Uganda faces persistent and complex global health challenges that strain its health system and hinder progress toward universal health coverage. The country continues to battle high burdens of infectious diseases such as HIV/AIDS, malaria, and tuberculosis, alongside emerging threats from zoonotic and vector-borne diseases. Maternal and child mortality rates remain high, particularly in rural and underserved regions, while growing concerns around antimicrobial resistance and pandemic vulnerability underscore the urgency of adopting a One Health approach (integrating human, animal, and environmental health)¹.

Despite these challenges, Uganda has made notable strides in expanding healthcare access and reducing disease prevalence, largely through strong collaboration between the Government of Uganda and international development partners such as the United States Agency for International Development (USAID). USAID was one of Uganda’s largest health sector partners, investing over USD $350 million annually in a variety of technical areas such as disease surveillance, national laboratory services, one health and health emergency preparedness².

At the systems level, USAID has worked closely with Uganda’s Ministry of Health to enhance institutional capacity, financial management, and local ownership. For example, targeted interventions in budget execution improved health sector utilization rates from approximately 79% to 97%, unlocking an estimated USD $17 million in additional domestic resources³. However, persistent weaknesses—limited human resources, supply chain bottlenecks, fragmented data systems, and donor dependency—continue to pose barriers to sustainability and resilience⁴.

In response, USAID/Uganda was required to develop and implement a comprehensive Global Health Strategy to guide programming, partnerships, and investments. As Director of Performance with Q2 Impact, supporting USAID/Uganda’s Monitoring, Evaluation, and Learning (MEL) platform, I led the team that collaborated with the USAID/Uganda Global Health Office to co-create this strategy. Our shared goal was to align USAID’s investments with national priorities, foster stronger government stewardship, and promote a systems-based, data-driven, and collaborative approach to addressing Uganda’s evolving health challenges.

While USAID/Uganda’s health investments were extensive, they were distributed across multiple technical areas—health emergencies, health systems, One Health, and others—each with its own partners, priorities, and reporting requirements. Without an overarching strategy, the Global Health Office struggled to articulate collective goals, demonstrate cross-sectoral impact, or ensure resources were allocated to areas of greatest need and strategic opportunity.

Developing the strategy posed significant challenges. The process required extensive collaboration across a diverse network of stakeholders—including the Government of Uganda (Ministries of Health and Finance), the U.S. Centers for Disease Control and Prevention (CDC), development organizations, non-profits, and implementing partners. Each operated under different mandates, funding streams, and performance frameworks, making consensus-building inherently complex.

Uganda’s health system context added further complications. Data systems were fragmented, limiting the ability to generate a unified, evidence-based picture of health outcomes. Coordination between disease programs was weak, and governance was often hampered by overlapping responsibilities. The health workforce—especially at district and community levels—faced chronic shortages and uneven capacity. These realities underscored the need for a strategy that would not only guide funding allocations but also strengthen the systems underpinning health service delivery.