Residents of Kalangala District endure boat journeys of up to four hours to access healthcare, with 56 of the district’s 84 islands lacking health centres, exposing significant inequalities in access to essential medical services, a report by the Equal Opportunities Commission (EOC) has revealed.
The report, which examines the state of equal opportunities in Uganda, warns that geographical isolation, inadequate transport infrastructure and a lack of nearby health facilities continue to put lives at risk in island and mountainous communities.
Yusuf Muziransa, the EOC Principal Information and Communications Officer, said the commission investigated the situation following complaints from residents and media reports highlighting the difficulties communities face in accessing healthcare.
“The Commission was getting information from the media and also from citizens who would come to our offices individually. So, the Commission took it upon itself to investigate the allegations. This is what we gathered when we visited the islands,” Muziransa said.
Susan Atukunda, a principal research officer at the commission, said geographical isolation delays access to medical attention, increasing the risk of complications and death among residents who cannot reach health facilities promptly.
She noted that inadequate transport and communication infrastructure further worsens the situation, forcing residents to incur substantial costs when seeking medical treatment.
“Individuals in these regions frequently face high health expenditures, leading to financial strain and increased poverty levels. The lack of timely medical intervention often results in prolonged illness, reducing individuals’ ability to work and support their families, thereby perpetuating a cycle of poverty,” Atukunda said.
The report recommends that the government review the requirement for a catchment population of 500,000 when planning hospital infrastructure, taking geographical isolation into account.
According to the commission, population-based planning may disadvantage island and mountainous districts, where low population density and difficult terrain can leave communities far from essential medical services.
The proposed review seeks to ensure that decisions on health infrastructure consider not only population numbers but also the distance patients must travel and the practical challenges of reaching health facilities.
Muziransa said the commission had recommended that the government increase the acquisition of boat ambulances for island communities and consider deploying mobile clinics to bring healthcare services closer to residents.
“We have recommended to the Ministry of Health a number of areas that can improve the situation. We ask that Government scales up the acquisition of boat ambulances for islands and considers mobile clinics,” he said.
Boat ambulances could help residents access emergency services more quickly, particularly in cases involving childbirth complications, serious injuries and other conditions requiring urgent medical attention.
Mobile clinics could also provide essential health services to communities that are difficult to reach through conventional health infrastructure.
The commission further called on the Ministry of Health to introduce targeted hardship allowances, housing support and career development opportunities to attract and retain health workers in hard-to-reach districts.
Such incentives, the report suggests, could help address staffing challenges in remote communities where difficult working conditions and limited access to basic services may discourage health professionals from taking up or remaining in posts.
The recommendations highlight the need for a healthcare delivery system that accounts for the circumstances of geographically isolated communities rather than relying solely on conventional population-based planning.
For residents of Kalangala and other hard-to-reach areas, improving access to healthcare will require investment in transport, health facilities, mobile services and measures to ensure that qualified medical personnel are available where they are needed most.
The commission’s findings underscore a wider equity challenge: ensuring that a person’s location does not determine whether they can obtain timely and affordable medical care.