Health
First-Ever Harmonized Health Facility Assessment by MakSPH and MoH Reveals Improvements in Uganda’s Overall Health Services
By Julius Tukacungurwa & Davidson Ndyabahika
The first ever Harmonized Health Facility Assessment (HHFA) jointly conducted by MakSPH and the Ministry of Health (MoH) has illuminated significant advancements in Uganda’s healthcare landscape. This ground-breaking survey, which serves as a robust benchmark for evaluating health services across the country, offers a comprehensive overview of service availability and readiness within Ugandan health facilities.
The HHFA, a successor to the esteemed Service Availability and Readiness Assessment (SARA) tool endorsed by the WHO, probes into four critical modules: service availability, service readiness, quality of care and safety, and management and finance.
Focusing initially on service availability and readiness, the HHFA embarked on a cross-sectional analysis of 642 facilities in April 2022, spanning National Referral Hospitals (NRHs), Regional Referral Hospitals (RRHs), General Hospitals (GHs), primary healthcare facilities at levels II, III, and IV.
The findings, while highlighting disparities in service availability and facility capacity across different healthcare sectors, underscore a promising trajectory towards enhancing overall health services nationwide.
Dr. Christopher Garimoi Orach, a Professor of Community Health at Makerere University School of Public Health (MakSPH), led the team that conducted the survey. He presented the report which was subsequently launched by Uganda’s Minister of Health Hon. Dr. Jane Ruth Aceng Ocero on Tuesday 12th.March.2024 during the 10th Annual National Health Care Quality Improvement Conference at Imperial Resort Beach Hotel, Entebbe.
The findings of the HHFA report indicate that Reproductive Maternal Newborn Care and Adolescent Health (RMNACH) services were available in most health care facilities across the country. In Uganda, healthcare facilities offer a wide range of essential services, including pediatric care, antenatal and postnatal care, malaria prevention during pregnancy, and newborn care, with over 95% providing these services according to the report. Findings also show that continuous antenatal care is available in about 79% of facilities, while skilled delivery services are offered in 89%. Additionally, family planning, emergency obstetric care, immunization, and adolescent health services are widely accessible, with percentages ranging from 77% to 91%.
During the launch event, Dr. Aceng underscored the significant steps made by the health sector in meeting crucial performance benchmarks. These include a notable 47% reduction in Maternal Mortality between 2016 and 2022, a commendable 12% decrease in Under 5 Mortality over the same period, and a promising 7% decline in Infant Mortality rates as highlighted in the Uganda Demographic Survey (UDHS) Report 2022.
“As you might know, overall, the health sector has made good progress towards achieving the key performance indicator targets. I wish to appreciate each one of you for the job well done,” said Dr. Aceng.
Adding that; “The Ministry of Health continues to make big investments in the national health system. Mulago National Referral Hospital, Mulago Specialised Women and Neonatal Hospital, and several Regional Referral Hospitals have received infrastructure development including installation of modern medical equipment.
There is also deliberate effort to improve access to health service, delivery to the community through purposeful upgrade of some HC IIs to corresponding equipping and general review of the human resource requirements in the health sector. There is also deliberate effort to improve access to health services, delivery to the community through purposeful upgrade of some HC lIs to HC Ills with corresponding equipping and general review of the human resource requirements in the health sector.”
The also study highlights a significant increase in Uganda’s general service index, rising from 48% in 2018 to 59% presently. Utilizing a similar survey methodology, researchers observed notable improvements in the availability of health interventions across various domains. Particularly in Reproductive Maternal Adolescent Health services, higher provision rates were evident, especially at higher-level health facilities. Moreover, delivery assistance at Health Centres IIIs and above by skilled attendants has become standard practice, with nine out of ten cases receiving skilled care.
Immunization services have also witnessed widespread availability, notably in hospital settings. However, while all surveyed facilities now offer malaria treatment services, access to non-communicable disease management, such as cancer diagnosis and treatment, remains limited, and readiness to provide transportation services for community members in need is inadequate.
According to Professor Orach, the Ministry of Health should strengthen and improve diagnosis and treatment of cancers generally across the country, especially at the National and Regional Referral Hospitals so that many more people at community levels can access the services. He also notes that the Ministry needs to quickly do everything possible to strengthen the transportation systems for patients from communities to reach and access health services.
The research noted that salary enhancement is a step in the right direction for improving how health workers perform. “We need to enhance that by ensuring that, ‘the health system, which is a complex system’, when we enhance salaries, we still need to continue to monitoring the health workers, we still need to continue to provide other requirements for the performance of health services, like drugs should be available,” noted Professor Orach.
Adding that; “Transport should be available, other ways of ensuring that their performance can be up to the expected standard. So, in other words, that’s an important step and we must thank the government for what they’ve done here for we should still support them in other ways and monitor them closely to ensure, guidelines are available for services, that drugs are available, so that they can continue to provide good services.”
“Our findings also show that for instance, the private health practitioners are not carrying out a lot of immunization, but government health facilities and private not for profit facilities are providing immunization services. This means that the private health practitioners don’t focus on immunization since it may not be bringing them money, they sought the ministry to engage with them to ensure that they’re brought on board so that they can provide their services in an integrated manner,” he noted.
During the event, Associate Professor Peter Waiswa from the Health Policy, Planning and Management Department at MakSPH delivered a keynote address on ‘Understanding Health Systems Strengthening in a resource limited set-up.’ Professor Waiswa has had research work in maternal, new-born and child health in low and middle-income countries.
According to Dr. Diana Atwiine, the Permanent Secretary of the Ministry of Health, this health facility assessment and report will significantly enhance MoH’s institutional capacity for strategic planning and policy development in Uganda’s health sector.
“The Makerere University School of Public Health (MakSPH) Team led by Prof. Christopher Garimoi Orach is appreciated for spearheading the entire process of undertaking the HHFA and developing the report. The MoH is very grateful for the diligent work well-done by the various actors that included the technical officers, research assistants and the administration staff to have the final report meticulously developed,” said Dr. Atwiine.
Dr. Henry G. Mwebesa, Director General of Health Services, emphasizes the pivotal role of robust health systems in achieving lasting health advancements. He underscores that the findings will facilitate the country’s ability to track health service progress, advancing towards Universal Health Coverage (UHC) and Sustainable Development Goals (SDGs). This data supports evidence-based decision-making, fortifying national health system planning and policy-making.
“This HHFA report is recommended for use by the various key stakeholders including health service managers, district leaders, ministry of health officials, both government, private sector, civil society organizations and development partners at different levels to inform and improve planning and implementation of effective health services delivery in Uganda,” says Dr. Mwebesa.
Photos by Julius Tukacungurwa.
On April 23, 2025, Makerere University School of Public Health (MakSPH) convened district leaders, health managers, and project partners to disseminate the outcomes of a major leadership and management strengthening initiative in Wakiso District, Central Uganda. The one-year project, part of the Global Health Partnerships programme funded by NHS England, was implemented in collaboration with Nottingham Trent University, Nottingham University Hospitals NHS Trust, Wakiso District Local Government, and Uganda’s Ministry of Health.
Launched in 2024, the project titled Strengthening Leadership and Management Among Local Government Health Managers in Wakiso District, aimed to co-design and pilot a leadership and management training tailored to the realities of Uganda’s decentralised health system. The intervention, led by Makerere University’s Dr. David Musoke and Nottingham Trent University’s Prof. Linda Gibson, through the over 15-year-old NTU-Mak Partnership impacting lives in Wakiso, began with a field visit to over 60 public health facilities in the district, a needs assessment within these facilities to identify key priority gaps, and a baseline survey with the health in-charges to establish the initial status of key indicators.
“We have been very fortunate to work with a supportive local government in Wakiso, from the top leadership down. While many projects struggle to engage district teams, our longstanding relationship with Wakiso made collaboration seamless. Although this was our first initiative specifically focused on leadership and management, we hope it will serve as a stepping stone for even more impactful work in the future,” Dr. David Musoke, a Senior Lecturer at Makerere University and the Uganda Project Lead, said during the dissemination workshop, highlighting the key success factors for the leadership and management project.
Initial results from the needs assessment and baseline on leadership and management competencies conducted among Wakiso District health facility supervisors early last year by the project team and shared during the three-day workshop in June 2024, held in Kampala, which kickstarted the six-month structured fellowship programme for 53 health managers in Wakiso, had found critical capacity gaps. Using a tool evaluating 17 leadership and 33 management competencies, only 40% of the managers met the 80% benchmark for leadership, scoring highest in cognitive skills, while just 33% met the required management standard, performing best in self-management and lowest in quality management.
Then, the health facility managers with postgraduate training, longer service, and strong team dynamics, showed overall better performance. While working relationships with subordinates and the district leadership were largely positive, performance was hampered by systemic challenges such as limited resources, low motivation, and weak teamwork. Overall, the study also pointed to a misalignment of expectations between the District Local Government and the Health Ministry, underscoring the need to strengthen coordination to improve services.
The result of this mismatch was to the effect that, as of this time last year, Wakiso District ranked among the bottom 10 on the national health league table, which is an annual Ministry of Health assessment of district performance across key service delivery and patient satisfaction indicators. This was despite Wakiso being Uganda’s most populous district, with over 3.4 million residents today, as it continued to struggle to deliver essential health services to the public. The 2022/2023 Annual Health Sector Performance Report also flagged persistent challenges, including frequent transfers of facility in-charges, overstretched management structures, and weak internal communication and coordination.
It was this stark reality that informed the leadership and management intervention in Wakiso. Officiating the dissemination of the project outcomes, Dr. Sarah Byakika, Commissioner for Planning, Financing, and Policy at the Ministry of Health and a member of the National Oversight Mechanism for the programme, commended the remarkable progress made in just six months, citing visible improvements across the district as a direct result of the intervention.
“I have been involved with this programme right from its inception, and I’m proud that Uganda became one of its major beneficiaries,” Dr. Byakika said with gratitude, commending the strong collaboration between the Ministry of Health, Makerere University, Nottingham Trent University, Nottingham University Hospitals, Wakiso District and the development partners for supporting the initiative. She emphasised the value of this partnership in strengthening leadership and management competencies among Wakiso District health managers to address critical performance gaps in health service delivery.
“Wakiso is Uganda’s largest and most populous district, yet it has long underperformed on key health indices. Despite its semi-urban nature, it faces enormous health service delivery challenges, partly due to the overwhelming burden on its District Health Officer, who oversees more than 60 public and over 340 private health facilities. Many of these private facilities open and close frequently, complicating service oversight,” Dr. Byakika observed with concern.
Her sentiments were echoed by the District Health Officer, Dr. Emmanuel Mukisa, in a message delivered by Wakiso District Biostatistician, Mr. Frank Kakande. He noted that the project had contributed to a noticeable shift in the district’s health system performance, with visible improvements in leadership, communication, and accountability among facility in-charges beginning to translate into better overall health service delivery outcomes.
“You cannot talk about management without addressing performance: they go hand in hand. As someone who sits at the centre of district health data, I can confidently say that performance has improved. During the most recent national local government performance assessment, where I participated in the evaluation, Wakiso District’s health department ranked 18th out of 146 districts. That health ranking is a major achievement. We have consistently performed poorly in the past, but this time, we made significant progress,” Mr. Kakande told the attentive audience, speaking with an air of relief and satisfaction.
The Wakiso District Biostatistician credited part of this progress within the district, from the poor performance last year, to the leadership training and mentorship delivered through the project, citing visible improvements across key health indicators. He stressed the need to sustain this momentum through continued mentorship, internal capacity strengthening, and consistent application of the skills acquired by health managers, particularly in tackling persistent management challenges such as absenteeism, delegation, and accountability.
“Last week, I held a performance review at Kakiri Health Centre III, and the improvements were clear. These management skills are making a difference. You can see the change across indicators. But what matters now is sustainability. The support provided through supervision and mentorship was essential. But it’s up to us to keep the fire burning. We have learned a lot: communication skills, problem-solving, time management, and decision-making. Managers are now communicating better. Even issues like absenteeism are being addressed through proper reporting and action,” Mr. Kakande said.
Earlier, Dr. Musoke, presenting the overall project overview and success, explained that based on initial findings from the baseline and needs assessment, the team co-designed and delivered a structured six-month capacity-building programme targeting 60 health facility in-charges in Wakiso District. The programme blended in-person and virtual sessions, combining practical training with one-on-one mentorship, and included an exchange component between Uganda and the UK to promote international exposure and peer learning. This allowed the health managers to apply new skills to strengthen health outcomes in Wakiso.
“This project rightly focused on addressing gaps in leadership and management. I advocated for including this component in the programme, because our national health review missions consistently show that poor performance often stems from weak leadership and management,” Dr. Byakika affirmed, adding that: “I am pleased to see that nearly all public facilities in Wakiso participated. While the project had a short implementation window, the evaluation already shows encouraging results. Health managers feel more empowered, motivated, and aware of their roles. That’s a significant step.”
For her part, Dr. Sheba Gitta, Uganda Country Director for Global Health Partnerships, formerly Tropical Health and Education Trust, applauded the leadership and management capacity-building initiative in Wakiso as a timely, locally driven intervention. She underscored the value of two-way learning between Uganda and the UK health systems through the programme, noting that Global Health Partnerships works closely with the Ministry of Health to ensure all funded initiatives align with Uganda’s national development priorities.
“What excites me most is that this was not a pre-packaged programme imported from the UK. The training was co-created by partners, based on local realities and needs. That approach reflects strong collaboration between Makerere University School of Public Health and Nottingham Trent University. I thank Prof. Linda Gibson for her continued commitment and Dr. David Musoke for his proactive leadership in bringing this programme to life. Your consistency and quality of work continue to stand out,” Dr. Gitta shared.
While commending the progress made, she cautioned against “pilotism”, as a tendency for promising projects to end prematurely, calling for the model to be scaled up nationally. To support sustainability, she stressed the importance of documenting the training process, outcomes, and costs to inform ministry-level decision-making and long-term adoption.
Dr. Gitta joined Prof. Linda Gibson, the UK Lead for the Project, to encourage the trained managers to become champions of leadership within their facilities and districts, ensuring that the impact of the programme endures beyond its current cycle. She also thanked NHS England and the UK Government for their trust and investment in Uganda’s health system.
Health
Makerere-Incubated Safe Bangle Technologies Wins Prestigious World Summit Award for Innovation Against GBV
By Joseph Odoi
In a groundbreaking achievement, SafeBangle Technologies, an innovation incubated at Makerere University, has won the prestigious World Summit Award 2025 for its groundbreaking contribution to the fight against gender-based violence (GBV) in Africa. This remarkable honor comes in recognition of the development and implementation of a real-time domestic violence reporting bracelet.
The award was presented to the SafeBangle team that was represented by Saul Kabali, Messach Luminsa, and Janet Christine Nabaloga from SafeBangle Technologies at the WSA Global Congress in Hyderabad, India, where Uganda’s innovation potential was proudly showcased on a global stage.
The award was conferred in the Inclusion & Empowerment category for Safe Bangle’s cutting-edge solution; a wearable safety bracelet designed to address the pressing challenge of gender-based violence (GBV) across Africa.
The SafeBangle is a smartwatch-like, real-time domestic violence reporting bracelet that allows users to send SMS alerts via a single button press. Its core mission is to create a safer, more secure environment for women and children in Africa through innovative, affordable tech solutions.
According to Saul Kabali and Messach Luminsa, the innovators behind SafeBangle from SafeBangle Technologies, hosted at the Resilient African Network Lab. This award is very timely and a recognition that cements the importance of community rooted technology.
The team further stated that ‘’This award is a powerful affirmation of our mission and refuels our commitment to empowering Ugandan women and girls through innovation and technology. It influences our next steps by opening doors to new partnerships, increasing our credibility, and accelerating efforts to scale the SafeBangle nationally. We’re now more equipped to positively impact the daily lives of Ugandan women and girls through our SafeBangle bracelet.
To further the innovation, the team has called upon government to support the Safe Bangle Innovation
‘’Governments can support us by providing funding, facilitating policy support, and creating collaborative platforms for innovation. NGOs can help with grassroots outreach, and connect us to potential donors and funders interested in solving Sexual and Gender Based Violence amongst vulnerable communities; and tech partners can enhance scalability through infrastructure, data insights, and capacity building.
Moving forward, the team emphasized the importance of uniting innovation, partnership, and purpose to scale impact. “As we empower communities, invest in local solutions, and promote collaboration, we can transform how technology protects and uplifts women and girls across Uganda,” added the award-winning team.
The Story Behind the Safe Bangle Bracelet Innovation
According to the Safe Bangle innovators Saul Kabali and Messach Luminsa , ‘’The inspiration behind SafeBangle came from a deeply personal place. ‘’We heard countless stories of women who couldn’t call for help during moments of danger. We were deeply affected by the story of Aisha, a young woman in a rural village who was attacked while walking home alone at night. With no way to call for help, she felt helpless and vulnerable. This incident made us realize the critical need for immediate reporting alert tools, accessible to women like Aisha. We knew technology could play a crucial role and this incident awakened a strong desire in us to create a solution’’
To Makerere University School of Public Health’s Dr. Juliet Kiguli, who collaborated closely with the team during the rollout of the bracelet, this award is a vote of confidence in the work of Makerere University, whose core function focuses on teaching, learning, community engagement, research, and innovation, all contributing to the university’s efforts in addressing domestic violence.
‘’The award-winning innovation stems from the findings of a longitudinal study led by the Makerere University School of Public Health.
While carrying out a study after the Covid-19 Pandemic, we identified gaps when it comes to reporting and response to Gender Based Violence (GBV) among women in informal settlements. Therefore, we used to incorporate the SafeBangle intervention to solve the problem of lack of affordable and immediate reporting mechanisms for violence using a bracelet that reports violence in real time
We’re excited about the progress so far, and with this recognition, we hope that more like-minded partners will join us to scale this initiative and ultimately help make the world a safer place for all.” Added Dr Kiguli of the Safe Bangle innovation potential
The research team, comprising Dr. Juliet Kiguli (Principal Investigator), Dr. Roy Mayega (Deputy Chief of Party, RAN), and Dr. Agnes Nyabigambo (Study Coordinator), piloted the bracelet under the PEER (Partnerships for Enhanced Engagement in Research) program with support from USAID and the National Academies of Sciences.
A consortium of partners, including SafeBangle Technologies, Makerere School of Public Health/RAN , the Medical College of Wisconsin, and Somero Uganda, implemented the rollout of the Domestic Violence Real-Time Reporting Bracelet. The initiative was supported by USAID and the National Academy of Sciences in Washington, DC. Key contributors to the project included Dr Juliet Kiguli Roy Mayega from Makerere University School of Public Health, Dr. Kelly Robbins, Dr. Lina Stankute-Alexander, Dr. Brent Wells, Dr. Melissa Trimble, and Uganda’s Dr. Gloria Kasozi at USAID. Wisconsin Madison Medical University’s Prof. Julia Dickson-Gomez was also a collaborator.
In terms of the acceptability of the SafeBangle innovation as a solution to GBV, the team has piloted the technology with more than 1,000 users, resulting in a 63% reduction in response times
During the event, SafeBangle Team participated in the “Equity by Design” panel, sharing insights on inclusive technology development with global experts including Dorothy Gordon, Abhishek Singh from India’s Ministry of Electronics and IT, Baroness Beeban Kidron, and representatives from UNESCO and WE Hub.
About SafeBangle Technologies
SafeBangle Technologies is a Ugandan social enterprise hosted at Resilient African Network Lab focused on addressing gender-based violence through innovative safety solutions. The company combines wearable technology with an interactive web platform to provide real-time reporting of violence and physical assaults, even in areas without internet connectivity. Founded in 2018, SafeBangle operates with a mission to make safety accessible and affordable for vulnerable populations, especially women and children.
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