It is 5:00 pm on a chilly Friday evening. As music plays from a mobile speaker across the yard at the Ministry of Health headquarters in Uganda’s capital, Kampala, a handful of staff converge to participate in their weekly aerobics class.

The high-intensity exercise, conducted with the guidance of a fitness trainer, usually lasts slightly over an hour. It is adequate time for the employees to achieve the World Health Organization (WHO)-recommended goal of 75 minutes of vigorous-intensity physical activity or 150 minutes of moderate-intensity physical activity that adults require weekly to maintain good health.

Although it is not a mandatory activity, and the number of staff who take part varies each week, active participation of all employees is highly encouraged, Dr. Gerald Mutungi, the assistant commissioner in charge of non-communicable disease (NCD) prevention and control at the Ministry of Health tells Equal Times.

Mutungi says the goal is to promote a culture of regular physical activity at workplaces that improves the health and well-being of workers and ultimately contributes to reducing the effects of sedentary lifestyles.

“Office workers spend most of their working hours sitting. If they don’t exercise regularly, their risk of developing diseases such as obesity or hypertension becomes high,” Mutungi notes.

The government, through the Ministry of Health first initiated the idea of workplace physical activity in 2018. This was followed in the same year with the launch of the first National Day of Physical Activity, a campaign to draw public attention to the growing burden of NCDs in the country.

The initiative did not fully take off due to disruptions caused by the Covid-19 pandemic. But over the past two years, employees at the health ministry have been taking part in weekly physical exercises.

Now the government is reviving the initiative to expand to all workers, starting with those in the public sector. Although data on the actual number of public sector workers in Uganda is limited, pre-Covid estimates put the figure at just shy of 60,000.

In a letter issued in March to all ministries, departments and agencies, the head of the country’s public service and cabinet secretary, Lucy Nakyobe Mbonye wrote: “This is to request you to initiate a two-hour weekly physical exercise session in your respective entities for purposes of promoting good health. Give this matter the attention it deserves because it will help to save the lives of your staff and reduce the disease burden.”

Although it was initially reported as an “order”, it was in fact a ‘recommendation’. It has also been communicated to ministries that the exercises should be conducted after the official close of work of 5:00 pm so that it does not interfere with employees’ day-to-day work schedules and does not come at a high financial cost.

“Most of the physical activities we are encouraging such as jogging or walking do not require any extra cost on the part of the employer. The only cost that may be incurred by the employer is buying water for the staff or hiring a trainer and music system for aerobics,” says Mutungi.

NCDs: a major risk factor

Physical inactivity has been highlighted as a major risk factor for people who develop NCDs such as cancer, chronic respiratory diseases, cardiovascular conditions, diabetes, and mental illness.

A 2014 survey on Uganda’s NCD risk factors (a more recent Uganda Demographic and Health Survey from 2022 is yet to be published in full) reveals that 5 per cent of Ugandans are physically inactive, 20 per cent are either overweight or obese and 24.3 per cent of adult Ugandans had raised blood pressure that needs treatment.

Although traditionally a large majority of Ugandans engaged in farming as their primary source of livelihood, recent decades have seen more people move to urban centres where a change in lifestyle and eating habits comprised of foods high in salt, sugar, and fat are contributing to sedentary lifestyles and obesity.

“People in urban areas are more likely to be obese compared to those in rural settings. Physical inactivity is mainly a problem of the urban working class because, in rural areas, people engage in more physical activity than is recommended. That is why we have decided to initiate fitness exercises among workers, and specifically those in urban settings where physical inactivity is a big problem,” says Mutungi.

According to the 2021 National Labour Force survey, rural residents were more engaged in subsistence agriculture – at 48 per cent compared to their urban counterparts who were more engaged in formal employment – at 64 per cent.

However, the health threat from NCDs is not just a problem for Uganda. Globally, diseases associated with physical inactivity account for 41 million deaths annually, according to the WHO.

The WHO estimates in its 2022 Status Report on Physical Activity that 500 million people will develop heart disease, obesity, diabetes, or other NCDs as a result of physical inactivity between 2020 and 2030, resulting in treatment costs of up to US$27billion annually, if governments don’t take urgent action to encourage more physical activity amongst their populations.

Being physically active leads to less absenteeism by employees as a result of ill health and therefore reduced expenditure in terms of treatment costs. In Uganda, the economic cost of managing and treating NCDs such as type 2 diabetes in both private and public health facilities for example, has been documented in this 2023 study by the policy think tank, Economic Policy Research Centre. In 2022 for instance, up to 2.2 trillion Ugandan shillings (approximately US$500 million) was spent on medication, treatment and the management of complications resulting from type 2 diabetes, with households bearing the largest financial burden.

“NCDs are putting a strain on our healthcare system. It should therefore be a collective and individual effort to fight it. When you have diabetes, you cannot be productive. When you have hypertension, you cannot be productive,” Mutungi notes.

What workers say

Jackie Namubiru, 34, has embraced the weekly physical activities at the health ministry where she works in the finance department of the Uganda National Expanded Programme on Immunisation.

Previously, she says that her work schedule did not provide her with enough time to engage in any form of physical activity outside of work. But now she is happy to get in a much-needed workout from the comfort of her workplace.

Moreover, she says it doesn’t interfere with her work schedule as the sessions happen once a week after official work hours.

“Our jobs, especially in finance, involve sitting for long hours and this causes fatigue and tension in the whole body. But the weekly exercises have been helping me to relax and make me feel good and light. I can walk up and down the stairs now and not feel out of breath,” says Namubiru.

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

Getting workers to be more physically active is a welcome move, Musa Okello, the chairman general of the National Organisation of Trade Unions (NOTU), tells Equal Times. However, Okello observes that for such an initiative to succeed and have a much greater impact on the health of workers and the general population, the government needs to invest in infrastructure that promotes physical activities, such as pedestrian walkways and cycling lanes.

“Employers also need to design workspaces in ways that allow employees to keep active. Many workplaces don’t have the space needed to engage in physical exercises,” says Okello.

The government says it is not just promoting an active lifestyle in its effort to fight NCDs. Policies that support healthier diets, and reduction in salt, tobacco and alcohol consumption, are also key priorities, as well as increasing general awareness about NCD risk factors.

For instance, a law passed by parliament in 2015 that bans smoking in workplaces and other public places has been crucial in protecting people from the dangers of second-hand smoke and improving the general health of citizens, according to the government.

Additionally, the government is also hoping that the 2023 Alcohol Drinks Control Bill will help regulate the manufacture, importation, sale, consumption and advertisement of alcoholic drinks while at the same time prohibiting the sale of alcoholic drinks to persons below the age of 18.

“With these laws in place, we expect to see fewer people accessing alcohol or tobacco products. These interventions will help us significantly reduce the burden of NDCs in the country,” notes Mutungi.

For now, the Ministry of Health is developing National Physical Activity guidelines which will spell out the different types of physical activities individuals can engage in based on factors such as age or health status.

“Once we disseminate these guidelines, [at a future date, as yet to be decided] we can then follow up to see which entities have instituted physical activities,” he adds.