Fifteen years after a sustained investment of over $100 million, Makerere University has transitioned Uganda’s digital health systems and assets to the Ministry of Health, marking a fundamental shift from externally supported interventions to full national ownership.

On 31 March 2026, a handover ceremony at Uganda’s Ministry of Health marked the closing of one chapter in Uganda’s digital health journey and the beginning of another, one in which systems built over 15 years through the Makerere University School of Public Health Monitoring and Evaluation Technical Support (MakSPH-METS) Program now sit firmly within government hands.

The national handover event brought together a cross-section of Uganda’s health leadership, academia, and development partners, led by the U.S. Ambassador to Uganda, H.E. William W. Popp; the Permanent Secretary, Dr. Diana Atwine; and the Director General of Health Services, Dr. Charles Olaro. They were joined by the CDC Country Director, Dr. Mary A. Boyd, senior government officials, implementing and development partners, technical teams, and the media. At the center of that moment was Makerere University School of Public Health, an institution that, over more than 70 years, has built its reputation as one of the region’s most enduring public health research and training hubs, working hand in hand with ministries of health, districts, referral hospitals, and partners to turn evidence into public systems that last.

Back in time, Uganda had made important gains in HIV control, but behind those gains were structural weaknesses that could not be ignored: fragmented data monitoring and evaluation systems, parallel reporting channels, weak digital integration, limited surveillance responsiveness, constrained oversight in decentralized structures, and uneven quality assurance across the HIV continuum of care. The problem was not simply that data existed in too many places but it was that the health system could not always use that data quickly enough, coherently enough, or at sufficient scale to guide action.

The MakSPH-METS program was designed as a response to that reality, build the backbone of a data-driven health system, supported through three successive grants totaling US$103.8 million by the United States Government through Centers for Disease Control and Prevention (CDC) and the President’s Emergency Plan for AIDS Relief (PEPFAR).

The program, rather than working around government systems, worked inside them with a deliberate and system-wide focus to strengthen health information systems, expand surveillance, improve governance and accountability, institutionalize quality improvement, and build the workforce needed to run all of it.

That choice to work within the Ministry of Health structures and across decentralized systems made all the difference. It meant the investment was not in parallel projects, but in national architecture, and over time, that architecture began to take shape.

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Reporting through DHIS2 (District Health Information System 2), the world’s largest open-source health management information system platform improved from 58 percent in 2020 to 98 percent in 2025. DHIS2 is a flexible, web-based tool used to collect, manage, and analyze both aggregate and individual-level data.

Also, tracked through the MakSPH-METS program, electronic medical record coverage rose to a high of 86 percent in 2024 from 50 percent in 2020, and reached 100 percent in high-volume sites. Additionally, a functional National Data Warehouse came into place. Across the country, 1,300 health facilities implemented HIV case-based surveillance, 1,084 facilities implemented HIV recency surveillance, and 300 sites established all-cause mortality surveillance. Six regional referral hospitals were implementing integrated surveillance for severe acute respiratory infections, influenza-like illness, acute febrile illness, and SARS, popular for Severe Acute Respiratory Syndrome, which is a viral respiratory illness caused by the SARS-associated coronavirus. At the governance level, 10 regional referral hospitals and 65 CDC-supported districts were trained and supported in planning and oversight, while regional referral hospital capacity scores improved from 58 percent in 2021 to 79 percent in 2024.

These are strong statistics. But the deeper story is that Uganda moved from fragmented systems to a more integrated, data-driven public health response. What had once been separate reporting streams, paper-heavy workflows, and delayed visibility became a system able to provide more timely access to data, better accuracy, stronger dashboards, and more confident decision-making. Health workers could access patient information faster. Today, district leaders are able to review performance data more accurately, national programmes can respond more strategically and data is no longer just collected, but used.

The transition also touched the practical side of care, including laboratory systems, patient records, commodity tracking, quality improvement, and outbreak intelligence.

Dr. Alice Namale, Executive Director of MakSPH-METS Program, was careful during the handover not to let the digital systems overshadow the broader institutional gains. MakSPH-METS, she noted, had “improved regional referral capacity and the district health team capacity to manage programs,” and those systems were now being leveraged by disease programs beyond HIV. She also captured the spirit of the team behind the work, saying the staff had adapted through a changing landscape. “For us, it was never business as usual. We had to continuously adapt as the landscape kept changing, and the team delivered with grace and professionalism,” Dr. Namale said.

Adding that; “We have strengthened systems and built capacity across the health sector, and these gains are now supporting not just HIV programs, but broader health services.”

That wider view matters that the systems handed over were not only about HIV reporting but they included platforms for electronic medical records, HIV case-based surveillance, stock monitoring, quality improvement, early infant diagnosis, viral load reporting, PEPFAR reporting, DREAMS tracking tool for tracking adolescents and young people data, outbreak and respiratory illness surveillance, ICT asset tracking, and e-learning platforms. In plain terms, these are the tools that allow clinicians to see results faster, managers to monitor performance more clearly, districts to respond to outbreaks sooner, and national leaders to plan with greater confidence.

The Ministry of Health now boasts of 16 such systems that have been fully developed and handed over, including UgandaEMR repositories, DREAMS Tracker, PREV Tracker, the HIV CBS dashboard, the Weekly Stock Status System, OpenHIM for health information exchange, EMR metrics, eIDSR, a platform for documenting patient level data on acute illnesses like pandemics, the QI database for visualising facility data on continuous improvement, EID and viral load dashboards, TB eCBSS, PIRS that supports PEPFAR indicator reporting beyond the DHIS2, and the SURGE Dashboard, a power BI based reporting platform.

This handover included 725 servers, more than 4,700 computing devices, solar systems for nearly 800 facilities, connectivity equipment for more than 1,300 sites, video conferencing systems, and network upgrades for regional referral hospitals. Those investments, valued at about US$9.3 million in ICT infrastructure alone, helped kick-start Uganda’s digitalization journey in practical terms: power, devices, connectivity, storage, and the ability to sustain real-time data exchange across facilities.

For the Ministry of Health, the significance of this transition is both strategic and immediate. Dr. Charles Olaro, Director General of Health Services, put it plainly that “Data is the lifeblood of decision-making,” and it provides “the raw materials for accountability.” In a sector where financing, human resources, commodities, and performance all depend on credible information, that was not a ceremonial line, but was a statement of what national ownership now requires.

“As a Ministry, we are focused on how this can support sustainable national ownership that is built to last, while strengthening resilient health systems. We look forward to leveraging these gains as part of our national digitalization roadmap, ensuring they continue to support and improve our systems moving forward,” said Dr. Olaro.

Dr. Diana Atwine, Permanent Secretary at the country’s Ministry of Health, spoke with equal clarity about what comes next. She described the handover as both a celebration of “tangible milestones of growth” and a call to responsibility. Uganda, she said, is not going back to paper-heavy systems. “We are not going to start again. We are just moving ahead.” At the same time, she was firm that ownership must come with inventory, verification, deployment, maintenance, and continued investment in people.

Calling the digital systems and assets “this treasure,” she urged districts and hospitals to take care of it, and made a broader plea that Uganda government should not lose the skilled workforce developed through the partnership, especially the technical teams that established these systems under the program. “This is the cream of the cream,” she said, arguing that the country should find ways to retain this talent as digital systems expand.

On his part, the U.S. Ambassador to Uganda, William W. Popp, framed the handover in similar terms, as a move from project implementation to self-reliance. He described it as “a new phase in national ownership and sustained self-reliance,” and linked it to the December 2025 U.S.-Uganda health memorandum of understanding, which set out a broader vision of government-led delivery, accountability, and stronger national systems. He stressed that foreign assistance, when delivered with discipline and accountability, should build lasting national capacity. In his words, the handover symbolizes a stronger Ugandan health system that benefits Uganda, the region, and the wider world.

For Makerere University School of Public Health, the moment was deeply consistent with its long institutional identity. The School began in the 1950s as preventive medicine, grew into one of sub-Saharan Africa’s earliest public health institutions, and has remained closely linked to the Ministry of Health through teaching, service, research, and workforce development.

Emphasizing the Ministry’s continued reliance on national expertise and long-standing institutional partnerships, the Permanent Secretary underscored the critical role of the Makerere University School of Public Health in sustaining and advancing Uganda’s health systems:

“We are still going to work with you… because you are our important resource in the country. You have the skill, you have the experience—and above all, you are Ugandans,” Dr. Diana Atwine said emphatically.

Her remarks stresses not only MakSPH’s technical capacity, but also the trust it has built over years of collaboration with government positioning the School of Public Health as the Ministry of Health’s strategic partner in driving nationally owned, sustainable health system improvements.

MakSPH has worked across more than 25 countries in Africa in recent years, trained thousands of public health professionals, and sustained long-term partnerships with organizations including CDC, NIH, the Global Fund, Johns Hopkins, WHO, the UN agencies and others. Its own strategic direction emphasizes community engagement, policy influence, partnership, and translating research into practical public good.

That is why Prof. Rhoda Wanyenze, Dean of MakSPH and Principal Investigator of METS, described the handover not as an ending, but as a transition. “As an academic institution, we are always exploring—looking for innovative, creative ways of doing things. We test them, and then work with key actors to take them over, scale them up, and sustain them,” she said. Later, she added, “This is not the end. This is the beginning of a new phase.”

For Wanyenze, that philosophy has always been intentional. “This is not our data, this is not our house, this is Ministry of Health,” she emphasized, an approach that places national ownership at the center from the very beginning. The School’s role, then, is not to hold systems, but to build them, prove them, and let them go when they are ready to stand.

And when that happens, she argues, it is not a loss but success. “When what we have contributed to is taken over, sustained, and continues to grow—that is success.”

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For years, much of Uganda’s health system operated with limited visibility, records stacked in paper files, data delayed, and decisions often made without a clear picture of what was happening on the ground. That is what makes this moment different.

After more than 15 years of investment and collaboration, Uganda is now taking over a digital health infrastructure built not just to collect data, but to actually use it, making information more timely, accessible, and practical for decision-making. The handover of the Monitoring and Evaluation Technical Support (MakSPH-METS) programme assets and systems marks more than a transfer of equipment or platforms; it reflects a shift toward a system that can better generate and use its own data.

In the end, the legacy of MakSPH-METS is not only the hardware, but something less visible and more important: a stronger ability to make informed decisions, knowing where the burden lies, where gaps remain, where stockouts occur, where patients are lost, and where progress is being made.

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