Will pressure to encourage public sector workers to exercise slow the rise of non-communicable diseases in Uganda?

It’s 5 p.m., a chilly Friday evening. As music plays from a portable speaker across the yard at the Ministry of Health headquarters in Uganda’s capital, Kampala, a handful of workers gather to take part in a weekly aerobics class.

High-intensity exercises, conducted under the supervision of a fitness trainer, usually last just over an hour. This is the right time for workers to meet the World Health Organization’s (WHO) recommended target of 75 minutes of vigorous-intensity physical activity or 150 minutes of moderate-intensity physical activity that adults need each week to maintain good health.

While this is not a mandatory activity and the number of staff taking part varies from week to week, active participation by all staff is strongly encouraged, Dr Gerald Mutungi, Deputy Commissioner responsible for the Prevention and Control of Non-Communicable Diseases (NCDs). in the Ministry of Health – informs Equal times.

Mutungi says the aim is to promote a culture of regular physical activity in workplaces, which improves the health and well-being of employees and ultimately helps reduce the effects of a sedentary lifestyle.

“Office workers spend most of their working time in a sitting position. If they do not exercise regularly, the risk of developing diseases such as obesity and hypertension becomes high,” notes Mutungi.

The government, through the Ministry of Health, first launched the idea of ​​physical activity in the workplace in 2018. This was followed in the same year by the launch of the first National Physical Activity Day – a campaign to draw public attention to the growing burden of non-communicable diseases in the country.

The initiative did not fully take off due to disruptions caused by the Covid-19 pandemic. However, for the past two years, health ministry employees have been participating in weekly physical exercises.

Now the government is resuming an initiative to cover all workers, starting with public sector workers. While data on the actual number of public sector workers in Uganda is limited, pre-pandemic estimates put the number at just shy of 60,000.

In a letter addressed to all ministries, departments and agencies in March, the head of the national public service and cabinet secretary Lucy Nakyobe Mbonye wrote: “It is my request to initiate two-hour weekly physical exercise sessions in relevant units for the purpose of promoting good health. Give this issue the attention it deserves because it will help save the lives of your staff and reduce the burden of disease.”

Although this was initially reported as an “order”, it was actually a “recommendation”. The ministry was also informed that the exercises should take place after the official end of work at 5 p.m. so that it does not interfere with the employees’ daily work schedule and does not involve high financial costs.

“Most of the physical activities we encourage, such as jogging and walking, do not require any additional costs from the employer. The only cost that the employer can incur is the purchase of water for staff or hiring a trainer and musical equipment for aerobics,” says Mutungi.

Non-communicable diseases: a major risk factor

Physical inactivity has been highlighted as a major risk factor for people developing non-communicable diseases such as cancer, chronic respiratory diseases, cardiovascular diseases, diabetes and mental illness.

A 2014 study on risk factors for non-communicable diseases in Uganda (the more recent 2022 Uganda Demographic and Health Survey has not yet been published in full) shows that 5 percent of Ugandans are physically inactive, 20 percent are overweight or obese, and 24.3 percent of Ugandan adults had elevated blood pressure that required treatment.

Although traditionally the vast majority of Ugandans have engaged in agriculture as their main source of income, in recent decades an increasing number of people have moved to urban centers where changing lifestyles and dietary habits that include foods high in salt, sugar and fat contribute to a sedentary lifestyle. lifestyle and obesity.

“People living in urban areas are at a higher risk of obesity compared to those living in rural areas. Lack of physical activity is mainly a problem for the urban working class because in rural areas people engage in more physical activity than recommended. That is why we decided to initiate fitness exercises among employees, especially those in cities where lack of physical activity is a big problem,” says Mutungi.

According to the 2021 National Workforce Survey, rural people were more engaged in subsistence farming at 48% compared to their urban counterparts who were more engaged in formal work at 64%.

However, health risks from non-communicable diseases are not just a Ugandan problem. According to WHO, worldwide, diseases related to physical inactivity cause 41 million deaths annually.

WHO estimates that in 2022 Status Report on Physical Activity that between 2020 and 2030, 500 million people will develop heart disease, obesity, diabetes or other non-communicable diseases as a result of physical inactivity, resulting in medical costs of up to $27 billion a year unless governments take urgent action to encourage more physical activity among their populations.

Physical activity leads to less employee absenteeism resulting from poor health, and thus to reduced medical expenses. In Uganda, the economic costs of treating non-communicable diseases such as type 2 diabetes in both private and public healthcare facilities were documented in a 2023 study by the economic policy think tank, the Center for Economic Policy Research. For example, in 2022, as much as 2.2 trillion Ugandan shillings (approximately $500 million) was spent on drugs, treatments and complications resulting from type 2 diabetes, with households bearing the greatest financial burden.

“Non-communicable diseases place a burden on our healthcare system. Therefore, the fight against this phenomenon should be collective and individual. When you have diabetes, you can’t be productive. When you have high blood pressure, you can’t be productive,” notes Mutungi.

What employees say

Jackie Namubiru, 34, engaged in weekly physical activity at the Ministry of Health, where she works in the finance department of Uganda’s National Expanded Immunization Programme.

She previously claimed that her work schedule did not allow her enough time for any physical activity outside of work. But now she’s happy to get some much-needed training from the comfort of her workplace.

What’s more, she says it doesn’t interfere with her work schedule, as sessions take place once a week after official working hours.

“Our jobs, especially in finance, involve sitting for long hours, which causes fatigue and tension throughout the body. But the weekly exercise helped me relax and made me feel good and light. I can now walk up the stairs and not feel short of breath,” says Namubiru.

Apart from physical fitness, Namubiru adds: “It has improved my productivity because I no longer feel tired. I can now work longer hours without feeling tired.”

Encouraging workers to be more physically active is a welcome move, says Musa Okello, president general of the National Organization of Trade Unions (NOTU). Equal times. Okello notes, however, that for such an initiative to be successful and have a much greater impact on the health of workers and the general public, the government must invest in infrastructure that promotes physical activity, such as pedestrian walkways and bicycle paths.

“Employers must also design workspaces in a way that allows employees to stay active. Many workplaces do not have the space needed for physical exercise,” Okello says.

The government says its efforts to combat non-communicable diseases go beyond just promoting an active lifestyle. Policies supporting healthier diets and reducing salt, tobacco and alcohol consumption, as well as increasing overall awareness of risk factors for non-communicable diseases, are also key priorities.

For example, according to the government, the law passed by Parliament in 2015 banning smoking in workplaces and other public places has played a key role in protecting people from the dangers of secondhand smoke and improving the overall health of citizens.

The government also hopes that the Alcoholic Beverages Control Act 2023 will help regulate the production, import, sale, consumption and advertising of alcoholic beverages, while also banning the sale of alcoholic beverages to persons under 18 years of age.

“With the introduction of these regulations, we expect fewer people will have access to alcohol or tobacco products. These interventions will help us significantly reduce the burden on NDCs in the country,” notes Mutungi.

For now, the Ministry of Health is developing national physical activity guidelines, which will outline the different types of physical activity you can do, depending on factors such as age and health.

“Once we disseminate these guidelines (in the future, yet to be determined), we will be able to check which entities have started physical activity,” he adds.