This varies meaningfully by country and city, so here is the honest overview by category.

For schooling, Nairobi has the most developed international school scene in the region by a clear margin, with a wide range of curricula, British, American and International Baccalaureate among them, and a long track record of serving the expat and diplomatic community. It is also the most expensive, with fees at the top schools reaching genuinely significant annual sums.

Kampala has a solid, if smaller, range of international schools, generally serving the NGO, diplomatic and business expat community well, with a mix of curricula available, though the overall number of options is lower than Nairobi’s.

Kigali’s international school offerings have grown substantially as the international community there has expanded, and quality is generally good, though the range of curriculum choice is narrower than in Nairobi.

Across all three, applying well ahead of a planned move is important, as good schools do have waiting lists, particularly for popular year groups.

For healthcare, Nairobi again has the most developed private healthcare infrastructure, with hospitals capable of handling most routine and a good range of more serious care needs locally. Kampala and Kigali both have decent private clinics and hospitals for general and routine care, and this has improved steadily in recent years, but for more complex or specialised treatment, it remains common practice for expats and increasingly for well-off local residents to fly to Nairobi, or further afield to South Africa, India or Europe.

Comprehensive international health insurance with medical evacuation cover is something we would consider essential rather than optional for any family relocating to the region, precisely because it covers the gap between what is reliably available locally and what may require travel to access.

Water quality, malaria prophylaxis for children, and routine paediatric care are all manageable with proper preparation and a good local doctor, and none of this should be a reason to avoid relocating, but going in informed rather than assuming Western-equivalent healthcare is available everywhere makes for a much smoother transition.