As Uganda continues to grapple with recurrent public health emergencies driven by epidemic-prone diseases and climate-related disasters, a new wave of strengthened district-level preparedness is emerging, thanks to sustained technical support from the World Health Organization (WHO).

In the first quarter of 2025 alone, Uganda recorded 10 public health emergencies, eight of which were infectious disease outbreaks. From Ebola and Mpox to Measles, Anthrax, and Yellow Fever, nearly every WHO hub sub-region faced significant health threats. In addition,   climate-related shocks, floods, and landslides further strained the already overburdened health system.

At the centre of Uganda’s frontline readiness is WHO’s District Health Management field teams, embedded across the country to support surveillance, coordination, and emergency response. These teams work through the District Health Offices and Regional Emergency Operations Centers (REOCs), serving as the first line of technical and operational support for districts.

A Turning Point Triggered by Ebola

The need for enhanced district preparedness became especially clear following the recent Ebola Virus Disease (EVD) events in Mbale District, Mbale City, Fort Portal, Jinja, and the Kampala Metropolitan Area. The outbreak exposed gaps in early detection, risk assessment, and multi-sectoral coordination, gaps that WHO moved quickly to address.

“ WHO has always been with us during the hard times when responding to Public Health Emergencies,” says Dr Jonathan Wanjisi, District Health Officer for Mbale district, adding that “the field teams have always stayed back to integrate emergency response actions into district health systems during recovery”. 

His words echo the experience of many district leaders who now rely on the WHO’s long-term, on-ground support as more emergencies strike with increasing frequency.

Technical Support That Stays Beyond the Crisis

WHO’s sub-national assistance goes far beyond outbreak response. District WHO teams remain in the districts long after emergencies subside, ensuring that critical functions, surveillance, Infection Prevention and Control, reporting, and coordination are embedded in routine health systems rather than treated as temporary interventions. This approach is helping districts shift from reactive response to proactive preparedness.

STAR Assessments: Mapping Risks Before They Strike

To further strengthen readiness, WHO collaborated with the Ministry of Health to roll out the Strategic Assessment of Risk (STAR) process in Ebola-affected districts. STAR provided an in-depth, evidence-driven picture of hazards such as Ebola, Mpox, Measles, Anthrax, Cremean Congo Hemorrhagic Fever, Malaria, Yellow Fever, Floods,  and landslides

These assessments informed the development of improved contingency plans. According to WHO documentation, 69% of completed STAR assessments translated directly into district-level contingency planning, marking a significant step toward national multi-hazard preparedness.

Putting Preparedness to the Test

Following the risk assessments, WHO supported multi-hazard simulation exercises to validate district readiness. These drills tested real-world capacities in:

• Early detection of priority diseases

• Reporting and communication pathways

• Emergency coordination and rapid response

• Sample transport and laboratory readiness

The exercises uncovered critical bottlenecks, such as delays in sample transport and gaps in partner coordination, which are now being addressed. The combined impact of WHO’s embedded technical support, STAR assessments, and simulation exercises has been transformative to the Health sector.

Key accomplishments 

The combination of WHO’s embedded technical support, STAR assessments, and simulation exercises has delivered a transformative effect on district readiness. This is evident through:

• Stronger multi-hazard preparedness across Ebola, Mpox, Measles, Anthrax, and climate-related disasters

• Evidence-based contingency planning, aligned with hazard profiles

• Improved emergency response capacity within districts

• Full integration of emergency functions into routine health systems, leading to sustainable surveillance and coordination structures

• Enhanced district autonomy, reducing reliance on external surge teams

In districts like Mbale and across the Kampala Metropolitan Area, these improvements are already strengthening resilience against recurrent outbreaks and climatic shocks.

Sustaining and Expanding Gains

Despite these achievements, Uganda’s sub-national health system still faces resource and capacity gaps. WHO recommends several priority actions to consolidate progress:

1. Expand STAR assessments to all high-risk districts.

2. Institutionalize annual multi-hazard simulation exercises, focusing on Ebola, Mpox, measles, and floods.

3. Strengthen emergency logistics and supply chains, particularly IPC materials, PPE, and sample transport.

4. Restore WHO’s full DHM field presence from the current three hubs back to nine for nationwide coverage.

5. Deepen district-level training in surveillance, coordination, and rapid response.

6. Boost community preparedness for recurring hazards, including floods, landslides, Mpox, and measles.

A Model for Resilient Health Systems

Uganda’s experience demonstrates that a strong sub-national presence, supported by continuous technical guidance and embedded field teams, can dramatically improve preparedness in high-risk settings. As climate change and emerging infections continue to fuel public health threats, the country’s strengthened district systems are becoming a model of resilience in the region and beyond.