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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.

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. 

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

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® (ivermectin, donated by Merck & Co., Inc.). The work expanded the Center's involvement in the country, which had begun 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 health education, Mectizan distribution, and vector control.

A unique aspect of Uganda’s success has been pioneering the use of extended family groups, known as kinship groups, for effective distribution of Mectizan.

Developed by Carter Center Senior Epidemiologist Moses Katabarwa, a native Ugandan, the kinship approach has been adopted by the Uganda government as a 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.

Vector control or elimination continues to be conducted in selected areas using the safe and effective larvicide Abate (Temephos), donated by BASF.

By 2019, eight of Uganda’s 17 transmission zones (foci) had received onchocerciasis elimination verification using World Health Organization guidelines. Seven foci had interrupted transmission, halted the distribution of Mectizan, and moved to a three-year post-treatment surveillance (PTS) phase; one large transmission zone was reclassified “transmission interruption suspected.” Only the Lhubiriha focus, a small transmission zone in western Uganda, with a potential cross-border transmission with the Democratic Republic of Congo, has ongoing transmission. Uganda is nearer to achieving its goal of interrupting onchocerciasis transmission nationwide by 2023. Over 2.9 million Mectizan treatments are no longer needed for onchocerciasis.

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® (ivermectin, donated by Merck & Co., Inc.). The work expanded the Center's involvement in the country, which had begun 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 health education, Mectizan distribution, and vector control.
A unique aspect of Uganda’s success has been pioneering the use of extended family groups, known as kinship groups, for effective distribution of Mectizan.

Developed by Carter Center Senior Epidemiologist Moses Katabarwa, a native Ugandan, the kinship approach has been adopted by the Uganda government as a 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.

Vector control or elimination continues to be conducted in selected areas using the safe and effective larvicide Abate (Temephos), donated by BASF.

As of mid-2021, 10 of Uganda’s 17 transmission zones (foci) had eliminated onchocerciasis according to World Health Organization guidelines. Five foci had interrupted transmission, halted the distribution of Mectizan, and moved to a post-treatment surveillance (PTS) phase; interruption of transmission is suspected in one other focus. Only the Lhubiriha focus, a small transmission zone in western Uganda, with a potential cross-border transmission with the Democratic Republic of Congo, has ongoing transmission. Uganda is nearer to achieving its goal of interrupting onchocerciasis transmission nationwide by 2023. Over 2.9 million Mectizan treatments are no longer needed for onchocerciasis.

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 aimed 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 targeted trachoma-endemic districts in the Karamoja and Busoga regions to scale up the SAFE strategy, with a primary focus on the surgical, facial cleanliness, and environmental improvement interventions. At the start of the project, trachoma was endemic in 36 of the 122 districts throughout the country, where an estimated one-third of the population resides and was at risk of infection. By the end of the initiative period, there were only two endemic districts remaining in the entire country.
The initiative built more than 15,000 latrines and provided sight-saving surgery to more than 38,000 people to correct the in-turned lashes of patients with advanced trachoma, known as trachomatous trichiasis.

The initiative also coordinated training for surgeons and health workers in the region. In addition, The Carter Center coordinated activities to improve hygiene education and sanitation practices and worked with all levels of government to improve access to safe water sources in the program areas. It invested significantly in sanitation and hygiene programs in 17 districts, creating new water points, establishing water and sanitation and hygiene (WASH) club activities in schools, and training over 50,000 volunteers on WASH methods.

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.