Strengthening the National Integration Agenda in Uganda: Evidence from 67 Baseline and 143 Follow-up Facilities
1
Ministry of Health, Kampala, Uganda
2
Clinton Health Access Initiative, Kampala, Uganda
Popul. Med. 2026;8(Supplement Supplement 1):A1756
ABSTRACT
INTRODUCTION:
In 2025, Uganda started the process of strengthening its national integration reform to consolidate chronic care platforms and reduce fragmentation across HIV, TB and Non-Communicable Disease services. To assess early effects, we compared performance before and after the initial efforts.
METHODS:
Baseline support supervision was conducted in March–April 2025 across 67 facilities. Follow-up mentorship and supervision covered 143 facilities in September–October 2025. Both rounds were conducted using a standardized questionnaire and analysis was based on the integration framework comparing integration domains and overall facility performance.
RESULTS:
Baseline assessments showed an overall facility integration score of 68%. Domain performance ranged from 59% in community systems and 60% in leadership and planning to 79% in supply chain and 76% in HMIS. Regional performance ranged from 52% (Kampala) to 83% (Tooro). After the integration reform, overall facility integration performance increased to 75%, representing a 7-point gain within one implementation cycle. Domain performance also improved, with HMIS increasing from 76% to 86.5%, lab and diagnostics from 69% to 90%, supply chain from 79% to 83.3%, and human resources from 72% to 83.2%. Leadership increased from 60% to 72.6%, while community systems rose from 59% to 64.1%. Quality improvement, which had no distinct baseline measure, remained the lowest scoring follow-up domain at 41.2%. Regional performance shifts reflected similar patterns. Tooro increased from 83% to 92%, Lango from 73% to 84%, Acholi from 75% to 92%, and Teso from 77% to 82%. Kampala remained unchanged at 52%, maintaining the widest gap relative to high-performing regions.
CONCLUSIONS:
Initial gains are most pronounced in health system backbone functions (HMIS, diagnostics, supply chain, HR), while community and quality improvement domains advanced more modestly. Persistent regional disparities suggest that integration reforms require differentiated sub-national strategies. Early results indicate feasibility and positive system effects within one implementation cycle.
In 2025, Uganda started the process of strengthening its national integration reform to consolidate chronic care platforms and reduce fragmentation across HIV, TB and Non-Communicable Disease services. To assess early effects, we compared performance before and after the initial efforts.
METHODS:
Baseline support supervision was conducted in March–April 2025 across 67 facilities. Follow-up mentorship and supervision covered 143 facilities in September–October 2025. Both rounds were conducted using a standardized questionnaire and analysis was based on the integration framework comparing integration domains and overall facility performance.
RESULTS:
Baseline assessments showed an overall facility integration score of 68%. Domain performance ranged from 59% in community systems and 60% in leadership and planning to 79% in supply chain and 76% in HMIS. Regional performance ranged from 52% (Kampala) to 83% (Tooro). After the integration reform, overall facility integration performance increased to 75%, representing a 7-point gain within one implementation cycle. Domain performance also improved, with HMIS increasing from 76% to 86.5%, lab and diagnostics from 69% to 90%, supply chain from 79% to 83.3%, and human resources from 72% to 83.2%. Leadership increased from 60% to 72.6%, while community systems rose from 59% to 64.1%. Quality improvement, which had no distinct baseline measure, remained the lowest scoring follow-up domain at 41.2%. Regional performance shifts reflected similar patterns. Tooro increased from 83% to 92%, Lango from 73% to 84%, Acholi from 75% to 92%, and Teso from 77% to 82%. Kampala remained unchanged at 52%, maintaining the widest gap relative to high-performing regions.
CONCLUSIONS:
Initial gains are most pronounced in health system backbone functions (HMIS, diagnostics, supply chain, HR), while community and quality improvement domains advanced more modestly. Persistent regional disparities suggest that integration reforms require differentiated sub-national strategies. Early results indicate feasibility and positive system effects within one implementation cycle.
| eISSN: | 2654-1459 |
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