ArticleHealth research policy and systems2025
Exploring the facilitators and barriers to achieving universal health coverage in Uganda: a qualitative study of the free healthcare policy.
Article in Health research policy and systems, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.
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Who cites it
5 citing papers in PubMed.
- Informal payments and the illusion of free care: a perspective from Somalia's fragile health system.International journal for equity in health · 2026Article
- Health system and treatment regimen determinants of delayed first-dose antibiotic administration in hospitalized adults in two public health facilities in Kampala, Uganda.BMC health services research · 2026Article
- Challenges and coping practices of frontline health workers in newly created districts in Uganda: an exploratory qualitative study.BMJ open · 2025Article
- Strengthening intersectoral cooperation for control and integrated surveillance of rabies in Uganda: A multistakeholder engagement workshop.One health (Amsterdam, Netherlands) · 2025Article
- High Prevalence of Antimicrobial Prescribing Among Public Health Facilities in Central Uganda: Findings from Point Prevalence Survey.Infection and drug resistance · 2025Article
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Authors and funding
5 authors.
Funding
Abstract
backgroundCritical variations often occur between a state's initial public policy goals and its implementation outcomes. After two decades, the implementation of the free healthcare policy in Uganda has not achieved the desired outcomes, and there is a lack of comprehensive contextual analysis applying implementation science approaches in the identification of barriers and facilitators. This study explores barriers and facilitators to the implementation of the free healthcare policy, drawing on the retrospective experiences of policymakers, policy advocates, policy supporters or influencers, policy implementers, and policy beneficiaries.
methodsWe employed an exploratory qualitative study design and conducted 27 semi-structured interviews with key informants and 16 focus groups with users. Perspectives on implementation over time were collected by incorporating questions relating to the policy implementation journey from inception to 2023. The Consolidated Framework for Implementation Research guided data analysis to categorize and examine the barriers and facilitators to implementation. Two coders independently coded the data, which were thematically analysed with NVivo.14.
resultsA total of five main factors were identified, synthesized, and categorized as barriers and facilitators with overlaps, namely: (i) financial resources, (ii) medicines and supply system, (iii) health human resources, (iv) infrastructure and functionality, and (v) equity and the FHP Implementation.
conclusionsFindings illustrate that policy implementation gaps are due to limited resources, political will that does not translate into sufficient allocation of funds, and incremental policy shifts that are not driving meaningful improvement in the health system. The findings explain why the free healthcare policy implementation has been unsuccessful and highlight the importance of investing in resources to support meaningful progress towards universal health coverage.
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