For two-year-old Ladit, a missing hospital file meant three days without treatment. His experience exposes the risks of Uganda’s paper-based health records and the urgent need for secure, connected systems that keep patients’ medical histories within reach.
For three days, two-year-old Ladit’s treatment at a referral hospital was interrupted. Not because the medicine was unavailable or doctors did not know what treatment he needed, but because his patient file could not be found.
Ladit, who has a kidney problem, was receiving care at the hospital when his medical records went missing. Doctors needed the notes to understand his treatment history, but the file could not immediately be traced. For the toddler and his family, the search for a file became a wait for treatment.
The notes were eventually found three days later. By then, Ladit had missed treatment he was supposed to receive.
His experience illustrates a problem that can easily be dismissed as administrative but can have direct consequences for patients: Uganda’s continued reliance on paper-based medical records.
A medical file contains much more than a patient’s name and appointment dates. It can hold previous diagnoses, laboratory results, medicines, investigations and treatment plans, information that doctors may need before deciding what to do next.
When that information cannot be accessed, treatment can be delayed.
Dr Gonzaga Andabati, director of Bethany Women’s Hospital International, says digitisation could reduce some of the delays associated with paper records.
‘With digitisation of medical records, we believe the patients will have less waiting time and we no longer have to struggle with poor handwriting on the patient notes,’ he says.
Why the file matters
In many Ugandan health facilities, a returning patient’s history may still be stored in a physical file or register in a records room.
Before a doctor can attend to the patient, a health worker may have to locate the file among hundreds or thousands of others. If it has been misplaced, taken to another department or not returned to the records room, the patient may have to wait. The problem becomes more complicated when a patient receives care from different facilities.
A hospital in Kampala, for example, may not have immediate access to records from a health centre in another district. The patient may have to explain their history again or carry copies of previous results and prescriptions.
‘This can mean repeated explanations of medical history, difficulty accessing previous laboratory results and, in some circumstances, delays in treatment,’ says Dr Andabati.
For patients with chronic conditions, the consequences can be particularly significant because their care often depends on knowing what treatment they have previously received and how they responded.
The move from paper to digital
The challenge is not limited to individual patient files. Every day, Uganda’s health facilities generate information about diseases, medicines, laboratory tests, patients and the services they provide. That information can help the Ministry of Health (MoH) understand what is happening across the country and where resources are needed.
But information is useful only when it can be collected accurately, accessed in time and shared appropriately.
According to Paul Mbaka, commissioner for Health Information Management at MoH, every health facility is expected to collect and submit information to the ministry, but fewer than half submit the required reports.
The gap can make it harder for health planners to get a complete and timely picture of the country’s health needs.
Digitisation offers a way of improving both patient care and the use of health information. Electronic systems can allow information to be retrieved faster and transmitted between connected facilities, while aggregated data can help identify changing disease patterns and demand for medicines and services.
‘Our goal is to ensure that digital transformation translates into meaningful impact. By connecting people, processes, and data, we can help healthcare providers strengthen their operations while creating better experiences for the patients they serve,’ Mbaka says.
The MoH’s interoperability guidelines are intended to support this connection between digital health systems.
In practice, this could mean that an authorised clinician treating a patient who has previously been seen elsewhere can access relevant information without waiting for a physical file to be transported or retrieved.
But that depends on more than having computers. The information must first be entered correctly, systems must be able to communicate and health workers must know how to use them.
Poorly entered or incomplete information can, therefore, remain a problem even after a facility goes digital. Training, supervision, standards and accountability are essential to ensure that electronic records are reliable.
More than medical records
The same principle applies to other parts of healthcare. Pharmacies, for instance, generate information about which medicines are being dispensed, which products are in high demand and which are approaching expiry. Digital systems can help pharmacies monitor this information and make better purchasing decisions.
This is the thinking behind Smart PharmaLink, an integrated pharmacy management platform launched by Smart Applications International Uganda Ltd during the Uganda Healthcare Providers CEOs Forum at Hotel Africana in Kampala. The forum was held under the theme ‘Empowering Medical Service Providers Through Digital Transformation for Efficiency, Growth and Sustainable Healthcare.’
Judy Elaine Mugoya, Country Manager, Smart Applications International Uganda Ltd, says the goal should be to create systems that work together rather than simply introduce more technology.
‘Healthcare digitisation is no longer about simply adopting technology; it is about creating connected systems that enable healthcare providers to work more efficiently, make better decisions, and ultimately deliver better experiences for patients,’ she says.
Mugoya says the platform can be accessed through a smartphone application, including by pharmacies in rural areas. Mbaka says such systems could help reduce overstocking and understocking while cutting down on manual processes.
The wider ambition is to have information move through the health system in a way that supports both individual patients and national planning.
One patient to a national picture
When health information from different facilities is aggregated responsibly, it can reveal patterns that may otherwise be difficult to see.
‘A sudden increase in patients presenting with a particular illness in one area could trigger investigation. Medicine consumption could reveal changing demand, while information from different regions could help planners determine where health workers, medicines and equipment are most needed,’ says Mbaka.
Who gets to see your history?
Uganda’s Health Data Protection, Privacy and Confidentiality Guidelines provide a framework for protecting personal health information and operationalise the Data Protection and Privacy Act 2019 and Regulations 2021. The guidelines apply to both digital and paper-based health information.
Judy Elaine Mugoya, Country Manager, Smart Uganda, says access should be limited according to a user’s role.
‘Patients’ information within the system is not simply available to everyone but is restricted to medical personnel. Each user should only have access to what is necessary for their legitimate role,’ she says.
This balance between accessibility and privacy will become increasingly important as Uganda expands its digital health infrastructure.
But Uganda faces another challenge: having multiple digital systems that do not communicate with each other.
The Ministry of Health has acknowledged that independent digital-health innovations can lead to duplication and limited integration. For patients, this means digitisation could fail to solve the problem if their information remains scattered across disconnected systems.
‘A patient should not have one digital record at a hospital, another at a laboratory and another at a pharmacy, with none of the systems able to communicate. The information may be electronic, but the patient could still experience the same fragmentation,’ Mugoya says.
The aim, therefore, is not simply to replace paper files with electronic ones. It is to build systems through which relevant information can move securely with the patient’s care.
Can a patient keep their medical file?
According to Uganda’s Ministry of Health Health Data Access, Sharing and Use Guidelines, patients have a right to access their health information and obtain copies of their medical records. However, the original individual-level medical record should generally remain at the health facility.
Patients can request copies of important results, prescriptions, discharge summaries and referral notes to keep for their own reference or when seeking care elsewhere.
Note: You can access and obtain copies of your health information, but you cannot take the original hospital file home.