WENDA Council Policy Brief: Strengthening Health Systems in the West Nile Region

Executive Summary

The West Nile Region, comprising 12 districts, 1 city, and 2 municipalities, faces significant health systems challenges exacerbated by its geographic isolation, high refugee population, poverty, and epidemic-prone environment. With a total of 320 health facilities and a regional staffing level of only 26.8%, the sector is under-resourced and overburdened. Funding for health supplies averages UGX 3,723 per capita, far below needs for a population hosting 80% of Uganda's refugees and bordering underdeveloped health systems in South Sudan and the Democratic Republic of Congo (DRC).

This policy brief, prepared for the West Nile Development Agency (WENDA) Council, outlines key challenges, leverages constitutional provisions for inter-district cooperation (Article 178), and proposes prioritized investments in infrastructure, human resources, and resilience-building. Recommendations include upgrading key facilities, enhancing staffing, and fostering regional partnerships to achieve sustainable health development. Immediate action could improve health outcomes, reduce epidemic risks, and support economic growth.

Background and Context

The West Nile Region, located over 500 km northwest of Kampala, is characterized by diverse cultures, friendly communities, and strategic borders with South Sudan and the DRC. It hosts approximately 80% of Uganda's refugees, making it the third-largest populated region but the second-poorest, with a young population exhibiting declining functional literacy and low primary education completion rates. The region is prone to communicable diseases, neglected tropical diseases (NTDs), zoonotic diseases, and epidemics, compounded by poor transport infrastructure, high substance use, limited electricity coverage, and biomass dependency.

Health is defined as a state of complete physical, mental, and social well-being (WHO, 1948), while health systems encompass institutions and actions aimed at promoting health. Sustainable development in this context requires improvements in living conditions that meet current needs without compromising future generations. The region's health context includes underdeveloped bordering health systems, high rates of land sales to foreigners, and environmental vulnerabilities.

Key Challenges in the Health Sector

1. Distribution and Infrastructure of Health Facilities

The region has 320 health facilities across 147 sub-counties/town councils and 24 counties. Facilities are unevenly distributed, with Yumbe having the highest (47) and Arua the lowest (11). Regional Referral Hospitals (RRHs) are limited to two (in Arua City and Yumbe), while nine local governments (LGs) lack general hospitals.

2. Human Resources and Management

Health management teams are understaffed, with only 6 District Health Officers (DHOs)/City Health Officers (CHOs) across 13 LGs. Total managers number 76, with gaps in roles like Assistant DHO for Maternal and Child Health (ADHO MCH) and Environmental Health (ADHO EH).

3. Staffing in Health Facilities

Staffing in government facilities stands at 26.8% of approved norms, with Yumbe at a critically low 13.9%. The region has 13,944 approved positions with only 3,741 filled.

4. Funding and Resource Allocation

Total funding for health supplies is UGX 16,320,640,218, with per capita expenditure varying widely (e.g., Moyo at UGX 13,300 vs. Arua at UGX 1,259). This reflects inequalities and insufficient resources for epidemic response and refugee health needs.

Legal Basis for Regional Cooperation

Under Uganda's 1995 Constitution, Articles 176-178 enable districts to form councils for cooperation in areas like health, education, and infrastructure. The Fifth Schedule specifies health as a key area, allowing for bodies corporate like WENDA Council to address shared challenges, with provisions for withdrawal.

Opportunities for Health Systems Development

• Enabling legal framework and government funding commitments
• Two RRHs and partnerships with development/implementing organizations
• Large population base, including refugees and border communities, for service utilization
• Academic institutions like Muni University for training and research
• Robust private sector for supplies and technologies

Investment Priorities for Resilient Health Systems

To build resilience, prioritize:

• Universal education and functional literacy
• Food production, safety, and nutrition
• Safe water and sustainable sanitation
• Energy for health technologies and innovations
• Environmental protection
• Transport infrastructure
• Poverty-reducing economic growth
• Formalized international trade and partnerships
• Law enforcement and policy review

Proposed Policy Recommendations

WENDA Council should advocate for:

• Upgrading Arua RRH to national hospital status and Nebbi General Hospital to RRH
• Constructing general hospitals in 9 underserved LGs
• Upgrading HC IIIs to IVs in constituencies without them, HC IIs to IIIs in lower LGs, and building new HC IIIs where they are absent
• Enhancing facilities in hard-to-reach areas
• Establishing a regional research laboratory, oxygen plant, waste incineration plant, and medicine stores and improving waste management
• Connecting all facilities to electricity/solar
• Reducing internet costs for health facilities

Implementation should involve pooled resources under Article 178, partnerships with private sectors and donors, and monitoring via regional indicators. This will foster sustainable development, epidemic preparedness, and improved quality of life.

Conclusion

The West Nile Region's health challenges demand coordinated action through WENDA Council to leverage opportunities and address inequities. By prioritizing infrastructure upgrades, staffing improvements, and cross-border collaborations, the region can achieve resilient health systems that support broader development goals. Urgent advocacy with national government and partners is recommended to secure funding and enact these priorities by FY 2026/27.