Kampala: Health, wellbeing and nutrition

Working Paper 35

Gloria Seruwagi, Henry Bazira, Maria Ssematiko, Jacqueline Kobusingye, Dorcus Kabahinda and Catherine Nakidde

December 2025

Abstract

This working paper investigates how political and urban systems shape health, wellbeing and nutrition (HWN) outcomes in Kampala’s informal settlements, where over 60% of the city’s 2.3 million residents reside. Despite Kampala being food-abundant, residents in informal settlements face significant barriers to accessing nutritious diets, due to economic hardship, weak governance and poor service delivery. The research was cross-sectional, employing iterative qualitative methods involving 317 participants, including community members, vendors, academia, policymakers and practitioners, through key informant interviews, focus group discussions, codesign meetings, workshops and direct observation. Key findings show that informal food traders are vital for food access, but operate in an environment marked by high taxes, corruption and licensing constraints, contributing to elevated food prices. Nutrition literacy is low, and residents often prioritise basic needs like housing or healthcare over dietary quality. Kampala’s health system is dominated by private providers, with only 2% of facilities publicly owned, leaving most low-income residents with expensive, curative-focused options and little exposure to preventive care or nutritional education. Sanitation and waste management systems are poorly maintained, particularly in informal settlements, increasing the risk of disease outbreaks. Governance challenges are central, with political interference delaying critical policies such as the Food and Nutrition Security Bill. Politically driven programmes such as Operation Wealth Creation (OWC) overshadow nutrition-focused initiatives. While non-state actors, including CSOs and development partners, fill service gaps, their efforts are often fragmented and donor-dependent. The paper concludes that sustainable HWN improvements require coordinated, multisectoral responses grounded in inclusive governance, regulatory reform and enhanced investment in community-led solutions and equitable urban development.

Keywords

Healthy diet, informal settlements, dietary uptake, nutrition, food security, politics and nutrition, urban systems