As Uganda’s older population grows, gerontologist Dr Arthur Namara Araali is calling for better healthcare, social protection and community support to help older people live with dignity, purpose and independence.
Uganda is one of the world’s youngest countries, making ageing easy to overlook in public discourse. Yet behind the youthful population is another demographic reality, about 2.3 million Ugandans, or five percent of the population, are aged 60 and above.
For Dr Arthur Namara Araali, a gerontologist, researcher and director of Health Nest Uganda, that growing number is a reality the country can no longer ignore.
‘I joined the field of gerontology after recognising that older persons were among the least visible groups in health and social policy despite carrying a heavy burden of chronic disease, poverty and caregiving responsibilities,’ he says.
His academic training and research gradually drew him towards ageing and eventually led him to specialise in gerontology.
But his work has also challenged some of his own assumptions about growing old.
‘What surprised me most was the resilience of older people. Despite limited resources, many continue to care for grandchildren, contribute economically and provide social leadership in their communities.’
Complex needs
In Uganda, a person aged 60 and above is considered an older person. As this population grows, so does the need for healthcare that can address the complex conditions associated with ageing.
‘Older Ugandans are increasingly affected by non-communicable diseases, particularly hypertension, diabetes, stroke, heart disease, arthritis, cancer, vision and hearing impairment, dementia, depression, and other age-related conditions,’ Dr Namara says.
Many live with several of these conditions at the same time, making treatment more complicated and often requiring long-term care.
Yet accessing appropriate services remains difficult. Older people may have to travel long distances to health facilities, struggle with transport, face medication shortages and high healthcare costs, or spend long hours waiting for treatment.
Uganda also has limited geriatric services and few healthcare workers trained specifically in caring for older people.
Those living in rural areas often face the greatest barriers.
But Dr Namara cautions against viewing older people primarily through the lens of illness and dependency.
Many continue to care for grandchildren, support households, preserve cultural knowledge and provide leadership in their communities.
For him, Uganda’s response must, therefore, go beyond treating disease. It should include age-friendly health services, social protection and community support that allow people to grow older with dignity and independence.
A system built around the young
Uganda has invested heavily in specialised health services for women and children, but comparatively little attention has been paid to the needs of older people.
Dr Namara says this reflects the historical priorities of the health system.
‘Health systems in Uganda and many other low-income countries were developed at a time when maternal mortality and child mortality were the most urgent public health concerns.’
Those investments have saved many lives, but the needs of older people received comparatively little attention.
‘Today, Uganda’s population is ageing steadily, yet specialised geriatric services remain limited. Older persons often seek care in facilities that are not equipped to address the complex health challenges associated with ageing.’
The shortage of health workers makes the situation worse. Uganda has about 2.06 doctors per 10,000 people, according to Dr Namara, while even fewer have specialised training in gerontology or geriatric medicine.
As a result, health workers may find themselves managing conditions such as dementia, frailty, falls, multiple chronic illnesses and the effects of taking several medicines at once without adequate specialised preparation.
For older patients, this can mean delayed diagnosis, inadequate follow-up, long waiting times and fragmented care.
‘Healthcare workers are frequently overstretched, making it difficult to provide the comprehensive and patient-centred care that older adults require.’
The gaps extend beyond hospitals. Communities also have limited rehabilitation, mental health, outreach and home-based care services, leaving families to shoulder much of the responsibility.
‘Families, therefore, shoulder a significant burden, often becoming informal caregivers without the necessary knowledge, training, or financial support.’
Dr Namara believes Uganda needs to prepare before an ageing population places even greater pressure on families and the health system.
‘The challenge is not merely to help people live longer, but to ensure they can age with dignity, health, and independence.’
Grandmother who changed his perspective
Working with older people has taught Dr Namara ‘humility, patience and the value of listening’.
‘Ageing is not merely a biological process but also a social and emotional journey.’
One woman, in particular, changed how he understood ageing. She was an 82-year-old grandmother caring for three grandchildren after losing her adult children. She was also living with hypertension, arthritis and declining vision.
‘By every conventional measure, she was vulnerable and in need of support. However, what struck me most was not her illness but her strength.’
During one conversation, she told him: ‘I may be old, but I still have people who depend on me.’
‘That statement changed my understanding of ageing.’
Despite chronic pain and financial hardship, the woman cultivated a small garden, cared for her grandchildren and remained a source of wisdom in her community.
‘What made her story particularly powerful was that she never saw herself as a burden. While others viewed her as someone needing assistance, she viewed herself as a caregiver, provider, and mentor.’
For Dr Namara, the experience meant healthy ageing is about more than the absence of disease.
‘It is the ability to maintain dignity, purpose, independence, and meaningful relationships despite the challenges that come with growing older.’
Ageing is not helplessness
One of the biggest barriers to improving the lives of older people, Dr Namara says, is society’s perception of ageing.
‘Many people assume that ageing automatically means sickness, dependence, weakness, or irrelevance. In reality, growing older is a natural stage of life, and many older persons remain active, productive, and engaged well into later years.’
He also rejects the idea that all older people experience ageing in the same way.
‘Some people remain physically and mentally healthy into their eighties and nineties, while others may develop health conditions much earlier. We need to move away from stereotypes and recognise the diversity, capabilities, and contributions of older persons.’
Investing in older people, he says, should not be seen as competing with investment in younger generations.
‘Healthy ageing benefits the entire society. Older persons are caregivers, custodians of culture, sources of wisdom, and important contributors to community development. Supporting them is not charity; it is a social and economic investment.’
When families are overwhelmed
Families often struggle to care for older people, particularly when they face dementia, disability or chronic illness.
Dr Namara says families should respect older people’s independence, involve them in decisions and address their emotional needs, not just provide food, shelter and medication. Caregiving can also cause stress and financial strain, while stigma may lead to isolation. He condemns the abandonment of older people, reminding society that ‘ageing is not someone else’s problem. If we are fortunate, we will all grow old one day.’
Preparation is key
Dr Namara founded Health Nest Uganda to address gaps in services for older people, focusing on healthy ageing, preventive care, research, advocacy and caregiver support. He believes preparation for old age should begin early, with lifestyle choices made decades before retirement.
However, individual responsibility alone is not enough. Uganda also needs stronger geriatric services, community-based care, social protection and age-friendly infrastructure. As the country’s older population grows, Dr Namara says ageing should be seen as a sign of progress rather than a burden. He remains optimistic that Uganda can avoid a crisis if it starts preparing now.