Will Gronefeld, Associate Member, Immigration and Human Rights Law Review
I. Introduction
Cervical cancer is the fourth most-common cancer among women worldwide.[1] Uganda has the seventh highest incidence rate of cervical cancer globally, with around 7,000 new cases each year.[2] Eighty percent of these cases are diagnosed at an advanced stage, making treatment difficult.[3] As a result, current estimates place around 4,607 deaths per year from cervical cancer alone.[4] Furthermore, Uganda’s rate of cervical cancer raises each year.[5] However, cervical cancer is preventable, and completely treatable with early detection.[6] Uganda’s cervical cancer crisis is a preventable public health issue that persists due to systematic healthcare inequities that disproportionately impact women, in violation of Uganda’s domestic laws and duties.
This blog explores the reasons behind Uganda’s growing cervical cancer crisis, arguing that it violates Uganda’s domestic obligations. Part II provides background on the history of healthcare in Uganda, focusing on the impact on women. Part III discusses the cervical cancer crisis and how some potential avenues for reform are hampered by the structure of Uganda’s healthcare system, which encourages inequities for women. Finally, Part IV concludes by examining possible paths forward for reform.
II. Background
Uganda’s history, including the healthcare system’s evolution, can be split across three distinct periods: precolonial, colonial, and postcolonial.[7] Uganda’s healthcare system transformed from a focus on traditional medicine in precolonial periods to providing care to British colonizers and missionaries while under their rule.
A. History of Healthcare for Women in Uganda
1. Precolonial period
Before Uganda was colonized by the British Empire, the country was separated into two spheres of political organization: kingdom states and segmentary states.[8] Kingdom states were highly patriarchal, forcing women to interact with society solely through their brothers, husbands and sons.[9] Due to a lack of sources, there is little known about how society treated women within segmentary states.[10] However, women’s societal roles are reflected within Uganda’s healthcare system during this era.[11]
During the precolonial period, Uganda’s healthcare was based solely on traditional medicine.[12] This system involved practitioners, such as herbalists, birth attendants, and spiritualists, using indigenous knowledge for healthcare.[13] As a result, women’s limited authority often came from their roles as spiritual leaders and healers.[14] In addition, the traditional system was based around the concept of bulungi bwansi (“for the good of the community”).[15] This concept centers around the idea of participating for the good of the community, rather than just for oneself.[16] In terms of healthcare, this meant medical attention was provided when needed, no matter the status, gender, or wealth of the individual, a concept that disappeared as Britain took control of Uganda.[17]
2. Colonial Period
From 1894 to 1964, Uganda was a British Empire protectorate.[18] To solidify control, Britain established the 1902 Orders in Council.[19] The Orders in Council established the legal framework for protectorate Uganda.[20] Article 15(1) of the Orders in Council established the judicial system, including Uganda’s High Court, which has full governance over all legal matters in Uganda.[21] This High Court became instrumental in setting forth access to healthcare through litigation.[22]
Throughout this era, Uganda’s healthcare system was built around the management of Britain.[23] The Ugandan government was structured to maintain “viable macroeconomic structures and flows that were necessary to keep the colonial exploitation alive as efficiently as possible.”[24] Essentially, this means a key purpose of the governmental structure was to protect the interests of European power.[25] Additionally, Christian missionaries played a large role in Uganda’s healthcare system and the role of women in society.[26] Missionaries education women for domesticity and reinforced the colonial government’s emphasis on providing care to colonial staff.[27] Furthermore, the healthcare system moved away from healers and traditional medicine and toward Western medical practices, causing women to lose much of the limited authority they had.[28] Colonialism not only transformed Uganda’s healthcare system but also impacted the laws and policies surrounding public health.[29]
Beginning in the 1930s, the colonial government shifted its focus to public health policy.[30] Many of the laws enacted drew criticism for being restrictive in areas specific to women, such as limited reproductive rights.[31] These restrictive laws have not been substantially updated or reviewed since their enactment.[32] As such, post-colonial healthcare laws were built on this flawed foundation rather than starting completely anew or re-incorporating the concept of bulungi bwansi.[33]
3. Post-colonial Period
Following 70 years of colonialism, Uganda faced political and economic turmoil in the 1970s and 80s that severely affected the healthcare sector.[34] As a result, the quality of healthcare declined dramatically.[35] Unfortunately, due to the chaos occurring during this transitional period, it is nearly impossible to pinpoint exactly what caused the decline, but the impact was clear.[36] Medicine, medical equipment, and hospital facilities became limited in supply due to the turmoil.[37] Rising inflation and the neglect and destruction of health facilities also contributed to the decline of the Ugandan healthcare system.[38] Additionally, these hostilities and the decline of the healthcare system influenced physicians to migrate to other countries.[39] However, Uganda’s healthcare slowly began to restructure after the turmoil subsided.
Starting in the late 1990s, Uganda began undergoing numerous reforms to reshape health services.[40] The increased relevance of public donors was an important aspect during reformation.[41] Thankfully, donors saw social services as a positive investment necessary for the economic growth of the country.[42] Global health crises, such as the AIDS epidemic, further reinforced the importance of reshaping healthcare policies to better service the general population.[43] Today, aid from public donors, such as the World Bank, comprises around 50% of the Ugandan government’s budget.[44] Unfortunately, these donor requirements do not take into account rights given under Ugandan law.
Under the current Uganda Constitution, women are delineated certain rights, extending to healthcare rights.[45] Article 5 explicitly recognizes the significance of women to society, while Article 33 is dedicated to recognizing the rights of women, including the state’s role in protecting and enhancing those rights.[46] In addition, these rights require the government to consider women’s unique statuses while protecting these rights.[47] Although limited, this Constitution enumerates the recognition of women’s rights.[48] Despite the recognition, women’s right to healthcare has fallen to the wayside, provoking a cervical cancer epidemic.
III. Discussion
The cervical cancer crisis in Uganda is preventable; however, due to violations of Ugandan law designed to acknowledge and protect the unique challenges faced by women, its incidence rate continues to rise each year.[49] However, efforts to reform are hindered by Uganda’s current dependence on steadily declining donor support.[50] These funding challenges exacerbate the spread of misinformation rooted in outdated and sexist ideas about women’s roles in society.[51] Nonetheless, there is evidence of positive reform through the reintroduction of traditional concepts like bulungi bwansi and by utilizing rural areas’ reliance on traditional medicine as a strength rather than a necessary evil.[52]
A. Inadequate Funding
Efforts to address the high rates of cervical cancer and treat diagnosed individuals are obstructed by government neglect, a lack of funding, and a lack of healthcare training.[53] Currently, Uganda operates on a six-tiered healthcare system, with level one representing small, village level hospitals and level six representing national referral hospitals.[54] The country’s already limited healthcare budget is often distributed to the higher level, national hospitals.[55] This unequal allocation of resources only further strains the unequal access to healthcare that exacerbates the cervical cancer crisis.[56]
Furthering the inadequate funding for healthcare is Uganda’s continued reliance on the donor structure.[57] The World Health Organization (“WHO”) recommends that low-income countries, such as Uganda, spend at least $86 per person on healthcare per year.[58] In the 2023/2024 fiscal year, Uganda allocated just 6.5% of the total national budget to the health sector, or about $23 per person.[59] In the current fiscal year, this spending has fallen to 4%.[60] This decline is due to Uganda’s shortage of external funding, caused by the passage of the Anti-Homosexuality Law in 2023.[61] For example, the World Bank released a statement proclaiming that “the law fundamentally contradicts the World Bank Group’s values.”[62] Furthermore, the World Bank suspended all new lending to Uganda, while the U.S. executed a variety of actions, such as ending Uganda’s eligibility under the African Growth and Opportunity Act and redirecting $5 million in funding from the President’s Emergency Plan for Aid Relief to nongovernmental organizations.[63]
A lack of donor funds only leads to a further decrease of funds given to the healthcare system across Uganda.[64] This leads to competition among different districts for funding.[65] The government’s political priorities lead to more “urban” regional hospitals being favored, such as Mulago’s National Referral Hospital.[66] For example, Mulago alone assumes around 20% of the national health budget.[67] Additionally, donor sponsored programs only support certain expenditures.[68] For example, in the Soroti District, ambulance drivers’ salaries must be covered by local revenue.[69] In addition, many rural Ugandans consult traditional healers before going to the formal healthcare system.[70] Across Sub-Sahara Africa, around 80% of the population uses traditional medicine for their healthcare needs.[71] Traditional healers often take the main role of cancer prevention and diagnosis.[72] However, this reliance on alternative medicine can sometimes contribute to misinformation within the healthcare system.
B. Misinformation in the Healthcare system
In addition to limited funding, Uganda’s ratio of doctors to patients falls below WHO’s recommendations.[73] WHO recommends a ratio of one doctor per 1,000 patients.[74] Uganda’s average is around one doctor per 25,000 patients.[75] To help curb this lack of care, Uganda’s Ministry of Health pays volunteers, called “village health officers,” (“VHO”) to raise public awareness on medical and health issues.[76] However, VHOs are generally poorly trained and spread misinformation to patients.[77] For instance, two mothers noted that VHOs had misinformed them about how Human Papillomavirus (“HPV”), the leading cause of cervical cancer, is spread.[78] One mother was told that long nails scraping the cervix while bathing caused cancerous cells, while another was told that simply sitting on dirty surfaces could cause the issue.[79] These misconceptions reflect the broader issue of misinformation surrounding women’s health, which adds to the cervical cancer crisis.
Efforts to help screen, prevent, and treat cervical cancer are often impeded by misconceptions regarding women reproductive health.[80] The two specific strains of HPV, HPV 16 and HPV 18, cause 70% of cervical cancers worldwide.[81] Uganda’s national positivity rate for HPV is 39.1%.[82] In 2015, Uganda launched a HPV vaccination campaign, offering girls between ages nine and twelve two free HPV vaccines six months apart.[83] Receiving both doses reduces the chance of developing cervical cancer by 97%.[84] Although 75% of Ugandan girls received the first dose, only 44% received the second.[85] The lack of full vaccination resulted from rampant conspiracies and misinformation.[86] For example, some locals believe that HPV vaccinations are part of a covert plan by the government to sterilize women and depopulate the area.[87] These conspiracies and misinformation are a direct result of the patriarchal role of women in Ugandan society.[88]
The traditional role of women in Ugandan society, along with stereotypical gender norms, has contributed to misinformation that exacerbates the cervical cancer crisis.[89] Cultural norms expect women to adopt a submissive role of only providing care to their families, beginning at a very young age.[90] For example, roughly one-fourth of Ugandan teenage girls aged 15 to 19 have “begun childbearing.”[91] Additionally, traditional societal roles are especially prevalent in rural areas with limited resources, such as Mayuge. [92] In Mayuge, the average age of first-time mothers is between fourteen and sixteen years old, with women having an average of 6.2 children throughout their lives.[93] Although pregnancy is not a direct link for cervical cancer, the WHO has recognized that first pregnancies at a young age is a risk factor for cervical cancer.[94] Further, the traditional gender roles found in Ugandan society often have a direct impact on treatment.[95] Treatments for cervical cancer typically require women to abstain from sexual intercourse for four to six weeks.[96] Three women have told stories of being forced into sex by their partners during this period, subjecting them to severe pain and requiring them to restart the treatment.[97] Finally, continuing to look at Mayuge’s society, the fishing industry is a core career, meaning men move from site to site and often have multiple sexual partners.[98] This means there may be a high risk of HPV spread. However, Ugandan men are not targeted in messaging campaigns about cervical cancer and generally show little interest when they are, viewing reproductive issues primarily as women’s rights issues.[99] The government’s failure to address problems unique to women violates longstanding Ugandan law.[100]
C. Domestic Law Violations
The Ugandan government’s lack of effort to address the cervical cancer crisis violates Ugandan domestic law, specifically Article 33 of Uganda’s constitution.[101] These violations are displayed in cases governing health crisis unique to women, such as Center for Health, Human Rights and Development (CEHURD), Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente v. Attorney General.[102] In Center for Health, the petitioners challenged the government’s failure to provide maternal care in violation of the right to health, right to life, and the right of women under Uganda’s constitution.[103] The petitioners were family members of two women who had died in childbirth.[104] One woman died because nurses refused to provide care unless the family paid with money and supplies, while the other women died due to being left unattended.[105] The Constitutional Court found for the petitioners, holding that it is the government’s responsibility to harness the resources to provide constitutional demands.[106] This case shows how the government’s handling of the cervical cancer crisis violates domestic law, as, similar to maternal care, cervical cancer is a unique, women’s health crisis that the government has obligations to correct. Ugandan women are dying in a crisis that the government not only knows about but exacerbates by providing little and/or inadequate care, in direct violation of their obligations under the constitution. Although donor funding is decreasing and domestic law violations continue, Uganda is providing the absolute bare minimum of funds to healthcare, while doing little to address the rampant misinformation.
D. Reform
Although the issues exacerbating the cervical cancer crisis in Uganda stem from the healthcare system, a complete restructure of the system is not necessary to alleviate or even resolve these issues. Providing education to better integrate traditional healers has been shown to help reduce cervical cancer rates.[107] Communities place a lot of trust in their traditional healers, especially considering that Uganda’s infrastructure means that in rural areas traditional healers are often far accessible or even only health providers available.[108] A study conducted by BioMed Central Primary Care found that traditional healers can help prevent and diagnosis cancer.[109] For example, a focus group study found that traditional healers already understood the link between HPV and cervical cancer.[110] After learning about the HPV vaccine, healers reported plans to not only spread awareness, but to refer patients to traditional hospitals when their care is not enough.[111] Fostering further collaborations between traditional healers and the healthcare system, ala the spirt of bulungi bwansi, which would help the healthcare system transition from one focused on fulfilling the aims of donors to one focused on providing the best possible care to Ugandans.
IV. Conclusion
Cervical cancer claims around 4,607 Ugandan women per year yet is preventable if not for the systematic healthcare inequities that disproportionately impact women.[112] These health inequities between men and women are furthered by Uganda’s reliance on donor support. However, despite a steadily declining amount of donor funds, Uganda’s healthcare budget still falls significantly below generally accepted standards. Consequently, Uganda’s healthcare inadequacies continue, worsened by misinformation rooted in outdated cultural beliefs and gender norms. This situation clearly violates Uganda’s Constitution, which states that women should not only be treated equally, but that the government must acknowledge and protect women based on their unique status, which includes issues related to cervical cancer. However, the key to reform does not require a complete restructuring of the healthcare system; rather, it involves better education for traditional healers while returning to the values of bulungi bwansi.
[1] Cervical Cancer, WHO, https://www.who.int/health-topics/cervical-cancer [https://perma.cc/AFF2-9XV8] (last accessed Mar. 30, 2025).
[2] Tracey Kansiime, Uganda Grapples with Cervical Cancer Crisis, NilePost (Jan. 15, 2025, 9:19 PM), https://nilepost.co.ug/nigerian-gospel-minister-dunsin-oyekan/237428/uganda-grapples-with-cervical-cancer-crisis [https://perma.cc/ZJ7X-5LPX].
[3] Id.
[4] Uganda: Human Papillomavirus and Related Cancers, Fact Sheet 2023, HPV Info. Ctr (Mar. 10, 2023), https://hpvcentre.net/statistics/reports/UGA_FS.pdf [https://perma.cc/Z374-B9P9].
[5] I. M. Usman et al., Knowledge, Attitude, and Practice Toward Cervical Cancer Screening Among Female University Students in Ishaka Western Uganda, 15 Int’l. J. Women’s Health, 611–620 (2023).
[6] Id.
[7] Moses Mulumba, Ana Lorena Ruano, Katrina Perehudoff, & Gorik Ooms, Decolonizing Health Governance: A Uganda Case Study on the Influence of Political History on Community Participation, 23 Health & Hum. Rts. J. 259-271 (June 2021).
[8] Alicia C. Decker, Women in Uganda, Oxford Rsch. Encyclopedia Afr. Hist. (Jan. 31, 2023), https://oxfordre.com/africanhistory/display/10.1093/acrefore/9780190277734.001.0001/acrefore-9780190277734-e-1451 [https://perma.cc/AMW9-L3Q].
[9] Id.
[10] Id.
[11] Id.
[12] Id.
[13] Id.
[14] Id.
[15] Id.
[16] Id.
[17] Id.
[18] Id.
[19] Id.
[20] Id.
[21] Id.
[22] Id.
[23] Id.
[24] Id.
[25] Id.
[26] Id.
[27] Id.
[28] Mulumba et al., supra note 7.
[29] Id.
[30] Id.
[31] Id.
[32] Id.
[33] Id.
[34] Id.
[35] Id.
[36] Id.
[37] Id.
[38] Id.
[39] Id.
[40] Nicholas De Torrente, The Evolving Role of the State, Donors, and NGOs Providing Health Services, Some Insights from Uganda, Crash (Aug. 1, 1999), https://msf-crash.org/en/humanitarian-actors-and-practices/evolving-role-state-donors-and-ngos-providing-health-services [https://perma.cc/FCZ2-U4YC].
[41] Id.
[42] Id.
[43] Id.
[44] Id.
[45] Const. of the Republic of Uganda, 1995.
[46] Id. at art. 5; Id. at art. 33.
[47] Andre Moreau, Sexual and Reproductive Health Rights in Uganda: Overcoming Barriers in the Pursuit of Justice, Equality, and Prosperity, 5 Ctr for Hum. Rts. & Legal Pluralism: Working Paper Series, 9 (2017), https://www.mcgill.ca/humanrights/files/humanrights/ihri_wps_v5_n10_moreau.pdf [https://perma.cc/DMQ3-Q425].
[48] Id.
[49] Khatondi Wepukhulu, ‘I feared I would die’: Inside Uganda’s cervical cancer crisis, Open Democracy (Feb. 4, 2025, 8:55 AM), https://www.opendemocracy.net/en/5050/uganda-cervical-cancer-misinformation-patriarchal-violence-women-hpv-health-funding/ [https://perma.cc/75PK-C3RP].
[50] Id.
[51] Id.
[52] Elizabeth F. Msoka et al., The role of traditional healers along the cancer care continuum in Sub-Saharan Africa: a scoping review, 83 Archives Pub. Health (2025), https://pubmed.ncbi.nlm.nih.gov/39948678/ [https://perma.cc/2XSD-VCV8].
[53] Khatondi Wepukhulu, supra note 49.
[54] Id.
[55] Id.
[56] Id.
[57] Id.
[58] Id.
[59] Id.
[60] Id.
[61] Id.
[62] Thomas Mackintosh & Mercy Juma, World Bank halts new Uganda loans over anti-LGBTQ+ law, BBC (Aug. 9, 2023), https://www.bbc.com/news/world-africa-66453098 [https://perma.cc/8E3S-AMJK].
[63] Asia Rusell & Maria E. Burnett, Discrimination in Public Health: How Funders Should Fight Laws Like Uganda’s Anti-Homosexuality Act, Ctr. For Strategic & Int’l Stud. (May 28, 2024), https://www.csis.org/analysis/discrimination-public-health-how-funders-should-fight-laws-ugandas-anti-homosexuality-act [https://perma.cc/CLT7-883K].
[64] Id.
[65] Id.
[66] Id.
[67] Id.
[68] Id.
[69] Torrente, supra note 40.
[70] Msoka, supra note 52.
[71] Id.
[72] Id.
[73] Id.
[74] Id.
[75] Id.
[76] Id.
[77] Id.
[78] Id.
[79] Id.
[80] Id.
[81] Cervical Cancer Causes, Risk Factors, and Prevention, Nat’l Cancer Inst. (Aug. 2, 2024), https://www.cancer.gov/types/cervical/causes-risk-prevention [https://perma.cc/2RFZ-PU4T].
[82] Khatondi Wepukhulu, supra note 47.
[83] Id.
[84] Id.
[85] Id.
[86] Id.
[87] Id.
[88] Id.
[89] Id.
[90] Linda Scott, Gender Divide in Uganda: Norms, Myths, and Household Consumption, The Double X Econ. (July 13, 2013), https://www.doublexeconomy.com/post/gender-divide-in-uganda-norms-myths-and-household-consumption? [https://perma.cc/E4CX-3LWD].
[91]Alex Baluka, Uganda’s Staggering Rate of Teen Motherhood Can Shatter Life Dreams, PassBlue (Jan. 15, 2024), https://www.passblue.com/2024/01/15/ugandas-staggering-rate-of-teen-motherhood-can-shatter-life-dreams/ [https://perma.cc/AKW4-UL3X].
[92] Khatondi Wepukhulu, supra note 49.
[93] Id.
[94] Id.
[95] Id.
[96] Id.
[97] Id.
[98] Id.
[99] Id.
[100] Wepukhulu, supra note 49.
[101] Const. of Uganda, supra note 46 at art. 33.
[102] Center for Health, Human Rights and Development (CEHURD), Prof. Ben Twinomugisha, Rhoda Kukiriza and Inziku Valente v. Attorney General [2011] UGCC 16 (Uganda), https://www.southernafricalitigationcentre.org/wp-content/uploads/2017/08/Petition-16-of-2011_CEHURD-and-Others-v-the-Attorney-General_Maternal-Health.pdf [https://perma.cc/ZQ3N-K568].
[103] Id., at 2-3.
[104] Id., at 15-16.
[105] Id.
[106] Id.
[107] Msoka, supra note 52.
[108] Id.
[109] Id.
[110] Khatondi Wepukhulu, supra note 49.
[111] Id.
[112] Id.
