Uganda’s health system is entering a new phase—one where the biggest challenge is no longer building it, but sustaining it. External funding is tightening. Domestic resources are under pressure. Demand for care is rising faster than both.

In this new reality, health is no longer just a social priority but a financing problem and a test of economic strategy.

For years, the system expanded on government investment, backed by strong external support.  Infrastructure grew. Services followed. But that model is now under strain. Expectations are rising. Citizens want better care, closer to where they live, and without the financial shock that so often comes with illness.

Uganda is already investing in health. The real question is whether that investment is sustainable and whether it is delivering value.

It was against this backdrop that policymakers, academics, and practitioners gathered at Makerere University on April 9 for a public lecture and high-level dialogue on health financing. At the centre of the discussion was a keynote by Ramathan Ggoobi, the Permanent Secretary to the Treasury.

The event was organised by Makerere University School of Public Health (MakSPH) in collaboration with the Ministry of Health and the Ministry of Finance, Planning, and Economic Development.

At the centre of that conversation was a keynote address by Dr. Ramathan Ggoobi, Permanent Secretary and Secretary to the Treasury, delivered under the theme “Investing in Health for Uganda’s Future: Delivering Vision 2040 through Smart and Sustainable Health Financing.”

He does not think about health the way most people in government do. He is not persuaded by the language of welfare. When he speaks about health, he reaches for the language of growth, productivity, and national wealth. In his view, the sector is not a cost centre. It is an economic engine.

“Health is not merely a social sector issue. It is an economic transformation issue, a productivity issue, and a national competitiveness issue,” he said, arguing that no country has achieved sustained growth without investing in human capital. Globally, human capital accounts for nearly 70% of national wealth. The World Health Organization (2021) estimates that every dollar invested in health can return four to nine dollars in productivity gains.

“Investment in health is not charity. It is growth finance. So, my first message is to treat health spending as an investment, not as consumption. Every shilling must buy measurable economic and social returns,” he emphases.

His views reveal a shift in how Uganda’s Treasury thinks about health financing. Spending must justify itself. Investments must deliver returns. And inefficiency is no longer just a technical issue but a fiscal problem.

Ggoobi’s worldview is shaped by the idea that Uganda’s long-term growth ambitions under Vision 2040, which is 13 years away, to achieve what he describes as a tenfold expansion to a $500 billion economy, will be decided not just by infrastructure or industry but by the quality of its human capital.

Globally, he notes, human capital accounts for the bulk of national wealth. Health, therefore, is not peripheral to development. It is central to it.

If health is an investment, then it must generate returns. If it does not, then something in the system is not working. “Every shilling must buy measurable economic and social returns,” he said.

This is where the optimism gives way to unease. Countries that have achieved and sustained middle-income status did so through deliberate, sustained, evidence-driven investments in human capital.

Uganda is working within tight fiscal limits. The national budget for 2025/26 stands at Shs 72.38 trillion, with about Shs 5.87 trillion going to health.

Government spending on health has increased over time, rising from about Shs 2.8 trillion a few years ago to Shs 4.4 trillion today. But even with this growth, spending per person is still low, around $50 a year, less than half of what is often needed to provide basic health services.

Not all the money is used efficiently. Global estimates suggest that weak systems, poor coordination, and procurement challenges can cause up to a third of health spending to be lost.

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According to Dr. Ggoobi, Uganda has made notable progress in strengthening its health system, driven by sustained public investment. Life expectancy has risen from about 50 years in 2000 to approximately 68.8 years in 2024, an increase of over 18 years. Access to services has also improved significantly, with about 91 percent of Ugandans now living within five kilometres of a health facility, while income poverty has declined from 24.5 percent in 2010 to 16 percent.

On the service delivery side, the government has introduced the malaria vaccine for children under five and rolled out electronic medical records across national and regional referral hospitals. Strategic investments have also been made, including 16 high-capacity oxygen plants, three regional blood banks, CT scan equipment in 14 of 16 regional referral hospitals, and 20 digital X-ray machines in general hospitals, with remaining gaps expected to be closed in the next budget. Together, he noted, these efforts demonstrate that sustained investment in health is yielding tangible results.

Beneath that progress, Dr. Ggoobi sees a health financing structure that is fundamentally unstable, noting that external partners still finance as much as 40–45 percent of health expenditure. Government contributes about 22 percent, household’s 31 percent, and insurance remains marginal at less than five percent. This balance, Ggoobi argues, is dangerous. It leaves the system exposed to shocks from outside while pushing risk onto those least able to bear it.

But the issue that troubles him most is government inefficiency. His priorities are to increase and protect domestic health financing, mobilise long-term capital, and improve efficiency.

“We are wasteful even with the little we have. Procurement is a major problem—many fights in government are not about mandate but about procurement. That is why we are moving all entities onto an electronic procurement system to improve transparency, reduce leakage, and ensure accountability,” said Dr. Ggoobi.

The government has enrolled 38 entities on the electronic procurement system. Full adoption is expected by mid-2026.

If you have good audits and we implement their recommendations, then we can expect positive outcomes. Number two is e-government, reducing human contact where it is not necessary. Unless you’re a doctor, you have to examine someone. Why do you have to sit in a hotel to discuss procurement? Humans must get out of discussing procurement. That’s why we are building the eGP and reviewing the procurement law. We are going back to the cabinet; we are going to remove human beings who are not necessary in the chain of procurement,” said Ggoobi.

Across the discussion, one issue drew near-unanimous agreement that prevention remains underfunded.

The Ministry of Health’s position, delivered through John Kauta, the Commissioner in charge of Health Information, Statistics, Monitoring, and Evaluation, is unequivocal that “the cheapest disease to treat is the one we prevent.”

Yet Uganda still spends more on treating illness than preventing it. Freddie Ssengooba, a Professor of Health Economics and Health Systems Management, MakSPH, highlighted malaria as a case study, both costly and preventable, while others pointed to rising non-communicable diseases driven by lifestyle factors.

This imbalance has fiscal consequences. Preventable diseases generate recurrent costs, crowding out other investments and reinforcing the cycle of inefficiency.

Mak Chancellor Hon. Dr. Crispus Kiyonga pushed the debate toward geography and access, citing that while Uganda’s health system was originally designed to follow administrative structures, the ambition to reach every village was never fully realised.

“We must plan based on what we can sustainably afford. We cannot import another country’s system. But where shall we save the majority of our people? It is in the villages. That is where children miss school due to illness. Where young girls drop out due to a lack of basic support, like pads. So, we must choose: given limited resources, what system gives the greatest impact? When the Minister of Health asks for a CT scan—something people travel to Nairobi for—that is important. But in the village, a child needs an antimalarial. The choice is between a CT scan and basic treatment. These are tough decisions,” says Dr. Kiyonga.

While the country is “highly indebted” and resources are limited, the level of care that Uganda can realistically provide to its citizens should borrow from China’s early pragmatic reforms of universal access first and quality later, according to the Chancellor.

“You cannot deliver health from a distance,” he said, arguing for a renewed focus on community-level access.

The Chancellor also strongly supported a shift from tertiary care to primary care. From Mulago National Referral and reducing its congestion to the village by investing in lower health facilities.

He urged the government ministries of Finance and Health to strongly collaborate with academic institutions to improve their work. “This dialogue should not be a one-off. It must be continuous. Makerere must engage the government with well-costed, risk-weighted proposals. We should build structured collaboration between universities and government so that research informs policy, and we reduce reliance on expensive foreign consultants. There is valuable research here,” said Dr. Kiyonga.

Taken together, the dialogue revealed a country’s health system in transition, from scarcity to expansion but not yet to performance.

As Ms. Jane Kyarisiima Mwesiga, Deputy Head of Public Service (Service Delivery), Office of the Prime Minister, framed it, the next phase must move “from expansion to performance, from inputs to outcomes, from financing to public value.”

But the path forward remains contested. Should Uganda prioritise insurance or direct public provision? Prevention or specialised care? Infrastructure or functionality?

The answers lie not in choosing but in sequencing, something Uganda has historically struggled to do.

Dr. Ian Clarke, a Physician, philanthropist, entrepreneur, and Chairman of Clarke Group Companies, speaking while representing the Private Sector during the dialogue, spoke emotionally on national health insurance, whose discussion has been ongoing for close to 20 years, but with minimal progress.

“We have had studies and proposals, but many were rightly rejected because they were not practical. You cannot design a National Health Insurance scheme that looks like private insurance. There is simply not enough money in Uganda—or anywhere—to sustain that. We still think in silos: public sector and private sector. Then we ask, how do we support the private sector? There are many ways—but as has been emphasized, we must focus on prevention and equity, especially in rural areas.”

For Ssengooba, while insurance is important and long-term, its implementation needs to be phased. He called for more investments in the health sector as the first line of insurance for citizens. He also called on the government to partner with institutions such as the National Social Security Fund (NSSF), which already have systems, capacity, and reach in place to support health investments. “If we leverage institutions like NSSF—for collection, for pooling resources—we can make progress. During COVID, they demonstrated that they can support national priorities. So, we should think about how to leverage what already exists,” he says.

Stephen Omojong of the National Social Security Fund highlighted an untapped opportunity. The Fund currently manages about Shs 30 trillion in assets, with millions of contributors.

This pool, he argued, could support health financing either through insurance-linked products or long-term investment vehicles. His example of a voluntary savings scheme now has 68,000 participants and Shs. 114 billion mobilised in a year, suggesting that behavioural barriers may be less rigid than often assumed.

Makerere University Vice Chancellor, Professor Barnabas Nawangwe, framed the dialogue as more than an academic exercise, describing it as a call to action. He urged the government to tap into the University’s research capacity to inform strategic investments, noting that “health research constitutes more than 50% of all research at Makerere University,” with institutions like the School of Public Health and the Infectious Diseases Institute playing a central role.

He referred to their national impact—from supporting over 20% of Uganda’s HIV patients to operating in more than 90 districts—and emphasised that Makerere brings in over one trillion shillings annually in research income. “When you fund Makerere University,” he said, “you should understand that we are not a net consumer—we are a net producer for the country.”

Taken together, the dialogue revealed a system in transition from expansion to performance, from spending to results. Uganda is no longer short of ideas, nor entirely short of resources. The real test is execution.

Whether the country can turn health spending into measurable outcomes will determine not just the future of its health system but the credibility of its economic ambitions.

View on MakSPH

By Moses Lutaaya

Kampala, April 10, 2026 — College Registrars and Senior IT Technicians at Makerere University have undergone intensive, hands-on training in the Research Information Management System (RIMS), in a move aimed at strengthening graduate training, improving completion rates, and advancing the university’s research agenda.

The training, held on Friday at the CFT 2 Building, Lecture Room 4.1 Computer Lab, brought together key custodians of academic records to gain practical skills in using the system that university leadership says will transform graduate education management.

In his opening remarks, the Director of Graduate Training, Julius Kikooma, underscored the strategic importance of RIMS, linking it directly to the university’s long-standing challenges in tracking graduate students and supporting research progression.

“Graduate training is central to the research mission of this university,” Prof. Kikooma told participants. “Yet for years, we have struggled to answer simple but critical questions, where exactly are our graduate students in their academic journey, and why are many not completing on time?”

He pointed out that the issue has consistently drawn concern from top university leadership, including Council, particularly as Makerere rolls out its new five-year strategic plan. “One of the key priorities identified is improving graduate completion rates,” he said. “But we cannot improve what we cannot measure.”

Prof. Kikooma explained that unlike undergraduate programmes, graduate studies are largely research-driven and therefore more complex to monitor. “The research component of graduate programmes has not been adequately captured in any system,” he noted. “That is why it has been difficult to track progress, supervise effectively, and provide accurate reports.”

Positioning RIMS as a transformative solution, he emphasized its role in bridging this gap. “RIMS is not just a system, it is the backbone of how we are going to support graduate students and research going forward,” he said. “With it, we can track every stage, from concept development to proposal, to thesis completion in real time.”

He stressed that the system will enhance both efficiency and accountability across the university. “This is the tool that will enable us to confidently assure Council and management that we know the status of every graduate student at any given time,” he said.

However, Prof. Kikooma made it clear that the success of RIMS depends heavily on the commitment of college registrars. “You are the custodians of graduate records. You are central to this process,” he said. “If RIMS succeeds, it will be because of your efforts. If it fails, it will be because you did not play your part.”

He revealed that registrars will now form part of the steering committees overseeing the full implementation of RIMS across university units. “You are not just users of this system, you are its drivers at the college level,” he emphasized.

Calling for seriousness and full participation, Prof. Kikooma set clear expectations for the training. “No one should leave this room without knowing how to use RIMS in their daily work,” he said. “You must understand the kind of data required, the information on students, supervisors, and every stage of the research process.”

He added that incomplete data has already limited the system’s effectiveness in some units. “Graduate students are already on the system, but some of the critical information is missing,” he noted. “That gap must be closed by you.”

In his technical presentation, Juma Katongole, the Manager Information Systems, highlighted the limitations of existing systems and how RIMS is designed to address them.

“We can only produce accurate statistics for students on coursework,” he said. “But we cannot tell how many graduate students are at proposal level, concept level, or thesis level. That is a major gap.”

He explained that RIMS will provide comprehensive, real-time tracking of graduate students throughout their academic journey. “This system will enable us to produce accurate reports of which student is where,” Katongole said. “It will help us identify delays and take action.”

On the issue of prolonged completion times, he added, “With reliable data, we can see where students are getting stuck and introduce administrative or strategic measures to address those bottlenecks.”

Describing the system as a turning point, Katongole noted, “We are moving towards having valid statistical information at our fingertips, which is critical for a research-led institution.”

From the administrative perspective, Eleanor Nandutu, Senior Assistant Registrar from MISR, welcomed the initiative, describing it as a practical solution to long-standing inefficiencies.

“RIMS will ease the tracking process and help us know exactly where each student is and how long they take at each stage,” she said. “It will also help us understand where the challenges are and how to better support students.”

She emphasized that the system will improve completion rates by identifying bottlenecks early. “We shall be able to see where we are stuck and take corrective action in time,” she noted.

Addressing concerns about possible conflict of interest between supervisors and students, Nandutu clarified that the system is designed to enhance transparency, not create tension. “This is about ensuring that processes are followed and that students succeed,” she said. “It brings everyone, administrators, supervisors, and coordinators onto one platform.”

She added that the system will even improve interaction between students and supervisors. “It will make follow-ups easier and ensure timely feedback, which is critical for research progress,” she said.

As the university intensifies efforts to strengthen its research output and graduate training, the hands-on RIMS training marks a significant step toward a more efficient, transparent, and data-driven academic environment, one that leaders believe will finally address the long-standing challenge of delayed graduate completion.

Applications are hereby invited for the 2026 Hainan International Youth Cultural Exchange Program, hosted by Hainan University.

• Theme: “Youth Nexus: Bridging Horizons in the Free Trade Port”
• Dates: May 19 – 26, 2026
• Location: Hainan Province, China
• Highlights: The program offers immersive visits to the Free Trade Port, academic exchanges, and cultural explorations (including Wenchang Space Center and China (Hainan) Museum of the South China Sea).
•  Accommodation, meals, and local transport are fully covered.

Application Deadline: Please submit your application by April 17, 2026.

Eligibility: Students, young faculty, and youth representatives aged 18–40 with proficiency in English are welcome to apply.

Please note: Interested students must purchase their own air tickets.

 Apply Here: https://v.wjx.cn/vm/QsFn61E.aspx#                                

For inquiries, please contact Mr. KONG Zeming (zeming.kong@qq.com).