Health
82% Stressed: Uncovering the Hidden Mental Health Burden Among Kampala’s Taxi Drivers
A new study by Dr. Linda Kyomuhendo Jovia, a medical doctor and graduate of the Master of Public Health programme at Makerere University School of Public Health, has found high levels of psychological distress among minibus taxi drivers operating in Kampala’s major taxi parks. In a cross-sectional survey of 422 drivers across Old, New, Kisenyi, Usafi, Namirembe, Nakawa, and Nateete parks, nearly two-thirds screened positive for symptoms of depression (65.6%), while anxiety affected more than 70%, and stress an estimated 82%. The findings point to a largely overlooked occupational health concern within the city’s informal transport sector, where long working hours, economic pressure, poor sleep, and prior road accidents were associated with higher levels of mental strain.
Before sunrise settles over Kampala, Old Taxi Park is already awake. White minibuses marked with the blue stripe of Uganda’s public service taxis sit jammed bumper to bumper, their noses pointed toward narrow exits that will soon release them into the city’s traffic. Dust clings to the windows. Torn seats peek through sliding doors. Diesel hangs low in the air. Conductors slap the metal sides of vans and shout destinations into the morning.
“Kireka! Banda! Bweyogerere!” The calls overlap until they become a steady roar.
Passengers squeeze through narrow corridors between vehicles where there was never meant to be walking space. Hawkers weave through the crowd with trays of roasted maize and boiled eggs. Somewhere, a small radio crackles. Nearby, two conductors argue over whose turn it is to load passengers. This scene is how Kampala wakes, in diesel fumes, shouted destinations, and the quiet urgency of people trying to earn a living before the traffic tightens its grip on the day.
Handwritten route boards fixed to the taxis signal their destinations: Masaka “A” Stage, Kaguta Road, Nakawa, Namirembe, Ntinda, Gayaza, Nansana, and Entebbe, guiding passengers through the organised chaos of the park. Behind every steering wheel sits someone doing the arithmetic of survival. Drivers wake before dawn to secure a place in the queue. For many, sleep is short, interrupted, and rarely restorative. The day stretches across long hours of traffic, uncertain earnings, rent, school fees, and taxi levies, including annual payments of about UGX 720,000. Passengers today mean dinner tonight. Yet inside the noise of the taxi parks, another story has remained largely invisible.
Across Uganda, an estimated 400,000 taxis move millions of passengers every day, forming the backbone of the country’s informal transport system. But almost nothing is known about the psychological toll on the drivers who keep it running.
That gap is what drew Dr. Kyomuhendo into Kampala’s taxi parks. What she uncovered were levels of depression, anxiety, and stress far higher than many had imagined.
A Medical Doctor Turning Toward Public Health
Born on 23 July 1994 to Mr. Muhigwa Lawrence and Ms. Kataito Jacqueline, Dr. Kyomuhendo grew up in Hoima District in western Uganda. Her early education took her from St. Christina Nursery School to Budo Junior School before she continued to Trinity College Nabbingo and later Mount Saint Mary’s College Namagunga for Advanced Level, where she studied Biology, Chemistry, and Mathematics.
In 2014, she earned a government scholarship through the Public Universities Joint Admissions Board and enrolled for a Bachelor of Medicine and Bachelor of Surgery at Busitema University, graduating in 2019.
During her medical internship at Masaka Regional Referral Hospital, she began noticing a troubling pattern in the cases arriving at the wards: road traffic injuries, complications of chronic diseases, severe malaria in children, and obstetric emergencies that might have been prevented with earlier intervention. Many of the crises doctors were treating, she realized, had begun long before patients reached the hospital. “They were symptoms of deeper problems,” she recalls.
Public health offered a way to investigate those underlying causes. In 2022, she enrolled in the Master of Public Health Distance programme at Makerere University School of Public Health, where students are trained to examine health problems not only at the bedside but across entire populations. Guided by Associate Professor Lynn Atuyambe, a respected scholar in Community Health and Behavioural Sciences at MakSPH, and Dr Juliet Kiguli, Senior Lecturer and public health anthropologist, the student’s work benefited from strong academic stewardship.
Uganda’s road transport system is dominated by motorcycles and 14-seater minibus taxis. About 15,000 operate in the Kampala Metropolitan Area alone.
These drivers navigate congested roads, pollution, erratic traffic patterns, and long working hours. Their workday often begins before dawn and stretches deep into the evening.
“They are important in Uganda’s transport industry,” Kyomuhendo said. “Yet they seem to be overlooked in our society.”
While commuting through Kampala during her studies, she began to notice the lives of taxi drivers. Arguments between passengers and conductors were common. When tensions rose, someone would eventually mutter the same question in Luganda.
“Oba abasajja ba takisi baabaki?” loosely to mean, ‘What is wrong with taxi men?’
The question lingered, and in June 2024, social media campaigns marking Men’s Mental Health Awareness Month pushed her to think about the issue differently. What if the behaviour many passengers dismissed as impatience or aggression was linked to something deeper? To her, taxi drivers seemed an unlikely but revealing group to study.
“They carry the responsibility for passengers’ lives every day,” she says. “Yet very little attention is paid to their own well-being.”
For instance, Kampala City Authority (KCCA) documents that between 2019 and 2024, geolocated crash data reveal a dangerous road environment in which Kampala’s taxi drivers operate daily. A total of 1,878 vulnerable road users, including pedestrians, motorcyclists, and cyclists, were killed in crashes involving motor vehicles, with buses and minibuses linked to 281 deaths, most of them pedestrians (147) and motorcycle occupants (131). Fatalities were heavily concentrated along major corridors such as Jinja Road, Kibuye–Natete Road, Bombo Road, and Ggaba Road, while for pedestrians, the most dangerous segments included Gayaza Roundabout (Kalerwe) and Kyebando Police Post along the Northern Bypass and Entebbe Road, where fatality densities reached 27–28 deaths per kilometer. These patterns highlight the high-risk traffic environments in which taxi drivers work, specifically busy arterial roads and bypass intersections where pedestrians, boda bodas, and public transport vehicles compete for space. These conditions contribute to the broader pressures that shape drivers’ safety, well-being, and mental health.
Research in the taxi parks
Her dissertation set out to answer two questions: how common are depression, anxiety, and stress among taxi drivers in Kampala, and what factors contribute to them? The study surveyed 422 male drivers across seven major taxi parks: Old, New, Kisenyi, Usafi, Namirembe, Nakawa, and Nateete, using a multistage sampling approach designed to ensure representation across the city’s transport hubs.
Participants completed structured interviews on socio-demographic, occupational, lifestyle, use of habit-forming substances, medical, and environmental factors. Mental well-being was assessed using the Depression Anxiety Stress Scale (DASS-21), a widely used screening tool in mental health research.
The data were analysed using statistical models that allowed Kyomuhendo to examine how occupational conditions, lifestyle factors, and health status interacted to shape mental well-being.
The study reflected the epidemiological training embedded in MakSPH’s Master of Public Health programmes, where students are encouraged to investigate real-world health challenges through evidence-based research.
Conducting interviews inside the taxi parks meant stepping into one of the most unpredictable environments in the city. “The atmosphere was survival for the fittest,” Kyomuhendo recalls.
Stories behind the statistics
The fieldwork brought moments that stayed with her long after the questionnaires were completed. One driver laughed when asked how he coped with stress. “I don’t drink or smoke,” he said, suggesting that multiple relationships were his way of managing the emotional strain of the job.
The answer was not in the questionnaire, and they both laughed. Yet the moment captured something deeper about life in the taxi parks: humour often hides exhaustion.
Another driver told her he had spent years buying herbal medicine for a hernia that never healed. Every month, he spent close to 100,000 shillings, hoping the treatment would eventually work. She advised him to seek hospital care, a conversation that stayed with her.
“Sometimes people spend far more trying to manage a problem than it would cost to treat it properly,” she explains.
When the data were analysed, nearly two-thirds of the drivers screened positive for symptoms of depression. More than 70 percent had symptoms of anxiety, and over 80 percent reported levels of stress. The psychological burden was far heavier than most people had assumed.
Several factors stood out. Drivers who had experienced road accidents in the previous year were significantly more likely to report depression. Chronic medical conditions and a family history of mental illness also increased the risk.
Sleep deprivation emerged as one of the most important predictors. Drivers who consistently slept fewer than seven hours per night were far more likely to report anxiety and stress. Also, economic security mattered. Drivers who owned their vehicles were substantially less likely to experience anxiety compared to those who rented taxis or paid daily remittance fees to vehicle owners. In other words, psychological distress followed the same lines as economic pressure.
More than a transport problem, and the silence around men’s mental health
The implications extend beyond the drivers themselves, she observed. Mental health affects concentration, reaction time, and decision-making. All abilities that are critical for safe driving in a city known for congestion, unpredictable traffic, and frequent road hazards, including flooding, among others.
“If drivers are anxious or sleep-deprived,” Kyomuhendo explains, “there is a risk they may struggle to follow traffic rules or respond quickly to hazards.”
In a transport system that carries millions of passengers daily, the well-being of drivers becomes a matter of public safety. The findings suggest that mental health among taxi drivers should be treated as both an occupational health issue and a transport policy concern.
During interviews, Kyomuhendo noticed another pattern. Few drivers openly described themselves as depressed or anxious. Instead, stress appeared through jokes, casual references to alcohol or relationships, or long pauses followed by silence.
Men’s mental health remains a difficult subject in many communities. “Men’s mental health is a serious public health issue that should not be ignored,” she says.
Breaking the stigma will require awareness campaigns, stronger occupational protections, and greater attention from both health authorities and transport regulators, she proposes.
A different way of seeing the city?
This research also changed how Kyomuhendo sees Kampala. Where passengers notice congestion or impatience, she now sees the pressures shaping the people behind the wheel. “It made me appreciate the men who show up every day and work hard despite their struggles,” she says.
One driver confided in her about the pressures of the job. “People will not help you unless they know the problems you are facing,” he said.
The city and its drivers
By late afternoon, the taxi parks are as crowded as they were in the morning. Conductors still shout destinations into the traffic. Engines idle in long rows of white vans waiting for passengers. Drivers lean against steering wheels, hoping the next arrival will finally fill the vehicle.
The city keeps moving because they do. Most passengers step into these taxis thinking only about where they are going—work, home, school, or the market. Few stop to consider the pressures carried by the people behind the wheel.
Yet Kyomuhendo’s research suggests that beneath the noise of the taxi parks and those car hoots on the streets lies something far quieter and far less visible: a level of stress, anxiety, and depression that touches not only the drivers themselves but also the safety of the passengers they carry and the communities they serve.
Each morning, the vans will still line up bumper-to-bumper. Conductors will still shout destinations into the traffic. Kampala will still climb inside and move.
If nearly half a million taxis keep Uganda moving every day, who is protecting the minds of the people behind the wheel?
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.
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 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.
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.”
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.”
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.
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.
“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.
Uganda’s health system is entering a new phase—one where the biggest challenge is no longer building it, but sustaining it. External funding is tightening. Domestic resources are under pressure. Demand for care is rising faster than both.
In this new reality, health is no longer just a social priority but a financing problem and a test of economic strategy.
For years, the system expanded on government investment, backed by strong external support. Infrastructure grew. Services followed. But that model is now under strain. Expectations are rising. Citizens want better care, closer to where they live, and without the financial shock that so often comes with illness.
Uganda is already investing in health. The real question is whether that investment is sustainable and whether it is delivering value.
It was against this backdrop that policymakers, academics, and practitioners gathered at Makerere University on April 9 for a public lecture and high-level dialogue on health financing. At the centre of the discussion was a keynote by Dr. Ramathan Ggoobi, the Permanent Secretary to the Treasury under the theme “Investing in Health for Uganda’s Future: Delivering Vision 2040 through Smart and Sustainable Health Financing.”
The event was organised by Makerere University School of Public Health (MakSPH) in collaboration with the Ministry of Health and the Ministry of Finance, Planning, and Economic Development.
Dr. Ggoobi does not think about health the way most people in government do. He is not persuaded by the language of welfare. When he speaks about health, he reaches for the language of growth, productivity, and national wealth. In his view, the sector is not a cost centre. It is an economic engine.
“Health is not merely a social sector issue. It is an economic transformation issue, a productivity issue, and a national competitiveness issue,” he said, arguing that no country has achieved sustained growth without investing in human capital. Globally, human capital accounts for nearly 70% of national wealth. The World Health Organization (2021) estimates that every dollar invested in health can return four to nine dollars in productivity gains.
“Investment in health is not charity. It is growth finance. So, my first message is to treat health spending as an investment, not as consumption. Every shilling must buy measurable economic and social returns,” he emphases.
His views reveal a shift in how Uganda’s Treasury thinks about health financing. Spending must justify itself. Investments must deliver returns. And inefficiency is no longer just a technical issue but a fiscal problem.
Ggoobi’s worldview is shaped by the idea that Uganda’s long-term growth ambitions under Vision 2040, which is 13 years away, to achieve what he describes as a tenfold expansion to a $500 billion economy, will be decided not just by infrastructure or industry but by the quality of its human capital.
Globally, he notes, human capital accounts for the bulk of national wealth. Health, therefore, is not peripheral to development. It is central to it.
If health is an investment, then it must generate returns. If it does not, then something in the system is not working. “Every shilling must buy measurable economic and social returns,” he said.
This is where the optimism gives way to unease. Countries that have achieved and sustained middle-income status did so through deliberate, sustained, evidence-driven investments in human capital.
Uganda is working within tight fiscal limits. The national budget for 2025/26 stands at Shs 72.38 trillion, with about Shs 5.87 trillion going to health.
Government spending on health has increased over time, rising from about Shs 2.8 trillion a few years ago to Shs 4.4 trillion today. But even with this growth, spending per person is still low, around $50 a year, less than half of what is often needed to provide basic health services.
Not all the money is used efficiently. Global estimates suggest that weak systems, poor coordination, and procurement challenges can cause up to a third of health spending to be lost.
According to Dr. Ggoobi, Uganda has made notable progress in strengthening its health system, driven by sustained public investment. Life expectancy has risen from about 50 years in 2000 to approximately 68.8 years in 2024, an increase of over 18 years. Access to services has also improved significantly, with about 91 percent of Ugandans now living within five kilometres of a health facility, while income poverty has declined from 24.5 percent in 2010 to 16 percent.
On the service delivery side, the government has introduced the malaria vaccine for children under five and rolled out electronic medical records across national and regional referral hospitals. Strategic investments have also been made, including 16 high-capacity oxygen plants, three regional blood banks, CT scan equipment in 14 of 16 regional referral hospitals, and 20 digital X-ray machines in general hospitals, with remaining gaps expected to be closed in the next budget. Together, he noted, these efforts demonstrate that sustained investment in health is yielding tangible results.
Beneath that progress, Dr. Ggoobi sees a health financing structure that is fundamentally unstable, noting that external partners still finance as much as 40–45 percent of health expenditure. Government contributes about 22 percent, household’s 31 percent, and insurance remains marginal at less than five percent. This balance, Ggoobi argues, is dangerous. It leaves the system exposed to shocks from outside while pushing risk onto those least able to bear it.
But the issue that troubles him most is government inefficiency. His priorities are to increase and protect domestic health financing, mobilise long-term capital, and improve efficiency.
“We are wasteful even with the little we have. Procurement is a major problem—many fights in government are not about mandate but about procurement. That is why we are moving all entities onto an electronic procurement system to improve transparency, reduce leakage, and ensure accountability,” said Dr. Ggoobi.
The government has enrolled 38 entities on the electronic procurement system. Full adoption is expected by mid-2026.
If you have good audits and we implement their recommendations, then we can expect positive outcomes. Number two is e-government, reducing human contact where it is not necessary. Unless you’re a doctor, you have to examine someone. Why do you have to sit in a hotel to discuss procurement? Humans must get out of discussing procurement. That’s why we are building the eGP and reviewing the procurement law. We are going back to the cabinet; we are going to remove human beings who are not necessary in the chain of procurement,” said Ggoobi.
Across the discussion, one issue drew near-unanimous agreement that prevention remains underfunded.
The Ministry of Health’s position, delivered through John Kauta, the Commissioner in charge of Health Information, Statistics, Monitoring, and Evaluation, is unequivocal that “the cheapest disease to treat is the one we prevent.”
Yet Uganda still spends more on treating illness than preventing it. Freddie Ssengooba, a Professor of Health Economics and Health Systems Management, MakSPH, highlighted malaria as a case study, both costly and preventable, while others pointed to rising non-communicable diseases driven by lifestyle factors.
This imbalance has fiscal consequences. Preventable diseases generate recurrent costs, crowding out other investments and reinforcing the cycle of inefficiency.
Mak Chancellor Hon. Dr. Crispus Kiyonga pushed the debate toward geography and access, citing that while Uganda’s health system was originally designed to follow administrative structures, the ambition to reach every village was never fully realised.
“We must plan based on what we can sustainably afford. We cannot import another country’s system. But where shall we save the majority of our people? It is in the villages. That is where children miss school due to illness. Where young girls drop out due to a lack of basic support, like pads. So, we must choose: given limited resources, what system gives the greatest impact? When the Minister of Health asks for a CT scan—something people travel to Nairobi for—that is important. But in the village, a child needs an antimalarial. The choice is between a CT scan and basic treatment. These are tough decisions,” says Dr. Kiyonga.
While the country is “highly indebted” and resources are limited, the level of care that Uganda can realistically provide to its citizens should borrow from China’s early pragmatic reforms of universal access first and quality later, according to the Chancellor.
“You cannot deliver health from a distance,” he said, arguing for a renewed focus on community-level access.
The Chancellor also strongly supported a shift from tertiary care to primary care. From Mulago National Referral and reducing its congestion to the village by investing in lower health facilities.
He urged the government ministries of Finance and Health to strongly collaborate with academic institutions to improve their work. “This dialogue should not be a one-off. It must be continuous. Makerere must engage the government with well-costed, risk-weighted proposals. We should build structured collaboration between universities and government so that research informs policy, and we reduce reliance on expensive foreign consultants. There is valuable research here,” said Dr. Kiyonga.
Taken together, the dialogue revealed a country’s health system in transition, from scarcity to expansion but not yet to performance.
As Ms. Jane Kyarisiima Mwesiga, Deputy Head of Public Service (Service Delivery), Office of the Prime Minister, framed it, the next phase must move “from expansion to performance, from inputs to outcomes, from financing to public value.”
But the path forward remains contested. Should Uganda prioritise insurance or direct public provision? Prevention or specialised care? Infrastructure or functionality?
The answers lie not in choosing but in sequencing, something Uganda has historically struggled to do.
Dr. Ian Clarke, a Physician, philanthropist, entrepreneur, and Chairman of Clarke Group Companies, speaking while representing the Private Sector during the dialogue, spoke emotionally on national health insurance, whose discussion has been ongoing for close to 20 years, but with minimal progress.
“We have had studies and proposals, but many were rightly rejected because they were not practical. You cannot design a National Health Insurance scheme that looks like private insurance. There is simply not enough money in Uganda—or anywhere—to sustain that. We still think in silos: public sector and private sector. Then we ask, how do we support the private sector? There are many ways—but as has been emphasized, we must focus on prevention and equity, especially in rural areas.”
For Ssengooba, while insurance is important and long-term, its implementation needs to be phased. He called for more investments in the health sector as the first line of insurance for citizens. He also called on the government to partner with institutions such as the National Social Security Fund (NSSF), which already have systems, capacity, and reach in place to support health investments. “If we leverage institutions like NSSF—for collection, for pooling resources—we can make progress. During COVID, they demonstrated that they can support national priorities. So, we should think about how to leverage what already exists,” he says.
Stephen Omojong of the National Social Security Fund highlighted an untapped opportunity. The Fund currently manages about Shs 30 trillion in assets, with millions of contributors.
This pool, he argued, could support health financing either through insurance-linked products or long-term investment vehicles. His example of a voluntary savings scheme now has 68,000 participants and Shs. 114 billion mobilised in a year, suggesting that behavioural barriers may be less rigid than often assumed.
Makerere University Vice Chancellor, Professor Barnabas Nawangwe, framed the dialogue as more than an academic exercise, describing it as a call to action. He urged the government to tap into the University’s research capacity to inform strategic investments, noting that “health research constitutes more than 50% of all research at Makerere University,” with institutions like the School of Public Health and the Infectious Diseases Institute playing a central role.
He referred to their national impact—from supporting over 20% of Uganda’s HIV patients to operating in more than 90 districts—and emphasised that Makerere brings in over one trillion shillings annually in research income. “When you fund Makerere University,” he said, “you should understand that we are not a net consumer—we are a net producer for the country.”
Taken together, the dialogue revealed a system in transition from expansion to performance, from spending to results. Uganda is no longer short of ideas, nor entirely short of resources. The real test is execution.
Whether the country can turn health spending into measurable outcomes will determine not just the future of its health system but the credibility of its economic ambitions.
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