SCHEMA-Uganda: Strengthening Community Health and Epidemic Management in Uganda

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 a decision support tool - an interactive R Shiny tool for planners for CHS and readiness for Outbreaks. Dissemination will occur via targeted workshops, conferences, and Outbreak Drills for learning and piloting the R-Shiny decision support tool. 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 from Community workforce, and establish a framework for sustained health system resilience to outbreaks.