People & Power

Uganda’s Health Pyramid

We investigate allegations involving a Chinese billionaire and a controversial alternative health scheme in Africa.

Living in a poor country with one of the worst doctor-patient ratios in the world – about one for every 24,000 people – it’s perhaps no surprise that many Ugandans are tempted by alternative remedies, even though there’s often little evidence to support the claims made about their efficacy in treating or preventing disease. But the phenomenon does beg many questions, not least of which are who is really benefiting from the sale of these products and how exactly are they marketed?

We’d heard reports about one particularly controversial business, a complex multi-level marketing scheme run in Uganda under the aegis of a Chinese company called Tiens, which produces food supplements.

Its products, we’d been told, were being inappropriately sold as medications – in some cases for very serious diseases. We had also heard disturbing claims that its sales representatives, or “distributors” as they are known, were being invited to invest large sums of money in Tiens products, when in reality there was little chance of most of them ever making the kind of dazzling returns that the company promised.

So we sent a filmmaking team and Ugandan reporter Halima Athumani to investigate further.


by Priya Biring

Three years ago a close friend in the UK started to work for a company that sold questionable products at high prices.

She would sell them door-to-door, from 8am to 11pm, six days a week, with the promise that if she sold enough units and recruited enough people into her team, she would be promoted to the position of manager and would no longer have to “work in the field”. She received no salary and worked completely on commission. If she had a good sales week the company would insist she spend it on her team. She became obsessed with wealth and often spoke at length about the lavish lifestyle she would lead once her business took off, emulating that of her “upline” manager.

It was only later that I realised that the only money she could make was from recruiting others to join the business. This was an aspect of the job she didn’t like to advertise and clearly struggled with.

Over the years, I watched as her health deteriorated, her debts increased and she severed every relationship she had to achieve success. What struck me most about this “job” was that she constantly blamed herself for not doing well. It was as if she had been brainwashed to believe that the reason she wasn’t making money had nothing to do with the company’s exploitative business model, but was due to her own ineptitude in being unable to sell expensive products to people on their doorsteps.

I could not understand how such businesses thrived and grew. How were distributors sustaining themselves if few were buying the products? Fascinated, I started to investigate these schemes and discovered that most used a business model called Multi-Level Marketing (MLM), which tells people they’re going to get rich selling products to friends and family and door-to-door, but also tells them to recruit those very same customers on to their marketing team. It’s a model used by many companies – selling everything from cleaning materials to mobile phone subscriptions and dietary products.

So the subject of this investigation, Chinese-owned herbal supplement company Tiens, one of the largest multi-level marketing companies in the world, is by no means unique in using such techniques. What marks it out is that it seems to be targeting so much of its activity in African countries with inadequate healthcare systems, where people are struggling desperately to get medical help.

Our Ugandan colleague Halima Athumani had told us that life expectancy in her country is among the lowest across the globe. She described the lack of insurance plans, health centres often lacking adequate doctors or medicine, and the best doctors – those who haven’t been tempted overseas – frequently found working in unsanitary conditions with outdated equipment.

In this environment, then, it was understandable why many people might be persuaded that Tiens products offered an accessible alternative to conventional medicine. But on the other hand, we knew its products are only licensed in Uganda as nutritional or food supplements. So how and why would people ever use them like medicines?

From what we knew about the close-knit nature of MLMs, we realised that to fully answer this question meant going undercover. So, equipped with a hidden camera, Halima went to get a check-up at a Tiens “clinic” in downtown Kampala.

The result was worse than we had feared. As you can see in the film, the “distributor”, a man called Frank – whom we later discovered had no medical qualifications whatsoever – uses a device called an “Aculife Magnetic Wave Machine” to diagnose Halima with a variety of very serious illnesses for which he prescribes only Tiens products.

Needless to say, Halima is perfectly healthy and the device is a nonsensical toy, but Frank put on a good show and if you had no reason to disbelieve him, the completely spurious consultation would have left you very disturbed and desperately wanting the treatment. Later, when looking through a sales handbook given to Tiens distributors, we also found – albeit after a medical disclaimer – disturbing suggestions that its products could prevent a number of life-threatening conditions such as cancer and HIV/Aids.

Living in a poor country with one of the worst doctor-to-patient ratios in the world encourages many Ugandans to use alternative remedies [Milante/Getty Images]
Living in a poor country with one of the worst doctor-to-patient ratios in the world encourages many Ugandans to use alternative remedies [Milante/Getty Images]

But there was more to this story than just medical quackery. We also wanted to investigate the allegations we’d heard about Tiens drawing people into a commercial relationship that could take over and ruin their lives.

Tiens products are expensive for most Ugandans, especially when compared with off-the-shelf equivalents, but we’d been told that the company tells customers the products will be cheaper if they become a distributor. Then – once they have been signed up and have paid their fees – the company uses clever psychological techniques to convince them to keep working, even when they are not personally making any money.

So we asked Halima to go to the weekly “training sessions” with her hidden camera.

This, we knew, was risky. I’d spoken to people who had been investigating MLM practices for years and they thought Halima, who would be attending training sessions over several weeks, might actually be in danger of being convinced and recruited.

She was going to be subjected to a barrage by the Tiens motivational speakers. We couldn’t be with her the whole time, so we agreed to monitor her with regular phone discussions to check that she was not suddenly having unrealistic dreams of becoming rich through selling food supplements.

Luckily she isn’t so easily fooled, and was able to document how Tiens convinces people to stay loyal through reinforcement of the idea that distributors are starting a new life and by its unrelenting “blame and shame” rhetoric about personal failure and not selling enough products. Only their inadequacies and doubts – and those of sceptical family and friends who should, of course, be dropped – were barriers to the recruits achieving great wealth.

When we met up with Michael Halangu, a former Tiens distributor, he confirmed these were the same techniques that had kept him in the business for years. In our interviews he was open about how they fooled him and how much money he lost, but the psychological impact had gone deeper; although he could see all the aspects of the scam, he still blamed himself for not having made a success of it.

But while it is clear that the poor, weak and vulnerable are particularly susceptible to such schemes, even strong people can succumb under enough pressure. Michael is an intelligent and determined man with a college degree, and we even met a university professor among the distributors at one Tiens event we attended.

Eventually, as you will see, we were able to put some of the points raised in this film to a Tiens representative. The company told us about its 5,000 distributors in Uganda and its operations across the African continent and how if people worked hard enough they too could enjoy the cars and yachts and millionaire lifestyles that their top distributors enjoyed. The company was less illuminating about those who hadn’t been so lucky – or those of its distributors who, after carrying out bogus medical diagnoses, were happy to con gullible members of the public into buying Tiens products.

Editor’s Note: the filmmakers would like to thank James Wan, African Arguments and the China-Africa reporting project for their help in conducting this investigation