By Dennis Katungi
Delivering Vision 2040 through smart and sustainable health financing.
Uganda is prioritising human capital development as a foundation for economic transformation under Vision 2040 and the ten-fold growth strategy. At the same time, the health financing landscape is evolving, with increasing pressure on domestic resources and growing uncertainty around external financing. This public lecture was intended to provide a platform for national reflection on these challenges and identify practical pathways for strengthening sustainable health financing in Uganda.
Makerere University’s School of Public Health [MakSPH] took the lead in organising this public lecture on Thursday, April 9, 2026 at their auditorium. The engagement brought together stakeholders in health, academia, policy, and government technocrats.
Health research constitutes more than 50% of all research at Makerere University. The School of Public Health and the Infectious Diseases Institute alone account for more than 40% of the University’s research income. Their combined research income exceeds the budgets of all other universities in Uganda, as Prof. Barnabas Nawangwe put it at the round table.
The impact of this investment is visible. The Infectious Diseases Institute supports the Ministry of Health in providing antiretroviral therapy to more than 20% of all patients in Uganda who require it. It operates in over 90 districts across the country.
The combined research income from Makerere University is also one of the largest contributors to Uganda’s foreign exchange earnings. The University brings in more than one trillion shillings annually.
Because of the specialised health programmes developed at Makerere over the years, there has been a noticeable reduction in Ugandans seeking treatment abroad. Having set this background, the Vice Chancellor opened the floor for the public debate. But that was not before he quipped that Makerere’s medical school is ranked among the top in Africa and within the top 100 globally.
“Investing in health for Uganda’s future is not merely an academic proposition. It is a call to action. We must recognise Makerere as a research-led university with a special role—and not fund it like any other institution or department.” The VC threw the gauntlet to the Permanent Secretary and Secretary to the Treasury, who was the keynote speaker.
The context of this dialogue was set by the Deputy Secretary for Public Service and Secretary to the Cabinet, Mrs Jane Mwesiga, who gave the opening remarks. She noted that Uganda has made important progress in strengthening its health system over the past decade. Referring to recent collaboration between the Ministry of Public Service and the Ministry of Health, she highlighted government investments in health infrastructure, strengthened management of resources, diagnostic capacity, and improved primary health care as well as specialised services. These investments, she said, had also supported improvements in the health workforce and service delivery across the country.
She pointed out reforms in public financial management, having strengthened the management of health sector resources. She alluded to the introduction of programme-based budgeting and results-based financing approaches, which had brought about efficiency, transparency, and accountability in the use of public funds. Other notable improvements she pointed to were in the availability and distribution of essential medicines and supplies. Stronger procurement planning, better coordination with National Medical Stores, and more consistent delivery cycles have reduced stock-outs in many facilities.
She highlighted programmes that were previously vertical, e.g. HIV, TB, malaria, maternal and child health, as continuously being integrated into broader primary health care systems. This, she noted, allowed patients to access multiple services in one visit—improving efficiency, reducing missed opportunities, and lowering household costs.
The downside, the research highlighted, was high demand with low functionality. Some newly built facilities are underutilised due to unreliable water and electricity supply. Others are operating below capacity due to understaffing—placing a strain on the limited staff and systems. There were further issues of weak supervision, limited specialist services, and medical personnel’s dual practice during official hours. As a result, there are persistent negative perceptions of public health facilities because of diminished public value. The public value, the Deputy Head of Public Service noted, is not so much about the construction of new facilities but is realised only when a mother delivers safely, a child is immunised on time, a patient receives effective care, and communities trust and use the health care service.
The PSST, Mr Ramathan Ggoobi, said that Uganda’s future and its ambitious ten-fold growth would be decided by the investments made in the health and human capital of Ugandans. He stated that health was an imperative, not a social afterthought. He referred to health as an economic transformation and productivity issue, as well as a national competitiveness matter. No country, he noted, has achieved sustained structural transformation without sustained investment in human capital. Globally, human capital accounts for nearly 70% of national wealth.
The PSST said that he treats health spending as investment, not consumption. Every shilling, he said, must buy measurable economic and social returns. He expressed concern that Uganda remains largely dependent on external financing for health, at a ratio of 40–45% of total health expenditure. The most recent figures show government at 22%, development partners at 42%, households at 31%, and insurance at 05%. This dependency creates structural vulnerability as global aid has become more uncertain.
Uganda’s total resource envelope for FY25/26 is Shs 72.38 trillion, with health receiving a slice of Shs 5.87 trillion within a broader human capital development allocation of Shs 11.44 trillion. Per capita government health spending has more than doubled over the past decade, and government spending rose from Shs 2.8 trillion in FY2020/21 to Shs 4.4 trillion in FY2025/26. Yet per capita health spending remains just USD 50 annually—below the USD 112 often cited as a lower-middle-income baseline for basic services.
In conclusion, the PSST suggested three interconnected priorities that must shape policy for Uganda. First, increase and protect domestic financing for health. Government will progressively increase domestic health allocations and protect them from in-year cuts and cash flow disruptions. Second, mobilise innovative long-term domestic finance—leveraging institutional investors, the retirement benefits sector which manages Shs 30 trillion already. The third one the PSST suggested was an efficiency drive and value for money. With continuous reforms, he said, additional resources must buy better outcomes.
Noteworthy positive highlights: Uganda has attained the criteria for moving out of Least Developed Countries [LDCs]. Ugandans are wealthier and more inclusive. Income poverty is down to 16%, subsistence down to 33%, and the Gini index has reduced to 38% from 45% in 2002. Remittances from Ugandans living and working abroad have reached USD 1.6 billion in FY2024/25. There is increased trust in Uganda’s economy. Last year, foreigners brought in over USD 5.4 billion despite the fact it was an election year. These are results of policy choices. The future outlook remains sunny as opposed to cloudy, if I may borrow a typical Englishman’s metaphor.
The writer is Head of Communications & Media Relations at Uganda Media Centre. @Dennis_Katungi