KAMPALA, UGANDA — Aisha Rashid Lukwago grew up around medicinal plants. Her father was a prominent herbalist in the 1980s, known for his work treating patients with symptoms linked to HIV and AIDS when Uganda was among the countries in Africa hardest hit by the disease.
Lukwago says after her father’s death, she wanted to follow in his footsteps, so she started her own herbal medicine practice in 2006, after graduating high school, when she was only 18.
Today she sits in her office, a kiosk along one of the busiest streets in Namasuba, a neighborhood in central Kampala. Outside, a line of patients wait to consult her on a range of health issues: from ulcers to high blood pressure, diabetes and hair loss. Although her practice is thriving, Lukwago says that in recent years, getting access to the medicinal plants she needs to treat her patients has become increasingly difficult.
“When I was starting, forests were free, and we could just go to someone’s forest and collect the herbs,” she explains. “But these days, one must pay even if it’s just to get mango tree leaves.”
In Uganda, 60% of the population still relies on traditional medicine for day-to-day health care because it is cheaper and more accessible than Western medicine. But the country’s widespread deforestation, resulting from agricultural encroachment, firewood production and urban development to accommodate a growing population, has led to an extensive loss of medicinal plants and herbs.
Herbalists say that because plants such as Warburgia ugandensis, which is used to treat symptoms of malaria and cough, and Zanthoxylum leprieurii, used to treat tuberculosis, have become increasingly scarce, private forest ownership has increased, driven by a realization that owners could profit from growing demand. But such curative herbs often don’t come cheap.
“The only sustainable solution for me was to grow my own forest of herbs,” says Lukwago, who five years ago bought a piece of land in Mukono district, about 30 kilometers (19 miles) from her private practice. She planted a 5-acre botanical garden that she now uses for her practice’s herbal supply.
Unlike Lukwago, many herbalists do not have enough land to grow their own plants.
Patricia Lindrio, GPJ Uganda
Patricia Lindrio, GPJ Uganda
Mathias Nakedde, a traditional healer for over 20 years, says until a few years ago he would spend 30,000 Ugandan shillings (8 United States dollars) for a two-week supply. Today the cost has risen to 80,000 shillings (about 22 dollars), as he now must buy the herbs from private forest owners.
Because most of the local forest land has either been cleared or privatized, Nakedde has to travel longer distances — sometimes as far as 300 kilometers (186 miles) from Mpigi, his hometown in central Uganda — to access the plants he needs. “This means that it can take days to get certain herbs,” he says. Other tree species, like Prunus africana, which is used to treat symptoms of prostate cancer, are now impossible to find. Those trees “have been cleared because they make good charcoal,” says Nakedde. “These valuable trees take over 10 years to grow.”
From 2001 to 2021, Uganda lost 967,000 hectares (2.3 million acres) of tree cover. According to Global Forest Watch, an online monitoring tool based on satellite imagery, the vast majority of tree cover loss is the result of the country’s expanding agriculture, which must meet the growing needs of a population that spiked from 10 million people in 1970 to over 48 million today.
“Scarcity means prices go up,” says Nakedde. “Few patients can afford the medicine. For example, herbs I used to sell at 30,000 Ugandan shillings [8 dollars] now cost 50,000 shillings [about 13 dollars]. This has also made treatment expensive.”
Peter Wandera, 62, has relied on herbs to manage symptoms of his prostate cancer for two years. “I was using Western medicine before, but it became so expensive,” he says. Wandera thought switching to herbal medicine would be affordable, but prices have increased over time. “Now instead of taking the medicine when I am in pain, I can only use it at night,” he says.
As access to Western medicine remains limited in the country, Ugandans rely heavily on traditional healers, who are far more available, with a ratio of one for every 400 patients, as opposed to one Western medicine practitioner for every 20,000 patients.
Gerald Ahabwe, the general secretary of the Uganda Sociology and Anthropological Association, says herbal medicine has long been used to manage a range of common conditions like malaria, digestive and respiratory problems, HIV and AIDS, toothaches, skin diseases and childbirth complications. A 2022 study from the London School of Economics found that, at the beginning of the pandemic, before COVID-19 vaccines were available, patients in Uganda opted for local herbal treatments to manage their symptoms.
Ugandans are not alone in their widespread use of medicinal plants. According to a report by the government, “nearly 80% of the populations in developing countries” uses traditional medicine as a first line of treatment before visiting a health facility.
Yahaya Sekagya, founder of the Dr. Sekagya Institute of Traditional Medicine and head of Prometra, a company dedicated to the preservation and restoration of African traditional medicine and indigenous science, worries that a lack of government interventions, such as investing in research and preserving medicinal plants, will hurt traditional medicine in Uganda. “There is a need for [the] government to allocate a few acres of land to herbalists so that we can grow medicinal value trees,” he says.
Professor John Stephen Tabuti, an ethnobotanist from Makerere University’s Department of Environmental Management, shares Sekagya’s concerns. “At the institutional level, there is little that has been done to protect the indigenous knowledge associated with herbal medicine,” he says. “There is no policy to protect herbal medicine or the associated knowledge.”
Patricia Lindrio, GPJ Uganda
In recent years, the Ugandan government has tightened security in most forest reserves to crack down on deforestation. As part of these efforts, it has also restricted herbalists’ access to forests, saying they contribute to the loss of trees.
John Michael Odeke, a marketer at the National Forestry Authority, says his agency’s mandate is to protect existing forests. “We are doing so by keeping away herbalists who are contributing to the destruction of trees, for example by debarking those that are of medicinal value,” he says.
Some practitioners have pointed out that a lack of access to healing plants could lead to malpractice, with traditional doctors relying on cheaper but dangerous adulterated or substandard products containing unknown ingredients whose interaction with other drugs is difficult to monitor. “This is a public health threat that needs to be taken seriously,” says Mukasa Joseph, an herbalist based in the Mpigi district.
Nakedde believes that plant scarcity and higher prices will push an increasingly higher number of traditional practitioners out of business. “I will do my part and plant the few plants I can just to ease the financial burden on myself,” he says. “But I call on the government and the world to rescue us from the burden of deforestation.”