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In 1995, the presidents of Uganda, Burundi, Rwanda, Tanzania, and Zaire (now the Democratic Republic of the Congo) asked The Carter Center to negotiate a regional initiative to repatriate 1.7 million Rwandan refugees and curb violence in the region. The Center also has assisted Ugandans in making great strides against river blindness and Guinea worm disease, and in increasing crop production.

Waging Peace

In 1999, President Carter and the Conflict Resolution Program negotiated the Nairobi Agreement, in which Sudan and Uganda committed to stop supporting forces against each other and agreed to eventually re-establish full diplomatic relations, opening the door for improved regional peacemaking.

+Mediating Conflict

Since the mid-1980s, the government of Uganda has been fighting the Lord's Resistance Army (LRA), a quasi-spiritual Ugandan rebel group that has had bases in Southern Sudan. The LRA has kept northern Uganda in a state of almost continuous insecurity and has attracted particular attention due to its use of child soldiers, kidnapped from their homes in northern Uganda and forced to fight, often against their relatives and neighbors. Additionally, the LRA contributed to hostilities between the government of Uganda and the government of Sudan, leading to the severing of diplomatic relations in 1995.

In 1999, President Carter and the Conflict Resolution Program negotiated the Nairobi Agreement in which Sudan and Uganda committed to stop supporting forces against each other and agreed to eventually re-establish full diplomatic relations, opening the door for improved regional peacemaking. The Conflict Resolution Program engaged intensively to ensure the agreement's implementation, convening ministerial and security meetings between the two governments and other interested parties and making strenuous efforts to initiate dialogue between the LRA and the government of Uganda. Full diplomatic relations have since been restored between the two countries, and Uganda became a key regional partner in pushing for a peaceful resolution to Sudan's civil war.

Read the Nairobi Agreement of Dec. 8, 1999

The Carter Center also continued to make strenuous efforts to initiate dialogue between the LRA and the government of Uganda. The Carter Center's Conflict Resolution Program worked with representatives of UNICEF, Uganda's Acholi community, and the governments of Sudan, Uganda, Canada, Egypt, and Libya and sought additional meetings with the leader of the Lord's Resistance Army, Joseph Kony, in an effort to end fighting in northern Uganda and return the LRA's child soldiers to their villages.

Through 2003, the program continued its efforts to establish a peace process between President Yoweri Museveni of Uganda and the LRA, leaving only after concluding that the conditions were not ripe to establish a peace dialogue between the two sides. President Carter remained in touch with key leaders while offering support to more recent peace efforts by Betty Bigombe.

Learn more about the Carter Center's Conflict Resolution Program >

+Waging Peace in Africa's Great Lakes

Following the Rwandan genocide of 1994, the presidents of Uganda and Zaire (now the Democratic Republic of the Congo) asked President Carter to facilitate a meeting between themselves and the presidents of Burundi, Rwanda, and Tanzania — countries collectively known as the Great Lakes region of Africa — to negotiate a regional initiative to combat the climate of genocide, repatriate 1.7 million Rwandan refugees, and curb violence in the region. President Carter was joined in this effort by former Tanzania President Julius Nyerere, former Mali President Amadou Touré, and South Africa Archbishop Desmond Tutu.

After summits in Cairo and Tunis in March 1996, the presidents agreed to:

1. Prevent cross-border raids into any country;

2. Halt arms flow to rebel groups;

3. Remove people stirring fears that it is unsafe to return to Rwanda from refugee camps;

4. Return military equipment to its country of origin, including Rwandan equipment held in Zaire;

5. Turn over individuals indicted for genocide crimes to the International Tribunal for Rwanda; and

6. Allow some 300 human rights observers in Rwanda to work with returning refugees.

However, despite these important commitments and strenuous efforts to implement them, there was little support from the international community, and most refugees finally returned to Rwanda only when full-scale violence broke out in Zaire in late 2006. 

Fighting Disease

When The Carter Center began working in 1991 with the Uganda Ministry of Health to establish one of the first Guinea worm elimination programs in Africa, there were more than 120,000 cases in more than 2,600 villages in 17 districts in the northern half of the country. The nation reported its last indigenous case of Guinea worm disease in July 2003. In the fight against river blindness, more than 1.5 million people no longer suffer from this disease due to its interruption in eight of the original 18 endemic areas in Uganda.

+Eliminating Guinea Worm Disease

Current Status: Transmission Stopped, July 2003 (Read the announcement)
Certification of Dracunculiasis Elimination: 2009

Current Guinea worm case reports >

In 2009, the World Health Organization certified that Uganda was free of guinea worm disease (dracunculiasis).

Invited by the Ugandan government, The Carter Center began working in 1991 with the Ministry of Health to establish one of Africa's first Guinea worm elimination programs. When the first active search was conducted, more than 120,000 cases were found in more than 2,600 villages in 17 districts in the northern half of the country. The areas most severely affected by Guinea worm were three northeastern districts: Kitgum, Moroto, and Kotido.

Each endemic health district in Uganda was assigned health educators to help promote Guinea worm disease prevention; every endemic village had at least one trained community volunteer who provided additional health education; and all households in endemic villages received nylon filters and replacement filters free of charge. The program also used ABATE® (donated by BASF) monthly to kill the parasites in water sources, and UNICEF helped the government provide safe sources of drinking water in priority villages.

By 1997, only 1,251 cases were reported, and the disease had been eliminated from 13 formerly endemic districts. 

A cash reward system helped the program discover cases imported from Sudan in villages previously considered to be nonendemic.

Although the country has not reported an indigenous case of Guinea worm disease since 2003, Uganda and other nations bordering South Sudan remain at risk until Guinea worm is eliminated there. Thus Uganda needs to monitor and report the exportation of any cases from South Sudan.

+Eliminating River Blindness

For additional information and updates on the River Blindness Program in Uganda, read the latest issue of Eye of the Eagle.

In 1996, after absorbing the River Blindness Foundation, The Carter Center began supporting the Uganda Ministry of Health to conduct health education and annual mass drug treatment with Mectizan® (donated by Merck). The work expanded the Center's involvement in the country, which began with the Guinea Worm Eradication Program in 1991.

Inspired by the success of river blindness elimination activities in the Americas, Uganda is positioning itself to be one of the first river blindness-endemic countries in Africa to wipe out the disease nationwide through the use of health education, Mectizan distribution and vector control.

A unique aspect of the nation's success has been pioneering the use of extended family groups, known as kinship groups, to effectively distribute Mectizan. Developed by Carter Center Senior Epidemiologist and native Ugandan, Dr. Moses Katabarwa, the kinship approach has been adopted by the Uganda government as national health policy and has provided positive results for other programs such as malaria control and prevention of infant mortality.

Strong political and financial support from the government and active community participation throughout endemic districts were critical to the program's early progress. In 2007, Uganda and Sudan became the first African countries to announce the goal of nationwide elimination of river blindness (onchocerciasis). A year later, The Carter Center helped the Uganda Ministry of Health to establish the Uganda Onchocerciasis Elimination Expert Advisory Committee (UOEEAC) to ensure river blindness elimination efforts were vigorously carried out and supported with scientific data.   In 2008 The Carter Center also supported the establishment of a molecular diagnostic laboratory at the Ministry of Health in Kampala to support the elimination program, in collaboration with partners at the University of South Florida.

By 2012, the River Blindness Elimination Program assisted twice per year community-directed Mectizan treatment and health education in the vast majority of endemic districts, as well as provided about more than 2.8 million treatments (or 87 percent) of the national output in program areas. Also that year, with Carter Center assistance, Uganda trained or retrained more than 38,000 community-directed distributors and 8,800 community-directed health supervisors.

In 2015, more than 5 million doses of Mectizan were distributed in all of Uganda, and semi-annual treatments were achieved in nearly all target areas for treatment. Vector control or elimination continues to be conducted in selected areas using the safe and effective larvicide Abate (Temephos), donated by BASF.

The World Health Organization verified in 2017 that transmission had been eliminated in 15 of Uganda’s 17 transmission zones (foci), positioning Uganda to achieve its goal of nationwide elimination by 2020. Over 1.7 million Mectizan treatments no longer are needed for onchocerciasis, the greatest number of Mectizan treatments stopped for onchocerciasis in the world. 

+Controlling Trachoma

Of the 229 million people living in trachoma endemic districts globally, about 10.8 million live in Uganda, where trachoma is known to be endemic in 36 districts. An estimated 1 million children under the age of 10 have active trachoma. Uganda launched its national trachoma program in 2006, focusing on the S and A components of the SAFE strategy (Surgery, Antibiotic distribution, Face washing, and Environmental improvement). About 10,000 people in Uganda have been blinded by trachoma.

In November 2014, The Carter Center was appointed coordinating partner in a five-year trachoma control program supported by the Queen Elizabeth Diamond Jubilee Trust and led by the Uganda Ministry of Health. The Center aims to make significant advances toward eliminating blinding trachoma in Uganda together with implementing partners Sightsavers and CBM (previously the Christian Blind Mission).

The Carter Center's Uganda Trachoma Initiative targets  trachoma-endemic districts in the Karamoja and Busoga regions to scale up the SAFE strategy, with a primary focus on the S, F, and E interventions.

Specifically, the Center helps lead efforts to provide surgeries to more than 38,000 people with advanced stages of blinding trachoma, known as trichiasis, to correct their in-turned eyelashes. In addition, The Carter Center coordinates activities to improve hygiene education and sanitation practices and works with all levels of government to improve access to safe water sources in the program areas. The Center helps ensure the use of preferred practices for trachoma, coordinates trainings for surgeons, and oversees the development of education training modules, among other activities.

+Increasing Food Production

The Carter Center also worked in Uganda to promote food security in the nation. Led by Nobel Prize Peace winner Dr. Norman Borlaug until his death in 2009, the agricultural development work was a joint venture between the Center's Global 2000 Program and the Sasakawa Africa Association.

Farmers received credit for fertilizers and enhanced seeds to grow test plots. These test plots often yielded 200 to 400 percent more crops, and farmers went on to teach other farmers, creating a ripple effect to stimulate self-sufficiency. In Uganda, the main objectives of the program were to improve cultivation of maize and the elimination of varieties of cassava that are susceptible to the cassava mosaic virus. A staple food, cassava crops have been devastated by this virus that has blighted extensive farmland in Uganda.

The program was so successful it enabled Uganda to help other nations. For example, in 2002, three consecutive seasons of large maize crops had kept the price of corn affordable. This abundance was beneficial to many Ugandans who began to enjoy increased food availability for home consumption. However, maize farmers were harmed by deflation in the value of their produce. Thus, the government took action by forming a grain traders' association. The association successfully exported more than 40,000 tons of excess maize to famine-stricken countries in southern Africa, such as Zambia and Malawi.

Also in 2002, 15,389 farmers participated in a demonstration to promote improved cereal farming systems hosted by The Carter Center and the Uganda Ministry of Agriculture, Animal Industries, and Fisheries. The program broadened the options of crops available for cultivation for farmers by introducing rice and pigeon peas.

Because resource-poor farmers found it difficult to organize into bodies that can make effective decisions and obtain services, "one-stop centers" were established in 2003 in Uganda to provide rural populations with access to agricultural services through farmer-owned and managed associations. The one-stop centers also bridged the gap between the rural poor and urban areas by bringing services closer to everyone in the community.

The Carter Center ended its agricultural activities in Uganda in 2011.

Read more about the Carter Center's agriculture work — with the Sasakawa-Africa Association — in Uganda

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Size: 241,038 square kilometers

Population: 39,570,125

Population below poverty line: 19.7 percent

Life expectancy: 56 years

Ethnic groups: Baganda, Banyankole, Basoga, Bakiga, Iteso, Langi, Acholi, Bagisu, Lugbara, other

Religions: Roman Catholic, Protestant (Anglican, Pentecostal/Born Again/Evangelical, Seventh-Day Adventist, Baptist), Muslim, other, none

Languages: English (official), Ganda or Luganda, other Niger-Congo languages, Nilo-Saharan languages, Swahili, Arabic

Source: U.S. Central Intelligence Agency World Factbook 2018



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