy of advancing public health through research, training, and policy engagement.
The School’s evolution, as often couched by its leadership, has been anchored on strategic and strong partnerships. These collaborations, be they local, regional or global, have driven health systems innovation, strengthened capacity, and informed policy, making partnerships the cornerstone of the School’s past achievements and future ambitions. At the celebration of the School’s 70th Anniversary, marked in December 2024, Makerere University Vice Chancellor Prof. Barnabas Nawangwe hailed MakSPH’s research output, community impact, and strong partnerships cultivated throughout the years. The Mak VC cited the School’s pioneering role in the HIV response led by Prof. Serwadda in the 1980s, the establishment of nutrition centres such as the Mwana Mugimu Unit at Mulago Hospital and across Uganda by the late Prof. John Kakitahi in the 1990s with support from Rotary International, and community projects like Kasangati Health Centre along Gayaza Road with support from the Rockefeller Foundation in the late 1950s, which advanced public education on healthy environments and wellness.
“The School of Public Health brings in almost half of all research grants at Makerere University, both in number and value, and these partnerships have been central to tackling Uganda’s public health challenges. From pioneering HIV/AIDS work that shaped global prevention strategies to interventions in maternal health, malaria, and infectious diseases, MakSPH has consistently combined academic excellence with community service. Its leadership during the COVID-19 pandemic further showed its ability to respond to national health emergencies with evidence-based solutions that directly benefit the people,” Prof. Nawangwe said with gratitude for the work done by the School through collaboration.
In 2024, the School had over 350 peer-reviewed publications in high-impact international journals as a result of this wide network and partnerships. MakSPH currently maintains a strong mix of North–South and South–South collaborations. Within the continent, the School is actively working in more than 25 countries, often partnering with multiple institutions within individual countries to advance research, capacity building, and policy influence. One such recent collaboration is the Partnership to Enhance Technical Support for Analytical Capacity and Data Use in Eastern & Southern Africa (PERSuADE) Project, funded by the Global Fund. Under PERSuADE, MakSPH, the prime grant recipient, hosted the secretariat led by Dean Prof. Rhoda Wanyenze as Principal Investigator, tasked with overall coordination across 12 countries, while a Steering Committee chaired by Prof. David Serwadda provided oversight.
PERSuADE was implemented in two phases between 2018 and 2023. The project brought together 12 universities and 12 Ministries of Health in East and Southern Africa to strengthen analytical capacity and promote data use in national health programmes, cascading skills to districts and lower facilities. In its second phase, the project trained over 1,500 health staff, including 934 at the sub-national level, in data analysis and use, and generated more than 80 analytical outputs on HIV, TB, and malaria. These informed National Strategic Plans in seven countries and improved programme strategies in all 12. Sixteen in-service staff from seven countries received specialised training in HIV key population surveillance, health information systems, and data use. The project also piloted the Maturity Index Model in five countries, helping ministries track progress in institutionalising data-driven decision-making.
In Uganda, the PERSuADE project was implemented in Kiboga, Buikwe, Kasanda, Mukono, and Mityana districts, selected by the Ministry of Health. According to the Principal Investigator, Prof. Rhoda Wanyenze, strengthening data analysis and use has greatly enhanced the capacity of Ministries of Health to deliver targeted interventions that directly benefit communities. She noted that improved analytical skills at national and subnational levels now enable ministries to identify disparities in HIV, TB, and malaria burdens, while district and facility health workers can use data to strengthen local service delivery. “With better data, districts can plan more efficiently, allocate medicines, and implement tailored prevention campaigns to address specific risks, raise awareness, and reduce new infections,” she said, emphasising the role of equitable collaboration as a key success factor in Uganda and across the continent for this partnership.
Indeed, during a learning visit to Uganda in September 2024, Dr. Estifanos Biru Shargie, Senior Specialist for Monitoring, Evaluation, and Country Analysis at the Global Fund, commended the PERSuADE Project for strengthening local capacity and fostering sustainable health system improvements through South-South partnerships among schools and ministries. “The impact has been significant. In Kiboga, I was impressed by how teams mapped gaps in services and addressed them over four years, using data to inform decisions and monitor progress. Working with Makerere University School of Public Health has been an honour. The School blends academic excellence with practical implementation, backed by strong financial management and a long-standing relationship with the Ministry of Health. Their coordination, networking, and efficiency have been exemplary,” Dr. Shargie said.
Another currently ongoing initiative at the School is the African Leadership and Management Training for Impact in Malaria Eradication (ALAMIME) program, led by MakSPH with ten participating institutions across nine malaria-endemic countries, funded by the Bill & Melinda Gates Foundation. Co-led by Prof. Elizeus Rutebemberwa and Prof. Dosithée Ngo Bebe, ALAMIME is cultivating the leadership Africa needs to defeat malaria by strengthening institutions, building capacity, and fostering regional networks. In 2024 alone, the program trained over 250 participants, nearly half women, from national malaria programs, ministries, and NGOs. Through structured training, alumni-led webinars, and cross-country exchanges, the program has demonstrated how equitable, multi-country partnerships translate investment into sustainable systems and shared momentum toward malaria elimination.
For nearly 15 years now, MakSPH has also hosted the NTU–Mak Partnership, a collaboration between Makerere University and Nottingham Trent University, first conceived in 2010, with Assoc. Prof. David Musoke and Prof. Linda Gibson as the Uganda and UK Co-Leads. One of the key reasons for the success of this partnership is equity, and it has since attracted over £1.4 million in grants, trained more than 900 Village Health Teams in Wakiso District, supported over 350 practitioners in antimicrobial stewardship, and facilitated exchanges for more than 200 students and faculty. It has also equipped community health workers to respond to non-communicable diseases, antimicrobial resistance, and the COVID-19 pandemic, while generating over 30 peer-reviewed publications and convening global platforms such as the first International Community Health Worker Symposium, held in Kampala in 2017.
Dr. Musoke, the Co-Principal Investigator for the project on strengthening equitable research collaborations in Uganda, described the NTU-Mak partnership as a model North–South partnership that has produced both joint scholarship and lasting institutional ties. He noted that its success has inspired wider collaborations, as the current project on equitable partnerships builds on this foundation. Emerging from a British Academy regional workshop in Nairobi in 2024, MakSPH extended its engagement to Mountains of the Moon University (MMU), Uganda Martyrs University (UMU), and the National Agricultural Research Organisation (NARO). Together with Nottingham Trent University, these institutions are now advancing reforms to embed equity in research partnerships across Uganda’s research ecosystem.
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