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.
A major milestone in Uganda’s efforts to reduce newborn mortality was marked on June 17, 2026, when Makerere University College of Health Sciences graduated the first cohort of fellows from the Perinatal and Neonatal Medicine Fellowship Programme.
The pioneering cohort of five specialists completed the two-year sub-specialty fellowship designed to equip pediatricians with advanced competencies in newborn care, leadership, research, advocacy, and neonatal intensive care. The programme is accredited by the Uganda Medical and Dental Practitioners Council and is implemented through a partnership involving Makerere University, Mulago Specialised Women and Neonatal Hospital, Kawempe National Referral Hospital, St. Francis Hospital Nsambya, Seed Global Health and Elma Philanthropies.
Speaking at the graduation ceremony, the Principal of the College of Health Sciences, Prof. Bruce Kirenga, described the occasion as a significant achievement for Makerere University and Uganda’s health sector.
“Today is a very important occasion for the College of Health Sciences, and indeed the health sector in Uganda,” he said, noting that the fellowship was established to develop highly skilled specialists capable of responding to increasingly complex healthcare needs.
Prof. Kirenga emphasized that Uganda’s changing disease patterns, increasing life expectancy, and growing demand for specialized healthcare services have created an urgent need for super-specialized training programmes. He challenged the graduates to use their newly acquired knowledge and skills to improve newborn health outcomes and save lives.
Addressing Uganda’s Neonatal Health Burden
Presenting an overview of the fellowship programme, the Head of the Department of Paediatrics and Child Health, Prof. Victor Musiime, highlighted the urgent need for specialists in neonatal care.
He noted that neonatal deaths, those occurring within the first 28 days of life, remain one of the leading contributors to child mortality in Uganda. The country continues to face a shortage of professionals with advanced skills in neonatal care, research, leadership, and advocacy.
“The demand for neonatologists remains extremely high,” Prof. Musiime explained, adding that the Ministry of Health envisions deploying neonatologists to regional referral hospitals and other health facilities across the country.
The fellowship programme was established to build a critical mass of neonatologists, strengthen care for high-risk newborns, develop expertise in advanced neonatal procedures, and produce leaders and advocates for newborn health.
A unique feature of the programme is its strong clinical apprenticeship model, complemented by international placements at leading institutions, including Yashoda Hospital in India and Aga Khan University Hospital in Nairobi, Kenya.
Ministry Commits to Expanding Neonatal Services
Representing the Ministry of Health, Commissioner for Maternal and Child Health, Dr. Richard Mugahi, congratulated the graduates and commended Makerere University and its partners for establishing the fellowship programme.
Dr. Mugahi revealed that the five graduates join another five neonatologists already serving in Uganda, bringing the country’s total number of neonatologists to ten. He described the locally trained fellows as a critical addition to Uganda’s healthcare workforce.
“The Ministry’s vision is to have a neonatologist at every Regional Referral Hospital,” he said, adding that Uganda aims to have at least 14 neonatologists by 2030.
He further outlined government plans to strengthen newborn care through the establishment of specialized neonatal care units at different levels of the health system, ranging from Health Centre IVs to Regional Referral Hospitals and super-specialized facilities such as Mulago Specialised Women and Neonatal Hospital.
Dr. Mugahi assured the graduates that the Ministry of Health is investing in equipment and infrastructure to support advanced neonatal services and pledged to advocate for improved career progression pathways for super-specialized health professionals.
Makerere’s Commitment to Advanced Medical Training
Representing the Vice Chancellor, the Deputy Vice Chancellor (Finance and Administration), Prof. Henry Alinaitwe, congratulated the fellows and their families on the achievement.
He praised the College of Health Sciences for its contribution to national development and noted that programmes such as the Perinatal and Neonatal Medicine Fellowship enhance Makerere University‘s position as a leader in knowledge generation and societal transformation.
Prof. Alinaitwe paid tribute to the graduates’ families, particularly their spouses and children, for supporting them through the demanding years of specialist training.
“The work you do is truly priceless,” he told the fellows. “The contribution you make to humanity is immeasurable.”
Graduates Hailed as Future Leaders in Newborn Health
In attendance were the director of Mulago Specialized Women and Neonatal Hospital, Dr. Sam Ononge, Deputy Director Mulago Referral Hospital, Dr. John Sekabira, Dr. Mary Nyanzi from Kawempe Referral Hospital, Sr. Dr. Assumpta Nabawanuka, the Director of St. Francis Hospital Nsambya, Dr. Irene Atuhaire from Seed Global Health Uganda and Ms. Ritah Akankwasa from ELMA Philanthropies Services, who partnered with the college in training the fellows.
The training partners described the graduates as pioneers who had demonstrated exceptional resilience and commitment throughout the rigorous training programme.
They applauded their contributions to patient care, teaching, mentorship, and supportive supervision, noting that their work had already contributed to improvements in maternal and newborn health services in Kampala and other regions of Uganda.
“As Kawempe National Referral Hospital, we have been privileged to witness your growth, not only as clinicians but also as leaders and advocates for newborn health,” Dr. Nyanzi said.
The graduates
- Dr. Tumwebaze Anita Kiiza Muhumuza
- Dr. Ediamu Tom Didimus
- Dr. Kezia Kibedi
- Dr. Hellen Kyokutamba
- Dr. Gerald Ojambo
For most people, the thought of death evokes grief, fear, or loss. But at Makerere University‘s College of Health Sciences, death became a lesson in gratitude, service, and humanity as students, faculty, and health professionals gathered to honour a unique group of teachers, individuals who continued to educate future doctors long after their passing.
At the Second Cadaver Commemoration Ceremony, on June 11, 2026, organized by the Makerere Students’ Anatomy Society, candles flickered softly as students paid tribute to what they fondly call their “silent teachers”, the human bodies that make it possible for medical students to learn anatomy and develop the skills that will one day save lives.
Standing before fellow students and guests, Chairperson of the Makerere Students’ Anatomy Society, Joseph Mwera, reminded the audience that the ceremony was not about mourning the dead.
“Today, we gather not only to remember those whose bodies have contributed to medical education but also to celebrate their lives,” he said. “Their legacy continues to inspire and serve humanity even after death.”
For many medical students, the anatomy laboratory is where they first encounter the reality of the profession they have chosen. Behind every lesson on muscles, nerves, blood vessels, and organs is a person who once lived, loved, worked, and contributed to society.
That reality was brought to life by the keynote speaker, Rev. Prof. Dr. Samuel Luboga, a surgeon, anatomist, and priest who spent nearly four decades teaching anatomy at Makerere University.
Reflecting on his own days as a medical student, Prof. Luboga recalled spending long hours in the anatomy laboratory after his classmates had gone home, studying human anatomy in detail.
Many people wondered whether he was afraid to spend so much time among cadavers.
His answer was simple.
“These men and women had lived productive lives. They had raised families, served their communities, and contributed to Uganda’s development. Even in death, they continued to teach us the science and art of medicine. They had earned my admiration, my respect, and my gratitude.”
His remarks resonated deeply with the students in attendance.
In a society where discussions about death and body donation remain sensitive, Prof. Luboga challenged participants to view the individuals in anatomy laboratories not as lifeless remains but as people who continue to contribute to humanity through education.
“The silent teachers before us today made learning possible,” he said. “The impact of their contribution is reflected in the doctors you have become and those you are yet to become. It is reflected in the countless patients you will treat and the innumerable lives you will save.”
Legal framework to guide body donation
The ceremony also sparked important conversations about the future of anatomical education in Uganda.
Head of the Department of Anatomy, Prof. Elisa Mwaka, highlighted the need for a national legal framework to guide body donation and anatomical research. While anatomy training in Uganda has traditionally relied on unclaimed bodies obtained through hospitals, he noted that many countries are increasingly embracing voluntary body donation programmes.
According to Prof. Mwaka, building public trust will be essential if Uganda is to establish a sustainable body donation programme.
“We must help the public understand how human bodies contribute to medical education, how they are treated with dignity, and how appropriate legal safeguards can protect donors and their families,” he said.
He revealed that discussions are already underway to develop an Anatomy Act that would provide a modern legal and ethical framework for the use of human remains in medical education and research.
Representing the Deputy Vice Chancellor (Academic Affairs), Prof. Julius Kikooma described the ceremony as much more than an academic event.
“Behind every competent healthcare professional stands an invaluable source of learning that often remains unseen and unheard,” he said. “These individuals taught us without speaking a single word. Though they are no longer able to communicate, their contribution continues to educate, inspire, and shape future generations of healthcare professionals.”
He commended the medical students for organizing what remains the only cadaver commemoration ceremony of its kind in Uganda, noting that the initiative reflects the values of compassion, professionalism, and respect for human dignity that are at the heart of medicine.
The event concluded with recognition of past and present leaders of the Department of Anatomy whose contributions have shaped anatomical education at Makerere University over the decades. Students also honoured exceptional educators who have inspired generations of future health professionals.
Yet the most powerful tribute of the day was reserved for those who could not be present to receive awards or applause.
The silent teachers
Individuals whose names may never appear in textbooks, whose stories may never be fully known, but whose gift continues to echo through hospital wards, operating theatres, and communities across Uganda.
Every doctor trained, every surgery performed, and every life saved carries a small part of their legacy.
And for one day at Makerere University, students paused to say the words that are rarely spoken aloud: Thank you.
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