Uganda’s health budget boost: A new era for community health

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OPINION

By Christine Namayanja

On Thursday, June 12, 2025, the Parliament allocated a groundbreaking sh4.48 trillion to the health sector budget for FY 2025/26, nearly doubling last year’s allocation and now representing 8.1% of the national budget, marking the highest proportion ever. I extend heartfelt gratitude to the Parliament and the Government of Uganda for prioritising health and elevating primary healthcare and community health services in this historic funding package.

This allocation will enable the functionalisation of Health Centre IVs, strengthen primary healthcare and community health services, scale up national e-health infrastructure, enhance nutrition, reproductive health, immunisation, health education, emergency referrals, specialised care nationwide, and, more significantly, the continued deployment of Community Health Extension Workers (CHEWs). This underscores a bold commitment to professionalise Community Health Workers (CHWs).

In Uganda’s community health structure, Village Health Teams (VHTs) and Community Health Extension Workers (CHEWs) each play a vital role in promoting health and providing essential services at the village and parish levels, respectively. CHEWs are positioned as a supervisory cadre more recently introduced by the government to support and oversee the work of VHTs.

Since 2007, Living Goods has worked closely with the Ministry of Health and partners to build the capacity of CHWs using the DESC model, ensuring they are Digitally enabled, Equipped, Supervised, and Compensated. They are trusted community-based individuals who deliver cost-effective health promotion and care services directly to homes: preventing and treating childhood illnesses, monitoring nutrition, providing reproductive health education, detecting disease early, making referrals, and supporting immunisation follow-ups.

Results from a Cluster-Randomized Trial in Uganda (2016–2021) demonstrated that financially incentivising and digitally enabling VHTs reduced under-five mortality by 27%. Given that over 75% of Uganda’s disease burden is preventable, community-based care through well-supported CHWs is the most equitable and efficient route to Universal Health Coverage (UHC). It also improves the timeliness and quality of data, driving better decisions and resource use.

In 2023, a quasi-experiment was conducted by external independent investigators to explore how financial incentives impact CHW performance, motivation, and retention in Uganda. It demonstrated that with proper skilling, close supervision, digital tools, and financial incentives, CHWs delivered better family planning coverage, stronger referral follow-ups, more consistent household visits, and fewer cases of sick under-fives. This underscores the importance of investing in fully supported CHW systems to strengthen performance and build a resilient community health workforce capable of advancing universal health coverage.

Wakiso District is a close example. The Assistant District Health Officer, Mr David Ssekaboga, attributed the district’s improved decision-making to CHWs using the electronic Community Health Information System (eCHIS) platform. He noted that community service reporting increased from 45% to 62.5% since January this year when they officially started using the system. He commended CHWs and the supervisors for their role in this achievement, emphasising that data is now guiding timely and responsive health actions.

The recent disruption in donor funding has heavily impacted the health sector, and the silver lining has been the government’s re-prioritisation of human capital development. By investing in CHWs and ensuring they have adequate tools, skills, supervision, and compensation, we secure community health gains and strengthen local ownership of services.

This 2025/26 health budget is more than a fiscal milestone; it’s a decisive investment that, if effectively implemented, will go a long way to deliver health gains. As Living Goods, we stand ready to join hands with the Ministry of Health, development partners, and implementing partners who have tirelessly advocated for a strengthened CHW system and community health funding. With solid evidence, technical capacity, and trusted partnerships, we are committed to turning this landmark budget into healthier lives, one village, one household at a time.

The writer is the Country Director, Living Goods Uganda