How Structured Mentorship and Capacity Building Transformed Work planning and Budget Absorption in Uganda's Subnational Health Facilities
1
Health Financing, Clinton Health Access Iniatitive, Kampala, Uganda
2
Division of Sector Policy and Planning, Ministry of Health, Kampala, Uganda
3
Ministry of Local Government, Kakumiro/ Kassanda, Uganda
Popul. Med. 2026;8(Supplement Supplement 1):A1759
ABSTRACT
BACKGROUND:
Uganda has advanced health financing reforms, including results-based financing (RBF), rollout of the Integrated Financial Management System (IFMIS), and the Public Financial Management (PFM) Reforms Strategy (2025–2030). Despite this progress, subnational capacity gaps continue to limit effective resource use. A 2023 bottleneck assessment across six districts found that only 11% of facility staff had adequate planning skills, workplans were often outdated, and budgeting was largely reactive. In Kassanda and Kakumiro districts, fund absorption rates were 60% and 74%, respectively, with limited financial oversight. This study documents the implementation and outcomes of a structured capacity-building intervention to strengthen planning, budgeting, and financial management at district and facility levels.
METHODS:
Between July 2023 and November 2025, the Ministry of Health, with partner technical support, implemented a capacity-building program across nine health facilities and two district health offices. The intervention comprised: (i) district-led quarterly mentorship; (ii) structured training on the Health Management Information System (HMIS) Form 001 as a standardized planning and budgeting tool; (iii) hands-on coaching to address implementation challenges; and (iv) institutionalized financial oversight. Data sources included key informant interviews (n=19; 92% response rate), primary health care (PHC) fund-flow analysis, and facility assessments.
RESULTS:
Fund absorption in Kakumiro increased from 60% to 87%. Facilities shifted from donor-driven, ad hoc budgeting to structured, evidence-based planning aligned with PHC priorities. Multidisciplinary facility teams actively participated in workplan development, strengthening ownership and bottom-up priority setting. Financial transparency improved through public display of financial information. Staff turnover affected sustainability: Kakumiro’s 9% turnover preserved institutional knowledge, while Kassanda’s 23% turnover eroded gains, requiring retraining. District officials reported improved capacity to analyze and monitor budget performance.
CONCLUSIONS:
Targeted mentorship, standardized planning tools, and participatory governance can strengthen subnational PFM capacity and improve accountability and efficiency in primary health care financing.
Uganda has advanced health financing reforms, including results-based financing (RBF), rollout of the Integrated Financial Management System (IFMIS), and the Public Financial Management (PFM) Reforms Strategy (2025–2030). Despite this progress, subnational capacity gaps continue to limit effective resource use. A 2023 bottleneck assessment across six districts found that only 11% of facility staff had adequate planning skills, workplans were often outdated, and budgeting was largely reactive. In Kassanda and Kakumiro districts, fund absorption rates were 60% and 74%, respectively, with limited financial oversight. This study documents the implementation and outcomes of a structured capacity-building intervention to strengthen planning, budgeting, and financial management at district and facility levels.
METHODS:
Between July 2023 and November 2025, the Ministry of Health, with partner technical support, implemented a capacity-building program across nine health facilities and two district health offices. The intervention comprised: (i) district-led quarterly mentorship; (ii) structured training on the Health Management Information System (HMIS) Form 001 as a standardized planning and budgeting tool; (iii) hands-on coaching to address implementation challenges; and (iv) institutionalized financial oversight. Data sources included key informant interviews (n=19; 92% response rate), primary health care (PHC) fund-flow analysis, and facility assessments.
RESULTS:
Fund absorption in Kakumiro increased from 60% to 87%. Facilities shifted from donor-driven, ad hoc budgeting to structured, evidence-based planning aligned with PHC priorities. Multidisciplinary facility teams actively participated in workplan development, strengthening ownership and bottom-up priority setting. Financial transparency improved through public display of financial information. Staff turnover affected sustainability: Kakumiro’s 9% turnover preserved institutional knowledge, while Kassanda’s 23% turnover eroded gains, requiring retraining. District officials reported improved capacity to analyze and monitor budget performance.
CONCLUSIONS:
Targeted mentorship, standardized planning tools, and participatory governance can strengthen subnational PFM capacity and improve accountability and efficiency in primary health care financing.
| eISSN: | 2654-1459 |
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