Uganda’s health taxes stall as donor cuts reframe alcohol and soda levies as fiscal tools

Uganda faces a rising burden of noncommunicable diseases at precisely the moment when pressure to mobilize domestic health financing has intensified, yet taxes on alcohol and sugar-sweetened beverages remain stuck near the bottom of the country’s policy agenda. A new qualitative study published in Globalization and Health examines why these fiscal measures have failed to gain political traction, drawing on 25 semi-structured interviews with stakeholders from government, parliament, civil society, academia, industry and the media, alongside a review of 22 documents spanning 2015 to 2025. The researchers, guided by the Shiffman and Smith framework on political priority, identified barriers operating at three interacting levels: transnational norms that promoted health taxes but were constrained by regional tax harmonization commitments within the East African Community; domestic advocacy weakened by fragmented ministerial mandates, limited local evidence, retreating policy entrepreneurs and industry lobbying; and a national political environment shaped by multiparty legislative dynamics, the high cost of sponsoring private members’ bills and revenue-centric fiscal framing.

The stakes are considerable. By 2019, noncommunicable diseases caused one in three deaths in Uganda, with hypertension, diabetes, chronic respiratory diseases, cancer and cardiovascular diseases among the leading causes. Tobacco, alcohol and unhealthy diets are the country’s leading risk factors for morbidity and mortality. According to the World Health Organization STEPS survey, one in three adults in Uganda reported alcohol consumption in 2023, while a localized survey of adolescents and young adults found that one in three consumed sugar-sweetened beverages two to three times per week. Current smoking stood at 8.3 percent in 2023, down from 9.6 percent in 2014. Despite this burden, spending continues to prioritize communicable diseases such as HIV, tuberculosis and malaria, along with maternal and child health, and funding for noncommunicable diseases remains uncertain in 2026, in part due to limited transparency in what noncommunicable disease allocations actually are.

The study’s timing reflects a dramatic shift in Uganda’s health financing landscape. Since January 2025, geopolitical shifts and donor fiscal tightening have led to substantial reductions in external health funding, including the withdrawal or restructuring of major bilateral programmes that had historically supported health-system operations. The researchers trace this to the January 20th U.S. presidential signing of an executive order pausing foreign development assistance and the January 24th issuance of guidance requiring stop-work orders on existing foreign-assistance awards worldwide. This reset exposed longstanding structural dependence on donor financing and intensified pressure on the government to expand domestic revenue sources to sustain essential services, including health. In this altered fiscal environment, taxes on health-harming commodities resurfaced not only as population-health interventions but also as potential instruments for revenue mobilization.

Yet the study finds that this renewed attention has come with a critical caveat. The 2025 donor financing contraction acted as a focusing event that revived debate on health taxes primarily as domestic health financing stabilization instruments rather than as tools for preventing noncommunicable diseases. Before the financing shock, advocacy largely emphasized reducing harmful consumption and preventing disease. Following the reductions in external assistance, debates increasingly centred on fiscal resilience, sustainability and domestic revenue generation. The researchers conclude that aid transition may not simply increase demand for new revenue sources; it can also transform the framing through which public-health policies gain political traction, with health taxes becoming valued less for their preventive potential and more for their perceived contribution to maintaining health-sector financing amid growing fiscal uncertainty.

At the transnational level, global norm promotion clearly elevated awareness among policymakers but did not independently translate into policy adoption. The 2015 United Nations General Assembly resolution 70/1 incorporated commitments from Heads of State and Government, including Uganda, to develop ambitious national responses implementing the Sustainable Development Goals, including SDG 3.4 with its indicators focused on addressing the noncommunicable disease burden. Member states further reaffirmed under resolution 73/2 their commitment to strengthening policies for resilient health systems to treat people living with noncommunicable diseases while preventing and controlling their risk factors. The WHO’s Global Action Plan for NCDs outlined 16 “best buys,” later extended through 2030, including three interventions targeting harmful alcohol use, though early iterations notably omitted measures addressing excessive sugar-sweetened beverage consumption. Most recently, the WHO has spearheaded a 3 by 35 initiative, a global effort to increase the real prices of tobacco, alcohol and sugar-sweetened beverages by at least 50 percent by 2035.

However, these global commitments collided with regional institutional constraints. Officials noted that obligations under East African Community tax-harmonization arrangements, which seek to align commodity taxation across member states, limited perceived national flexibility to adopt differentiated health-tax structures. In practice, these regional commitments shaped how policy options were evaluated within ministries responsible for trade and finance, constraining the translation of global norms into legislation. A Ministry of Trade official explained in an interview that domestic taxes are where policy objectives might be manipulated, whether for health or industrial development, but that tariffs for international trade are a major trade policy tool, and the drivers of high taxes are largely not for health purposes but rather for the protection of domestic industry. Meanwhile, industry actors responded strategically to evolving global advocacy: document review showed expansion of multinational beverage production capacity and distribution networks in Uganda, reinforcing their economic embeddedness and strengthening their leverage in policy discussions, with industry narratives reframing taxation debates toward employment protection, investment promotion and industrial growth themes that resonated with Uganda’s development agenda centred on structural transformation and foreign direct investment.

Domestic advocacy faced its own structural handicaps. Conflicting institutional mandates weakened cohesion within the policy community, particularly between revenue-oriented and health-oriented agencies. Respondents described how performance expectations tied to revenue generation often conflicted with public-health framing of excise duty reform, with agencies frequently prioritizing narrow sectoral objectives. A Ministry of Health respondent noted that the Uganda Revenue Authority sometimes acts as a barrier because it wants to collect money and report the large amount of revenue it has collected. Although coalitions such as the Parliamentary Forum on Noncommunicable Diseases sought to bridge sectoral divides, their influence was uneven and frequently countered by coordinated industry lobbying. Respondents reported that industry actors sponsored stakeholder participation in consultations and emphasized economic contribution narratives to dilute reform proposals, with one ministry representative describing how industry sponsors stakeholders to attend meetings and oppose suggestions, while convincing those in the executive arm that taxes and jobs would be lost. Limited external financial support emerged as a defining feature: stakeholders reported difficulty securing donor resources for advocacy, evidence generation or legislative facilitation, with one civil society representative asking why ailments such as malaria, HIV and tuberculosis are easily funded while health taxes on alcohol find very few funders.

Political leadership for health taxes proved inconsistent, in part because of Uganda’s legislative architecture. The country’s system allows individual parliamentarians to introduce private members’ bills, which are advanced without executive sponsorship and require independent mobilization of financial and technical resources. Respondents described how this arrangement created vulnerability when policy champions withdrew or faced procedural barriers. One parliamentary respondent recounted introducing an alcohol-control bill that faced suspicion from the government side because the sponsor was from the opposition, leading the government to take over the bill, which then bounced back as a private member’s bill from the very person who was supposed to handle it as a minister. Subsequent reintroduction attempts encountered lobbying pressure and procedural objections; tax provisions were ultimately removed prior to parliamentary debate, and the bill still failed to advance. When Parliament declined to proceed with the alcohol control bill in August 2024, the reasons cited were its fiscal implications for government, an argument that undercut privately sponsored legislation lacking budget provisions. A civil society respondent noted that a private member’s bill is expensive, requiring consultations, drafting and parliamentary processes that health-sector actors cannot afford to sponsor.

Evidence credibility also functioned as a political battleground. Stakeholders frequently highlighted perceived gaps in locally generated evidence demonstrating the revenue and behavioural impacts of health taxes. Although international evidence was widely cited, respondents reported that policymakers often questioned its applicability within Uganda’s economic and consumption context. A Ministry of Health representative stated that efforts to convince colleagues in trade that increasing taxes on alcohol and sugar-sweetened beverages would generate more revenue and discourage consumption had not succeeded. The researchers caution that calls for further context-specific evidence should not be assumed politically neutral, noting that research on commercial determinants of health shows such demands are frequently deployed to delay policy action, though their findings cannot determine whether requests for local modelling reflected genuine uncertainty, strategic resistance or a combination of both. Uganda’s existing excise duties on soft drinks do not target sugar content, do not meet the recommended 20 percent threshold, and are driven mainly by revenue goals rather than health objectives, sitting within broader luxury goods duties. The routinized annual amendment process following the 2014 Excise Duty Act has entrenched incremental, revenue-centred adjustment as the default policy pathway, narrowing consideration of health-oriented alternatives.

The study concludes that health taxes on alcohol and sugar-sweetened beverages remain politically contested and weakly prioritized in Uganda, with their limited advancement reflecting the interaction of fragmented institutional mandates, competing sectoral incentives, industry influence, regional policy constraints and resource-intensive legislative processes that disadvantage public-health advocacy. The researchers recommend conducting more in-country and regional comparative research, strengthening technical and advocacy capacity to generate context-specific evidence demonstrating both health and fiscal benefits, securing institutional sponsorship and dedicated resources for health tax legislation rather than relying solely on private members’ bills, building broad-based political support across parties and sectors, and establishing mechanisms to protect legislators and policymaking processes from undue industry influence. They also note limitations: much of the empirical material reflects perspectives preceding or during the early stages of the 2025 financing contraction, industry perspectives were underrepresented due to access barriers, the framework does not explicitly theorize commercial determinants of health, the single-country focus may limit generalizability, and the emphasis on elite policy actors may underrepresent public, consumer and subnational perspectives. As external financing declines, the authors argue it will be essential to strengthen locally grounded evidence, cross-sector coalitions and integration of health objectives into fiscal reforms if health taxes are to serve as a durable policy option for mobilizing resources for health and preventing noncommunicable diseases.

Subject of Research: Political prioritization of alcohol and sugar-sweetened beverage taxation in Uganda

Article Title: Political prioritization of alcohol and sugar-sweetened beverage taxation in Uganda: Agenda dynamics amidst a shifting funding landscape

Article References: Ssegujja, E., Zakumumpa, H., Ssempala, R., Lwin, K. S., Koon, A. D., & Ssengooba, F. (2026). Political prioritization of alcohol and sugar-sweetened beverage taxation in Uganda: Agenda dynamics amidst a shifting funding landscape. Globalization and Health, 22(1), Article 69. https://doi.org/10.1186/s12992-026-01229-5

Image Credits: AI Generated

DOI: 10.1186/s12992-026-01229-5

Keywords: Uganda, health taxes, alcohol taxation, sugar-sweetened beverages, noncommunicable diseases, health financing, political prioritization, East African Community, industry lobbying, aid transition, excise duty, policy agenda-setting