We send you warm greetings from the skies above Kampala — from your old, bald-headed friends, the Marabou Storks, or as we are fondly called, the Kalooli. We are not the prettiest of birds, with our wrinkled faces, hunched shoulders, and sharp beaks, but we carry an important duty. Where others see waste and decay, we see purpose. We are nature’s cleaners, recycling what would otherwise rot and cause harm.
Some count us among Africa’s “Ugly Five,” alongside hyenas, vultures, wildebeests, and warthogs, but we take no offense. Beauty was never the Creator’s mission for our mission, but service was. We glide quietly between life and death, keeping the balance, cleaning the mess, and doing the work that must be done.
Today, we come to you not with complaints, but with a plea for partnership, to protect our shared home and ensure a cleaner, healthier Uganda for all. We still remember the day in 2008, Mr. President, when you gave the Uganda Wildlife Authority and the Kampala Capital City Authority instructions to “kindly relocate us” from the esteemed grounds of State House, Nakasero. We don’t harbor angry feelings. Truly. We realized back then, as we do now, that not everyone finds our odd looks or the noble scent that naturally results from a lifetime of cleaning your lovely nation appealing.
Your Excellency, we are modest. And forgiving. We maintained our composure even when we were discussed in Parliament in 2020, when honorable members referred to us as “health threats” and asked that we leave the Parliament gardens. We birds, after all, literally have thicker skin!
We are better citizens now. Thanks to Makerere University‘s kind hospitality, we have discovered a new haven. We express our deep thanks to Vice Chancellor Professor Barnabas Nawangwe for preserving the ancient trees, the very canopies that now provide us with protection, generation after generation. Students here lovingly refer to us as “the real professors of Makerere,” observing us as we keep a watchful eye on campus life with our sage, steady gaze. Some people think it’s a blessing to see a Kalooli before an exam. We take selfies with other people. We have kind of turned into little celebrities, sir. We appreciate the tranquility, love and peace you provided, with your comrade freedom fighters. They bring uhuru to these trees, and our kids pray for you every day for more life.
However, we come before you today not just to reminisce, but to raise important concerns not for ourselves alone, but for the survival of Uganda’s fragile ecosystem.
We are concerned about the growing crisis in waste, plastics, and environmental decay.
Your Excellency, you are a man who loves numbers. Allow us to present some:
768 metric tons — that is the amount of food waste produced DAILY in Kampala alone.
65% to 79% of solid waste in Kampala landfills consists of food waste.
The dairy industry in Uganda loses $23 million annually from waste alone, according to the Food Rights Alliance.
135,804 tons of plastic waste generated in the Kampala Metropolitan Area recently.
42% of that waste remains uncollected, leading to clogged drains, flood risks, pollution of wetlands, and of course, diseases.
Shockingly, 10% of this waste ends up in Uganda’s precious water systems!
One of Marabou Storks draws closer to the camera.
Your Excellency,
It might surprise you but it’s true. Between 2018 and 2021, Uganda produced 12,330 tons of recycled polyethylene (rPET). And that’s not all conservative estimates predict a 91% increase in production between 2022 and 2025, should imports stay the same.
Mr. President, we Marabou Storks have served loyally as your unpaid, unsung environmental officers. While your citizens discard waste carelessly, we fly across the city, scavenging, sorting, and managing organic decay. We are your frontline solid waste managers, yet without uniforms, pensions, or even a simple “thank you.”
We join you in mourning the tragic loss of life that occurred at Kiteezi Landfill. We experienced devastation because the birds that live there consider that place their territory. We directly observed your people’s struggle to survive while they navigated hazardous unstable waste piles. Our deepest condolences go out to the families who lost loved ones and to every Ugandan citizen. The disaster served as a harsh reminder that waste mismanagement impacts people directly beyond just environmental concerns. Working together as environmental custodians we ask you to take action to prevent more deaths from occurring beneath waste mountain piles.
Just for context, Mr. President, since you fondly like science, here is the scientific truth about us
You may recall Dr. Derek Pomeroy and Mr. Michael Kibuule, distinguished researchers at Makerere University, who in 2021 published the history of our kind in Uganda. They noted:
Over 1,200 nesting pairs once graced Kampala city alone.
Uganda likely hosts the largest urban colony of Marabou Storks in the world.
Dr. Pomeroy and Kibuule should receive Katonga medals because we recognize their devotion to us. They have loved us. Dr. Pomeroy first came to Uganda in 1969 to work in Makerere University‘s Department of Zoology. He developed deep affection for us and demonstrated excellent understanding. He has written affectionately about us. He knows we are innocent. Dr. Pomeroy maintains his affiliation to Makerere University while conducting independent research as both a Zoologist and an ecologist.
Mr. President, in the beginning, our existence was in the untamed savanna. We transitioned to urban areas alongside human development to assist with cleanup duties rather than to create any disturbance. We came to clean up the areas where you discarded bones and waste. Ronald Norman Magill stated that despite being part of Africa’s “Ugly Five,” we remain crucial to ecosystems because our simple and gritty nature is what makes us indispensable. Our role includes feeding on dead animals and decomposing matter to prevent diseases and sustain soil health through silent and selfless recycling of life.
Your Excellency, here are our humble pleas to you, Our President
Please urge your people to plant trees. Our homes are disappearing completely. Sky scrapers are popping up everywhere we used to patch. Your Excellency, we merely ask that you recognize our role and protect our habitats; we are not opposed to development. In order to locate nesting sites, we now have to travel a considerable distance between Kiteezi, Lubigi, and the University. For all creatures, feathery, four-legged, and two-legged—healthy trees translate into richer soils, cleaner air, better rainfall, and cooler cities.
Please strengthen plastic waste management. Your laws Mr. President, the 10-Year Restoration Plan, the National Environment Act 2019, and the Extended Producer Responsibility rules are all positive steps, but laws that do nothing are just as useful as wings on a tortoise. Please advocate for implementation, particularly in the areas of public education on responsible dumping and enforcement. We implore you to encourage your people to stop illegal dumping, sort their waste, recycle, and treat the environment as a gift rather than a trash can.
Please invest boldly in waste infrastructure. Your Excellency,
If Parliament can enjoy a small patriotic “thank you” of the legendary “100 silver coins” for safeguarding peace, surely a few crumbs can reach us, the Marabou Storks; Kampala’s tireless, unpaid sanitation workers, as a token of national gratitude. Imagine what a few billion shillings for KCCA, for trucks, bins, and civic education could achieve. A cleaner Kampala would mean less wandering for us and less embarrassment for you when tourists meet our noble, bald-headed selves. At least then, we would feast in dignity, not after cross-country marathons over scattered rubbish.
Support Community Environmental Heroes. Students, youth, schools, churches, and communities are already doing cleanup drives. Support them with grants, incentives, recognition, and encouragement. Empower a new generation of eco-warriors.
Mr. President, we, Marabou Storks are no longer the nuisance you once sought to relocate. We are living proof that resilience, adaptation, and hard work can co-exist even in a changing, urbanized world.
All we ask now is for you and your government to join wings with us, birds and humans alike to clean up Kampala, to green Uganda, and to create a legacy that future generations will bless you for.
Let us work together, so that Uganda shines not under mounds of waste, but under canopies of trees, rivers flowing freely, and skies where even the humble Kalooli can soar proudly.
The Ministry of Health and Makerere University in Uganda co-organised the National Annual Communicable and Non-Communicable Diseases (NACNDC) and 19th Joint Scientific Health (JASH) Conference 2025 under the theme: “Unified Action Against Communicable and Non-Communicable Diseases in Uganda“. The conference brought together stakeholders from government ministries and departments, local governments, academia, civil society, the private sector, development partners, professional associations, and communities who deliberated on the important role of coordinated action in addressing Uganda’s growing burden of infectious and non-infectious diseases in an evolving local and global health landscape.
Discussions reaffirmed the need for strengthened multisectoral collaboration and One Health approach that engages all government sectors and clearly defines the role of the private sector. Participants emphasized the importance of an integrated, people-centred model of disease prevention and care model, along with the need to enhance data systems, research, and policy translation. The conference also underscored the urgency of increasing domestic financing and adopting innovative financing mechanisms that broadly support the health system’s capacity to tackle the dual disease burden.
The conference proceedings feature selected abstracts presented during the conference, showcasing a wide range of research, innovations, programmatic solutions and field experiences. The conference offered a unique platform that demonstrated how academia, programme implementers, and policymakers can collaborate to generate and apply evidence for improved health outcomes. The findings shared at the conference and captured in the proceedings will inform national policies and strengthen efforts to prevent and control communicable and non-communicable diseases in Uganda.
Two new studies by researchers at Makerere University School of Public Health (MakSPH) reveal a troubling pattern at the centre of Uganda’s escalating antimicrobial resistance (AMR) crisis, a public health challenge where disease-causing bacteria and other germs stop responding to known medicines meant to kill them, making common infections harder or more expensive to treat.
The studies, conducted in Wakiso and neighbouring districts and recently published in leading scientific journals, examined key drivers of AMR from distinct yet connected perspectives. Together, they expose a health system under strain; shaped by poor-quality medicines circulating in communities, high and often inappropriate antibiotic use in healthcare facilities, and limited public awareness of safe medicine use, conditions now reinforcing one another and accelerating drug resistance.
At the centre, Assoc. Prof. David Musoke, one of the lead researchers on the two studies, and Ms. Bonny Natukunda (Senior Health Educator, Wakiso District) pose with community health workers, district health officials, and facilitators after an AMR workshop in Bukondo, Namayumba Sub-County, on September 22, 2025. Delivered under the NTU–Mak Partnership with Buckinghamshire Healthcare NHS Trust, the week-long workshop trained more than 380 community health workers from Namayumba Sub-County.
According to the Ministry of Health, AMR in Uganda has reached concerning levels. By March 2025, resistant infections were estimated to kill 37,800 people annually, with over 7,000 deaths directly caused by AMR and more than 30,000 linked to infections no longer responding to available treatment. This surge is driven by unrestricted access to antibiotics, weak drug-regulatory enforcement, and widespread misuse of antimicrobials in humans and animals.
The Ministry acknowledges that many patients are treated without diagnostic testing, while low public awareness and weak stewardship across human and veterinary health services continue to fuel microbial resistance. As a result, bacteria that once responded to routine antibiotics now show resistance rates of up to 80 per cent in some cases, undermining treatment outcomes, food safety, and household incomes. It is this challenge that informed the two MakSPH studies.
Part of the study team, led by Assoc. Prof. David Musoke (extreme left), at the recent 10th National AMR Conference in Kampala on November 19, 2025, organised by the Ministry of Health, where they presented evidence from the two studies in Wakiso generated through the NTU–Mak Partnership.
Two Studies, One Warning
Evidence from both studies points to the need for coordinated action to strengthen medicine quality, improve prescribing practices, and build community awareness to preserve the effectiveness of essential treatments. In the first paper, published on October 6, 2025, in the Journal of Pharmaceutical Policy and Practice, researchers led by Associate Professor David Musoke examined how consumers encounter and respond to substandard and falsified medicines for both human and animal use.
Conducted in 2024, the study surveyed 432 community members in Wakiso District, where the Nottingham Trent University – Makerere University(NTU–Mak) Partnership, initiated by NTU’s Prof. Linda Gibson and MakSPH’s Assoc. Prof. Musoke, has implemented community-based health systems programmes for 15 years now. Using a structured household questionnaire, the team assessed knowledge, attitudes, and everyday practices related to medicine use.
NTU’s Prof. Linda Gibson and MakSPH’s Assoc. Prof. David Musoke at the British Academy Equitable Partnerships Workshop on November 20, 2025, reflecting on 15 years of the successful NTU–Mak partnership.
The second study, published on November 21 in the Dovepress Journal of Infection and Drug Resistance, was led by Dr. Bush Herbert Aguma, a pharmacist, health-systems researcher, and Lecturer in the Department of Pharmacy at Makerere University. Working with Assoc. Prof. Musoke and colleagues, the team applied the standardised Global Point Prevalence Survey (GPPS) to examine antibiotic prescribing across three hospitals and five lower-level health centres in Wakiso, Nakaseke, and Butambala. The survey assessed patient demographics, antimicrobial therapy details, and adherence to treatment guidelines to identify gaps requiring improvement.
The surveys were conducted at Entebbe Regional Referral Hospital, Gombe General Hospital, Nakaseke General Hospital, and five lower-level facilities in Wakiso, all part of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) project at MakSPH implemented through the NTU–Mak Partnership. Alongside the surveys, the partnership has strengthened antimicrobial stewardship in these eight facilities through routine staff training, mentorship, community engagement, and capacity-building in infection prevention and control, microbiology, and detection of substandard and falsified medicines.
“The work was to empower the facility through its Medicines and Therapeutics Committee, which has a sub-committee on antimicrobial stewardship. That committee oversees the process, ensures future surveys are conducted, and can initiate targeted assessments when problems with specific prescriptions arise,” Dr. Herbert Bush Aguma, lead author of the second study, explained.
Dr. Herbert Bush Aguma, explaining the study’s results and impact from his office on December 8, 2025, noted that it has enabled the health facilities to independently track antimicrobial use, identify prescribing gaps, and strengthen stewardship practices.
He added that the programme in the selected facilities for the study went beyond just measuring antimicrobial use, to supporting the facilities develop stewardship plans, strengthening laboratory capacity, and training health workers across human, animal and environmental sectors under a One Health approach. As a result, he stated, facilities can now independently conduct point prevalence surveys, identify prescribing gaps such as inappropriate ceftriaxone use, and advocate for improved diagnostics, while hospitals, Village Health Teams (VHTs), veterinary and environmental officers increasingly address AMR drivers within their settings, leading to significant and lasting impact.
Over the last 15 years, the NTU–Mak Partnership, as part of this work, has trained more than 600 health workers across the human, animal, and environmental sectors in Wakiso, Nakaseke, and Butambala, and equipped over 1,300 community health workers (VHTs) in Wakiso with practical AMR knowledge. University-led programmes, international student competitions, and a 900-member online Community of Practice have further extended its reach. Together, these initiatives demonstrate how sustained community engagement can translate national AMR priorities into real-world impact, offering a model for locally anchored AMR interventions while also supporting the generation of new evidence to strengthen health systems, including the current two studies.
Right: MakSPH student Bridget Ahumuza celebrates a commendation as the 2025 Antibiotic Guardian Health Student of the Year, awarded through the NTU–Mak Partnership for her AMR stewardship advocacy.
What Communities Know, and Don’t Know, About Fake Medicines
In the first study, Assoc. Prof. Musoke and colleagues found that while 83 per cent of respondents had heard of substandard and falsified medicines, only 31 per cent could correctly define the terms, and just seven per cent could accurately identify a falsified product. According to the World Health Organisation (WHO), a global health watchdog, substandard and falsified medicines fail to meet quality standards or deliberately mimic genuine products, often containing the wrong, too little, or no active ingredients. Such medicines put patients at risk of treatment failure, toxicity, and death and accelerate antimicrobial resistance by exposing bacteria to ineffective drug levels.
In Wakiso, the most populous district in Uganda with over 3.3 million people, although over 95 per cent of respondents recognised substandard and falsified medicines as dangerous, many reported having purchased drugs they suspected to be fake: 14 per cent for human and 24 per cent for animal use. To check authenticity, residents relied on advice from health workers or veterinary officers and on buying from trusted outlets. Yet reporting remained extremely low, as only one in four informed a health worker when they suspected a problem, and still, just four per cent had ever reported a case to the National Drug Authority (NDA), mandated to regulate drugs in Uganda.
These patterns reveal a community that recognises the threat of poor-quality medicines but lacks the agency to act. As the study notes, “community members from a range of backgrounds had limited knowledge and poor practices despite commendable attitudes on substandard and falsified medicines… Many respondents reported never having purchased and used substandard and falsified medicines knowingly or unknowingly, although a good number suspected that a medicine they previously purchased had been substandard or falsified.”
Over 50 health managers from 51 healthcare facilities in Wakiso District received certificates at the end of a two-day leadership development training on November 26, 2025, delivered through the NTU–Mak Partnership and Nottingham University Hospitals NHS Trust (NUH) in collaboration with the Wakiso District Local Government and the Ministry of Health. The workshop strengthened leadership capacity across the district health system.
In the second study on antibiotic prescribing, the researchers found high rates of antibiotic use across all eight public facilities. In the three hospitals, 87.2 per cent of inpatients were receiving at least one antibiotic, with ceftriaxone alone, the most commonly prescribed antibiotic in other studies, accounting for nearly one-third of all prescriptions. Most antibiotics were administered prophylactically, especially for obstetric and gynaecological surgeries, which made up 30.7 per cent of all hospital antibiotic use. In lower-level facilities, 60.7 per cent of outpatients received antibiotics, with amoxicillin accounting for 39.1 per cent of all prescriptions. Upper respiratory tract infections, many of them viral, were the leading reason for outpatient antibiotic use.
“Resistance to first-line antimicrobials increases the risk of morbidity and mortality. Unfortunately, the global rise in AMR has not been matched by the development of new antibiotics effective against resistant bacteria,” reads the paper in part. “As a result, healthcare costs are expected to rise, economic productivity will fall due to reduced workforce activity, and global life expectancy could drop by an estimated 1.8 years. This existential threat must be averted to avoid a post-antibiotic era in which even minor infections become fatal.”
In the study on antibiotic prescribing, the researchers found high rates of antibiotic use across all eight public health facilities, with ceftriaxone as the most commonly prescribed antibiotic.
Read together, the two studies provide a ground-level view of how AMR takes root long before a patient reaches a hospital or pharmacy. Poor-quality medicines remain widespread yet poorly understood, while health workers operate under heavy workloads, limited diagnostics, and outdated guidelines that make empirical treatment with antibiotics the default option.
These realities echo the warning delivered by Assoc. Prof. David Musoke, during his keynote address at the 10th National AMR Conference in Kampala on November 19, 2025. Speaking at the event organised by the National One Health Platform, institutionalised in 2016 under the Ministry of Health to coordinate AMR efforts, and held to mark World AMR Awareness Week 2025 under the theme Act Now: Protect Our Present, Secure Our Future, he cautioned that Uganda’s fight against AMR will falter unless communities are placed at the centre of national action.
“One in six bacterial infections globally, and one in five in Africa, are now resistant to available antibiotics,” Dr. Musoke said, citing the latest Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report 2025. “If Uganda is to make real progress, communities must be treated not as recipients of information but as genuine partners in the fight against AMR.”
Assoc. Prof. David Musoke delivers the keynote address at the 10th National AMR Conference in Kampala on November 19, 2025, warning that Uganda’s fight against AMR will stall unless communities are placed at the centre of national action.
What Must Change: Recommendations from the Researchers
To strengthen antimicrobial stewardship, the study on antibiotic prescribing recommends scaling up diagnostic capacity in public facilities so that treatment decisions are based on laboratory evidence rather than broad empirical prescribing, a medical term that means treatment initiated based on a clinician’s “educated guess” and clinical experience, in the absence of a definitive diagnosis or complete information about the specific cause of a disorder. Expanding functional microbiology services, the study says, would reduce reliance on broad-spectrum antibiotics, which accelerates resistance.
The authors also call for strict enforcement of national treatment guidelines, especially in surgical wards where antibiotics are routinely continued longer than clinically required. For them, reducing unnecessary prophylaxis, particularly in obstetric and gynaecological surgery, would go a long way in limiting misuse without compromising patient safety.
They further urge the Ministry of Health to eliminate non-recommended antibiotic combinations from routine use and ensure consistent stock management to prevent missed doses. This, in addition to strengthening Water, Sanitation, and Hygiene (WASH), and Infection-Prevention and Control (IPC) systems, combined with regular stewardship-focused training for prescribers, is highlighted as essential for improving prescribing standards. Finally, they recommend institutionalising routine point prevalence surveys in Uganda to track trends, guide facility-level action, and reinforce accountability for stewardship.
Makerere University students demonstrate proper hand hygiene while engaging residents in an AMR and hygiene awareness outreach in Kamwokya’s informal settlements on April 11, 2025.
On the other hand, to address the widespread circulation of substandard and falsified medicines, the study team call for a nationwide effort to improve public literacy on how to recognise, verify, and report suspicious medical products. The authors also argue that current reporting pathways are largely invisible, leaving most community members unsure of how or where to lodge complaints. Strengthening the National Drug Authority’s visibility and making its reporting mechanisms simple and accessible, in that case, is identified as a critical first step.
They also highlight the need to engage frontline actors, and this includes Village Health Teams, Community Health Extension Workers, veterinary officers, and local leaders, as primary change agents. These trusted community structures, the authors assert, are well-positioned to translate regulatory messages into actionable information than mass-media campaigns alone.
Given the extensive use of suspected counterfeit veterinary medicines, the authors call for strengthened One Health education and a fully integrated communication approach linking human, animal, and plant health risks. They recommend sustained messaging through radio and other local media, supported by community-driven monitoring systems able to empower consumers to act as partners in protecting the medicine supply chain.
Mr. Mathias Sserwanga (extreme right) of Namulonge HCIII in Wakiso district receiving his certificate from Assoc. Prof. David Musoke (2nd right), following a two-day leadership and management training on November 26, 2025, at Makerere University. The programme by MakSPH and partners has helped enhance the capacity of facility in-charges in Wakiso District to improve health service delivery to the people.
The Sub-Saharan African Network for TB/HIV Research Excellence (SANTHE) at Makerere University invites applications for a PhD and Masters of Science training opportunity.
The PhD training is focused on HIV Cure whereas the Masters of science opportunity is for TB elimination. Refer to the adverts/flyers attached for further details.
For inquiries or clarifications please call +256 787-278-393.
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