Uganda institutionalises adolescent healthcare to survive budget cuts, donor exit

The government has incorporated District Committees on Adolescent Health (DICAH) into the Office of the Prime Minister’s official performance assessments, a key move aimed at keeping youth health interventions alive despite a sharp decline in foreign donor funding.

The initiative is part of a broader strategy by the Ministry of Health to institutionalise adolescent healthcare, ensuring continuity as international development partners withdraw support and domestic funding remains unpredictable.

Speaking at the national Sexual and Reproductive Health and Rights (SRHR) Impact and Learning Forum in Kampala, Mr Allan Kasozi, a senior medical officer in the Ministry’s Division of Adolescent and School Health, noted that reliance on stand-alone, donor-backed projects leaves critical achievements vulnerable.
“Given the funding environment currently, where funding is unpredictable and a number of players are pulling out, we know that we stand to lose a number of gains made over the previous years,” Mr Kasozi said.

To mitigate these losses, the health ministry is steering public health facilities away from training isolated focal persons toward building capacity across all healthcare personnel. Under the new approach, any adolescent visiting a health centre for a routine service will have their broader reproductive and general health needs addressed by whichever health worker receives them.

“If you’re going to conduct a training, it’s no longer about focal persons at given service points, but that everyone at that service point should be able to respond to an adolescent’s health needs,” Mr Kasozi explained. He added that multi-sectoral collaboration is crucial because issues like teenage pregnancy stem from wider social challenges. “Teenage pregnancy is a side effect of what’s going on in the communities. Prevention requires action from communities, education, and other sectors.”

The push for sustainability comes amid tightening public resources. Uganda’s health sector budget dropped from Shs5.87 trillion in the 2025/2026 financial year to Shs5.23 trillion for the 2026/2027 financial year, primarily driven by reduced external financing. This fiscal pressure coincides with massive demographic demands; recent census figures highlight that Uganda is home to 11.4 million adolescents aged 10 to 19 and 10.8 million young adults aged 18 to 30.

Civil society advocates stress that shrinking budgets threaten essential gains made in empowering marginalized demographics. Ms Hadijah Nansubuga, programme manager at Paradigm for Social Justice and Development, emphasized that donor-backed projects have given refugees and youth with disabilities a direct line to policymakers.
“Since receiving funding, we have been touching the lives of refugees, disabled, and youth so that they know their sexual rights,” Ms Nansubuga said, noting that beneficiaries have successfully presented their needs directly to district budget councils. “The challenge now is to ensure the gains made through such programmes are not lost as funding arrangements change.”
For young beneficiaries, these initiatives have yielded transformative results. Ms Patricia Alena Namiwamba, a visually impaired Makerere University student, shared how rights training helped her navigate systemic barriers and participate in local budget allocations.

“Before, I had never read the budget,” Ms Namiwamba said, explaining that she now uses human rights frameworks to challenge stigma and advocate for disability-inclusive healthcare. “The opportunity pushed me to examine budget allocations and identify areas that affected people with disabilities.”
By embedding adolescent health indicators directly into district-level performance reviews under the Office of the Prime Minister, the Ministry of Health aims to ensure local government accountability and service delivery long after individual donor cycles come to an end.