Research for stronger health systems during and after crisis

ReBUILD in Uganda

Related Resources:

Find more resources relating to ReBUILD in Uganda


The ReBUILD work in Uganda is being led by the Makerere University School of Public Health. The programme focuses on the North (Acholi sub region) of the country which is facing particular health system challenges after emerging from many years of conflict.


This work focuses on the Districts of Gulu, Kitgum and Amuru. Health financing and the workforce for health programme form the main themes of the ReBUILD work. For instance, difficulties in recruiting and retaining the health workforce mean that there is a lack of qualified personnel in rural health facilities. The ratios of health worker to population are extremely low: 1:4000 in the Acholi sub-region. Many public rural facilities are non-functional: 32% in the Acholi sub-region. Despite intensive efforts to re-equip facilities over the past couple of years, most communities are too far away from a functional facility. In some areas, dual practice is an issue while informal charging for health services creates a barrier to access to services. Nonetheless, the reconstruction activities in post conflict northern Uganda represent opportunities to rebuild the health system. The Government and international community have provided additional financial resources to address different constraints in the health and related systems. The ReBUILD Consortium is contributing research evidence to help optimize these opportunities for health system development. The Consortium is providing a platform to strengthen existing research-to-policy links and broker new opportunities for exchange.

The research under ReBUILD is conducted under two broad themes:

Understanding changes in health financing and poor households’ expenditure on health

User fees in Uganda were abolished in 2001 and so health services are theoretically free. In practice there is a complex, plural system. Our research is looking at changes in health financing policy and its relationship to the post conflict trajectory. We are exploring how policy changes influence the behaviour of households and their spending. Attention has been paid to the gendered implications of policy and expenditure.

Specifically; the study whose preliminary findings are shared here, sought to document the changes in health financing in Northern Uganda; document changes in patterns of household health expenditure by the poor of northern Uganda pre, during and post conflict; document how these changes in household health expenditure have affected general household welfare; document changing perceptions of household health expenditure by the poorest households and develop strategies/interventions to access health care to the poorest households in Uganda.

See short video below in which lead researcher Dr. Sarah Ssali talks about the change in household health expenditure in northern Uganda, before, during and after the conflict.


A ReBUILD phase two project is also considering the impact of performance-based financing in the state.


Exploring the development of the health workforce in post conflict areas

As health systems are reconstituted post conflict, there are opportunities to modify health worker policies and practices, including health worker incentives. In Northern Uganda many internally displaced people have returned and many more are returning to their homes but it is unclear whether health workers are following suit as expected. In the light of the need to attract health workers from the urban to the rural areas the government has agreed to provide a 30% pay rise to those who work in hard-to-reach areas. Our research in this field is helping us to better understand the post-conflict dynamics for health workers and what form of incentive environments best supports rational and equitable health services. We are exploring how incentive environments have evolved in the shift away from conflict, what has influenced their trajectory and what are the effects.


For more information about ReBUILD in Uganda, refer to our briefing update here.