The ruling National Resistance Movement (NRM) party, in their 2021-2026 manifesto, promised to transform the country’s healthcare system, an essential area for the population.
With the national resources at their disposal to execute the plans, our assessment of their performance discovered a mixed bag of remarkable achievements and glaring shortfalls.
While notable progress was made in expanding primary healthcare and increasing funding for medical supplies, significant gaps remain, with unfulfilled commitments, such as the completion of Lubowa International Specialised Hospital, reappearing in the 2026-2031 manifesto.
Overall, of 17 promises assessed and rated, only around 18 percent (3/17) of health promises were fully achieved, while the majority were either partially fulfilled (11/17) or showed no implementation (3/17).
When each of the items is weighted, the overall achievement is around 50 percent. Our analysis shows there were significant strides made in increasing access to care in communities, with the party reporting the construction of 454 Health Centre IIIs, surpassing the initial target of 331.
Some of these were upgraded from Health Centre IIs (HCIIs), to enhance access in underserved areas, according to the Ministry of Health.
By April this year, the Health Minister Dr Jane Ruth Aceng, had confirmed that 398 were completed, with funding from the World Bank’s Uganda Intergovernmental Fiscal Transfers Programme (UgIFT) and Uganda Maternal and Child Health Improvement Project (UMCHIP) of around Shs720 billion.
Some HCIIs were upgraded to HCIIIs to improve access in underserved areas.
Achievements
Kayunga and Yumbe general hospitals were upgraded to regional referral status, and blood banks were established in Hoima, Arua, and Soroti.
This further improved access to care for complicated cases and addressed death related to the shortage of blood. We also found that advanced equipment, including CT scans and oxygen plants, was installed in major referral hospitals. However, during an April visit to Hoima Regional Referral Hospital, the equipment was found non-operational due to insufficient electricity.
The budget for essential medicines and supplies through National Medical Stores (NMS) rose from Shs258 billion in 2017/18 to Shs537 billion in 2023/24, reducing stock-outs.
The government did this amid the enhancement of salaries for medical workers. However, absenteeism persisted or worsened, according to Ministry of Health reports.
The manifesto pledged completion of Lubowa International Specialised Hospital (ISHU) by June 2021 to curb medical tourism (Ugandans spent $186 million abroad in 2017) and promote regional medical exports. However, construction remains incomplete.
Attorney General Kiryowa Kiwanuka, in an April letter, set a new completion date of June 2026.
‘The anticipated completion date for the hospital is June 2026. While the project experienced delays due to a considerable number of unforeseen force majeure events, including the global Covid-19 pandemic, the government and the developer have, as a cure, agreed to an accelerated works programme to ensure timely completion,’ he said in an April 17 letter to the Monitor.
The promise has been recycled in the 2026-2031 manifesto, amid prevailing concerns by Opposition politicians regarding the transparency in this multi-billion-shilling project.
The NRM, in their previous manifesto, also promised new general hospitals in Wakiso and Kampala to ease overcrowding in KCCA facilities. These were not delivered, despite Kampala’s institutional maternal mortality rate of 213 deaths per 100,000 deliveries-far above the national average of 83.
The manifesto committed to upgrading Kisenyi, Kotido, and Kyegegwa HCIVs to general hospitals. While Kotido and Kyegegwa were upgraded, Kisenyi was not, exacerbating Kampala’s healthcare challenges.
The new manifesto is also silent about the national health insurance scheme which could be essential in bridging gaps in access to health care by reducing heavy out-of-pocket expenditure on health.
In the new manifesto for 2026-2031, NRM said they would construct HCIIIs in sub-counties without them; rehabilitate 40 HC IVs and provide them with theatres, 16 general hospitals, and eight regional referral hospitals.
This was also promised in the previous manifesto, but it was not fully implemented. Apart from this, the party has also promised to renovate old and dilapidated staff houses and construct new ones for health workers.
New promises in 2026-2031
They have also promised to construct, equip and functionalise regional blood banks in regions without them (Masaka, Busoga, Lango, Karamoja and Kigezi) and construct and equip new hospitals.
Masaka and Karamoja were mentioned in the previous manifesto, but were not implemented.
‘NRM will construct the orthopaedic and traumatology centre of excellence at Naguru National Referral Hospital [and] complete construction of Lubowa International Specialised Hospital,’ the manifesto reads.
This is largely recycled from the previous manifesto. There is also an expanded plan for the Greater Kampala Metropolitan Area (GKMA) where the party plans to upgrade and equip health facilities to general hospital status. But this particular promise was made in the previous manifesto and not implemented.
The targeted facilities include Kampala (Kisenyi, Kawaala, Kiswa, Kisugu and Komamboga), Wakiso (Nansana, Kira, Wakiso HCIV, Ndejje HCIV in Makindye-Ssabagabo), Mukono (Goma) renovate and expand Soroti Regional Referral Hospital, and equip Bugiri General Hospital.
How we arrived at 50% assessment
There were 25 promises assessed (see table below). We had most of the information about 17 promises and so these qualified for our rating. Eight promises could not be rated because of insufficient information.
Achieved (A): 3/17 promises = 18%
Partially Achieved (PA): 11/17 promises = 62%
Not Achieved (NA): 3/17 promises = 18%
To calculate the NRM’s overall percentage performance, we evaluated the 17 rated promises out of the 25 assessed. The ratings were broken down as follows:
3 Achieved (100 percent performance each),
11 Partially Achieved (50 percent performance each), and
3 Not Achieved (0 percent performance each).
We then calculated the total performance score by multiplying the number of promises in each category by their respective weights ((3 × 1) + (11 × 0.5) + (3 × 0) = 8.5).
Dividing this score of 8.5 by the total number of rated promises (17) and multiplying by 100, gave an overall performance of 50%.