Uganda takes up to 27 days to detect Ebola and Marburg outbreaks after patients first seek care, despite its ability to mobilise response teams within 24 hours of confirming an outbreak, a study by Makerere University School of Public Health and FHI 360 has found.
The findings were presented during a country validation workshop convened by the Meeting Targets and Maintaining Epidemic Control (EPiC) project to examine lessons from Uganda’s response to filovirus outbreaks.
Presented by Dr. Steven Kabwama, an epidemiologist at Makerere University School of Public Health, the study synthesised lessons from 12 Ebola and Marburg outbreaks recorded in Uganda between 2000 and 2026, drawing on after-action reviews of the 2017 Marburg outbreak, the 2019 Ebola outbreak in Kasese, the 2022 Sudan Ebola outbreak and the 2025 Ebola outbreak in which the index case was a health worker.
The review found that Uganda has developed strong laboratory systems, sample transportation networks, surveillance structures and coordination mechanisms that support rapid action once an outbreak is confirmed. However, delays in recognising suspected cases, inadequate emergency financing, infections among health workers and gaps in isolation infrastructure continue to undermine preparedness.
The study found that the time between a patient’s first presentation at a health facility and confirmation of an outbreak ranged from 9 to 27 days in the outbreaks reviewed, against a target of detecting outbreaks within seven days.
Prof. Rhoda Wanyenze, Dean of Makerere University School of Public Health, said the delays allow diseases to spread within communities before health authorities can mount an effective response.
“Our target is to make sure that we detect within seven days. So we are not yet where we ought to be in terms of quick detection of the outbreaks,” Wanyenze said.
She attributed some of the delays to patients seeking treatment outside formal health facilities, including from traditional healers, making it difficult for the health system to identify unusual illnesses promptly.
Wanyenze said communities needed to be more vigilant and report unusual disease patterns to health authorities as soon as they emerged. She also called for stronger district-level alert systems to ensure reports from communities reach the relevant authorities quickly.
Kabwama said Village Health Teams (VHTs), local council leaders and other community structures were important in identifying unusual illnesses and alerting health officials.
“If there’s a health worker at the community who can identify anything unusual and report it to the ministry, it improves the process of detection but also the response starting earlier,” he said.
He added that strengthening community-level capacity, including through the Ministry of Health’s community health extension worker initiative, could help reduce delays in identifying and reporting suspected outbreaks.
The review also identified difficulties in accessing emergency funds, delays in procuring essential supplies and inadequate isolation facilities as recurring challenges during outbreaks.
Wanyenze said district health teams needed timely funding to deploy responders and obtain essential supplies, including personal protective equipment and diagnostic materials.
She noted that although some funding had been earmarked for emergency response, it remained insufficient to meet the needs of districts during outbreaks.
Kabwama said Uganda often depended on donors and implementing partners to finance emergency operations, highlighting the need for a reliable domestic funding mechanism.
“As a country I think we need to mobilise a fund that can support us to deploy medical workers, pay them when they go to respond, so that we don’t rely too much on external resources whenever we have to respond,” he said.
The study further identified health worker infections as a recurring concern, including outbreaks in which a health worker was the first identified case.
Kabwama said stronger infection prevention and control measures were needed to protect frontline workers, who may encounter infected patients before the disease has been identified.
He called for adequate protective equipment, including masks and other personal protective equipment, alongside regular training to strengthen safety in health facilities.
The review also highlighted gaps in isolation infrastructure. Wanyenze said some facilities lacked dedicated spaces for isolating patients suspected of having highly infectious diseases, potentially forcing health managers to displace other patients to create room.
Dr. Andrew Acero, Director of the EPiC project at FHI 360’s Uganda office, said lessons from previous outbreaks needed to translate into lasting changes in public health practice.
“The real value lies in ensuring that what we learn changes what we do. Our findings should inform policy, shape guidelines and training, strengthen systems and ultimately improve practice,” Acero said.
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