Uganda’s community health workers are stretched between routine care and disease outbreaks, with no clear system for balancing the two. The COVID-19 pandemic and recurrent Ebola outbreaks exposed deep weaknesses in how the country prepares for emergencies while still delivering everyday health services. Community health workers—often the only link to care in rural areas—are deployed without evidence-based planning or adequate resources. This research tackles that gap by asking how Uganda can strengthen its community health systems to handle both routine care and outbreaks without sacrificing one for the other. The project will map who holds power and money in outbreak response, assess what community health workers actually do and need, and build computer models that simulate outbreaks to test the most cost-effective strategies. If successful, the work will produce an interactive tool for Ugandan decision-makers to allocate resources more efficiently during health emergencies. The ultimate change would be a community health system that does not collapse under the next outbreak, but absorbs the shock while continuing to deliver vaccines, malaria treatment, and maternal care to the people who depend on it.
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Uganda’s community health systems face persistent challenges in managing disease outbreaks and delivering routine care, particularly in rural and underserved settings. The COVID-19 pandemic and recurrent Ebola outbreaks have exposed systemic weaknesses, including inadequate preparedness, poor integration of routine and emergency health services, and ineffective governance of community health programmes. Despite the critical role of Community Health Systems (CHS) in bridging service delivery gaps, Community Health Worker (CHW) deployment approaches and contributions remain constrained by suboptimal resource allocation and limited evidence-based planning. In this study we are guided by two research questions 1) How can Uganda’s CHS be strengthened to optimise resource allocation, improve outbreak management, and enhance delivery of routine and emergency services? 2) How can stakeholder engagement, supported facilitate evidence-informed decision-making and strengthen policy coalitions for CHS in Uganda? Aims and Objectives This research aims to strengthen Uganda’s CHS by advancing their capacity to integrate routine service delivery with outbreak management. Study aims are to: Explore models to optimise community workforce strategies and system efficiency in outbreak management, Foster participatory governance to enhance evidence-informed decision-making; and Develop epidemiological and economic models to optimise resource allocation and outbreak response strategies in uganda. Methods The project is structured around three interconnected workstreams: 1) Political Economy Analysis and Stakeholder Mapping enabled by social network analyses will identify key actors, governance structures, and resource flows for outbreak management. Data will be gathered through stakeholder interviews, policy document reviews, and participatory workshops to inform policy recommendations. 2) Knowledge Mobilisation and Capacity Building: Evidence on CHWs' roles in outbreak response will be synthesised through primary data collection alongside a scoping review. Activity logs and structured audits will assess CHW workload, resource requirements, and operational constraints in exemplar districts. Training in outbreak modelling and decision analysis will enhance stakeholder competencies. 3) Modelling and Decision Analysis: An integrated epidemiological and economic modelling framework will simulate outbreak scenarios and assess the cost-effectiveness of CHW-led interventions. Constrained optimization models will evaluate resource allocation strategies under various outbreak and routine care conditions. Participatory workshops will ensure the contextual relevance and practical utility of these tools. Anticipated Impact and Dissemination The research will generate actionable insights to optimise CHW contributions, improve outbreak preparedness, and strengthen routine health service delivery. Key outputs include policy briefs, peer-reviewed publications, and an interactive R Shiny tool for decision-makers. Dissemination will occur via targeted workshops, conferences, and publicly accessible data repositories. Capacity-building activities will ensure sustained local expertise in modelling, governance, and evidence application. By enhancing Uganda’s community health systems, this project will support more effective outbreak responses, promote equitable health outcomes, and establish a framework for sustained health system resilience.
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