Health service integration in lower-level facilities: Application of the Health Systems Integration Maturity Framework across Hoima, Kabale and Wakiso Districts, Uganda
- 1Department of Health Policy Planning and Management, Makerere University School of Public Health, Kampala, Uganda
- 2District Health Office, Kabale District Local Government, Kabale, Uganda
Abstract
Introduction: Service delivery in Uganda has historically been shaped by vertical, donor-funded programmes, resulting in fragmented systems. In February 2025, the Ministry of Health mandated integration of standalone services. This study assessed health service integration at lower-level public facilities. Methods: A convergent mixed-methods case study was conducted at three facilities. Integration was assessed using a 40-item checklist adapted from the Uganda Ministry of Health integration standards and the World Health Organisation health-system building blocks, then mapped to the Health Systems Integration Maturity Framework. Key informant interviews explored facilitators, barriers, and perceived effects of donor funding cuts. Quantitative data were summarised using mean scores, while qualitative data were analysed thematically. Results: Kasangati Health Centre IV had minimal integration, with a mean score of 2.6, while Dwoli Health Centre III and Kamukira Health Centre IV had moderate integration, with mean scores of 3.2 and 3.3, respectively. Integration was strongest in supply chain and laboratory services (3.7 each), followed by clinic-space reorganisation (3.5). Community engagement (2.3), financing (2.4), policy and governance (2.5), and health information systems (2.8) showed lower levels of integration. Facilitators included national policy direction, district-level oversight and support, and health worker adaptability. Barriers included staffing shortages, inconsistent availability of medicines and diagnostics, fragmented information systems, and reduced supervision and outreaches following donor funding cuts. Participants perceived that donor funding cuts constrained service delivery while accelerating organisational integration through resource pooling. Conclusion: Following Uganda’s 2025 integration directive, facilities achieved minimal to moderate integration. Progression towards full integration requires adequate financing, facility-specific implementation guidance, integrated Health Management Information System tools, and context-appropriate integration of community services.
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BibTeX
@article{kigongo2026health,
title = {{Health service integration in lower-level facilities: Application of the Health Systems Integration Maturity Framework across Hoima, Kabale and Wakiso Districts, Uganda}},
author = {Angella Nabakooza Kigongo and Albert Tonny Okia and Ibrahim Ssebukulu and Irene Tumwebaze and Stuart Mayira and Amon Lucky Bwambale and Mousa Matovu and Agatha Tukamuhebwa and Irene Elizabeth Nuwe and Gilbert Mateeka and Connie Nait and Immaculate Nakasiita and Suzanne Namusoke Kiwanuka},
journal = {Journal of Interventional Epidemiology and Public Health},
year = {2026},
month = sep,
doi = {10.37432/jieph-d-26-00100},
url = {https://doi.org/10.37432/jieph-d-26-00100},
note = {CC BY},
}
RIS
TY - JOUR
TI - Health service integration in lower-level facilities: Application of the Health Systems Integration Maturity Framework across Hoima, Kabale and Wakiso Districts, Uganda
AU - Angella Nabakooza Kigongo
AU - Albert Tonny Okia
AU - Ibrahim Ssebukulu
AU - Irene Tumwebaze
AU - Stuart Mayira
AU - Amon Lucky Bwambale
AU - Mousa Matovu
AU - Agatha Tukamuhebwa
AU - Irene Elizabeth Nuwe
AU - Gilbert Mateeka
AU - Connie Nait
AU - Immaculate Nakasiita
AU - Suzanne Namusoke Kiwanuka
PY - 2026
DA - 2026/09/01
JO - Journal of Interventional Epidemiology and Public Health
DO - 10.37432/jieph-d-26-00100
UR - https://doi.org/10.37432/jieph-d-26-00100
AB - Introduction: Service delivery in Uganda has historically been shaped by vertical, donor-funded programmes, resulting in fragmented systems. In February 2025, the Ministry of Health mandated integration of standalone services. This study assessed health service integration at lower-level public facilities. Methods: A convergent mixed-methods case study was conducted at three facilities. Integration was assessed using a 40-item checklist adapted from the Uganda Ministry of Health integration standards and the World Health Organisation health-system building blocks, then mapped to the Health Systems Integration Maturity Framework. Key informant interviews explored facilitators, barriers, and perceived effects of donor funding cuts. Quantitative data were summarised using mean scores, while qualitative data were analysed thematically. Results: Kasangati Health Centre IV had minimal integration, with a mean score of 2.6, while Dwoli Health Centre III and Kamukira Health Centre IV had moderate integration, with mean scores of 3.2 and 3.3, respectively. Integration was strongest in supply chain and laboratory services (3.7 each), followed by clinic-space reorganisation (3.5). Community engagement (2.3), financing (2.4), policy and governance (2.5), and health information systems (2.8) showed lower levels of integration. Facilitators included national policy direction, district-level oversight and support, and health worker adaptability. Barriers included staffing shortages, inconsistent availability of medicines and diagnostics, fragmented information systems, and reduced supervision and outreaches following donor funding cuts. Participants perceived that donor funding cuts constrained service delivery while accelerating organisational integration through resource pooling. Conclusion: Following Uganda’s 2025 integration directive, facilities achieved minimal to moderate integration. Progression towards full integration requires adequate financing, facility-specific implementation guidance, integrated Health Management Information System tools, and context-appropriate integration of community services.
SN - 2664-2824
ER -