BACKGROUND:
Health workforce retention is a critical determinant of health system performance, particularly in faith-based facilities delivering essential services in rural, low-resource settings. In Uganda, retention rates at rural health facilities are estimated at 71%, yet evidence from frontline leaders who directly manage workforce decisions remains limited. This study presents leadership-generated insights on retention challenges and mitigation strategies from 97 faith-based Private Not-for-Profit (PNFP) facilities supported by LifeNet International in Uganda.

METHODS:
In September 2025, 97 facility in-charges and 6 diocesan health coordinators were purposively selected to participate in structured, group discussions focused on workforce retention challenges and feasible mitigation strategies. Discussions were facilitated by trained LifeNet staff using a standardized guide, with detailed notes taken concurrently. Data were manually analyzed using content analysis: discussions were inductively coded, organized into workforce, organizational, and leadership categories, and synthesized across facilities to identify recurrent challenges and common strategies. To ensure consistency, cross-validation was adopted.

RESULTS:
Analysis revealed interconnected financial, organizational, and contextual challenges. Leaders cited low remuneration relative to government facilities, high workload and multitasking, contract-based employment, limited professional development, inadequate housing, weak staff management practices, and lifestyle constraints associated with remote locations. Mitigation strategies reflected adaptive leadership responses, including strengthening income-generating models to fund incentives, implementing staff savings and credit schemes, introducing flexible work schedules and multi-skilled staffing, engaging trained volunteers during peak periods, improving housing and infrastructure, enhancing communication and supervision, instituting performance reviews and recognition, providing leadership and management training, and introducing mental health and psychosocial support initiatives.

CONCLUSIONS:
Health worker retention in Ugandan PNFP facilities is influenced by interconnected financial, organizational, and leadership factors. Context-responsive strategies that extend beyond remuneration to workforce management, staff welfare, and service continuity are critical. These findings provide transferable lessons for strengthening leadership-driven workforce stability in rural, private and faith-based health facilities.