Kampala, February 18, 2025 – Uganda’s care-support system remains significantly underdeveloped, with government facilities struggling to meet the growing demands of vulnerable populations. A recent study by the Economic Policy Research Centre (EPRC), first published in October 2024, presents a sobering assessment of the state of government-supported care services. It reveals not only the insufficiency and underutilization of care facilities like hospitals but also the deep-rooted social and gender norms that hinder their adoption. As Uganda continues to invest in social infrastructure, the study underscores the pressing need for behavioral change and policy reforms to ensure that these services reach those who need them most.
Scope and Methodology of the Study
The EPRC research aimed to examine the availability, accessibility, and utilization of government-provided care-support services, with a particular focus on childcare, healthcare, and support for disabled or ill adults. The study also evaluated the effectiveness of the P.O.W.E.R. intervention model, a behavioral change initiative designed to challenge gender and social norms that often dictate household responsibilities and access to care services. Data were collected through household surveys, focus group discussions, and key informant interviews conducted across both rural and urban settings.
The research findings shine a bright light on a critical paradox: while Uganda has made substantial investments in care infrastructure, actual service utilization remains low due to a combination of inadequate facilities, high costs, long distances, and entrenched cultural perceptions about care work.
A System Under Strain: The Shortfall of Government Care Services
One of the most striking findings of the study is the acute shortage and underutilization of childcare facilities. Despite some improvements in infrastructure—such as better access to electricity, healthcare centers, and clean water—childcare services remain critically inadequate. The study reports that less than seven percent of surveyed households had access to or used government-provided childcare facilities. Even among those who did, only 20 percent of users indicated that these facilities were state-run, suggesting a heavy reliance on private or informal childcare services.
The findings also reveal mixed public perceptions about government responsibility in providing care services. While there was a strong consensus that the government should care for disabled or ill adults, there was less enthusiasm about its role in childcare and healthcare. However, the P.O.W.E.R. intervention model significantly influenced public opinion, leading to a 19.5 percentage point increase in women supporting government-provided healthcare, a 13.7 percentage point increase in support for government childcare, and a 10.1 percentage point rise in backing for state-funded care for disabled persons. These shifts highlight the impact of targeted interventions in reshaping public attitudes toward care responsibilities.
The care services discussed in the research refer to government-supported programs and facilities designed to assist children, the elderly, individuals with disabilities, and the sick. These services include childcare centers, healthcare facilities, and support for disabled or chronically ill adults. Additionally, investments in infrastructure such as clean water, electricity, and sanitation indirectly support caregiving by improving overall living conditions. Despite these efforts, the study reveals that many of these services remain insufficient and underutilized due to accessibility barriers, high costs, and entrenched gender norms that discourage their use.
Care services play a critical role in reducing unpaid domestic labor, particularly for women, and ensuring equal access to essential support systems. However, the study finds that social and gender norms often prevent households from fully utilizing these services, especially childcare, which is still widely perceived as a mother’s sole responsibility. While public attitudes toward government-provided care have shifted due to interventions like the P.O.W.E.R. model, actual service uptake remains low. The findings highlight the need for both policy reforms and cultural shifts to make care services more accessible and widely accepted.
Investments in Social Care Infrastructure: Progress and Limitations
The Ugandan government has allocated substantial resources to improve social infrastructure, with the national budget reflecting major investments in energy, healthcare, education, and water access. According to the study, Shs 983 billion has been earmarked for energy development, including rural electrification and clean cooking technology programs, while Shs 10.2 trillion has been directed toward education, healthcare, water, and sanitation.
Despite these efforts, significant challenges persist. The Rural Electrification Program (REP), for instance, was designed to expand electricity access in underserved communities. However, the study found limited success, citing high connection costs and a lack of awareness as key obstacles. Similarly, the introduction of liquefied petroleum gas (LPG) starter kits was meant to reduce women’s unpaid labor by promoting cleaner cooking solutions, yet adoption rates remain low due to cost barriers and cultural resistance.
Barriers to Access: Distance, Cost, and Social Norms
The study also highlights significant access barriers that prevent households from fully benefiting from existing care services. Access to clean water, for example, remains time-consuming and burdensome, particularly for rural women and girls who are traditionally responsible for water collection. The report found that rural households spend an average of 24 minutes walking and 22.8 minutes waiting to fetch water, while urban households spend slightly less time but still face long queues.
Healthcare access also poses serious challenges. Respondents cited unavailability of medicines, long waiting times, and distant health facilities as primary reasons for low healthcare utilization. Similarly, early childhood education enrollment remains low, with only 38 percent of children aged 3-5 years attending pre-primary programs. The study attributes this to the limited availability of childcare centers, high costs, and cultural beliefs that discourage external childcare, reinforcing the expectation that mothers should provide full-time care.
Social and Gender Norms: A Hidden Barrier to Care Utilization
One of the most deeply entrenched barriers identified in the study is the influence of gender norms on care-service utilization. Many communities continue to view childcare as the sole responsibility of mothers, and placing infants in government-run daycare facilities is stigmatized as a sign of neglect or irresponsibility. The study also found that many men resist investment in household care services, perceiving such work as a woman’s duty. Even where care facilities are available, cultural stigma often discourages their use.
Evaluating the P.O.W.E.R. Model: Successes and Shortcomings
The P.O.W.E.R. intervention model was introduced to challenge these social norms and encourage greater use of care services. It consists of five key components: Promoting savings groups, male engagement programs, community dialogues, leadership engagement, and policy advocacy. The model was successful in shifting public perceptions, particularly in increasing support for government-provided childcare and healthcare services.
However, its impact on actual service utilization was mixed. The study found that while there was increased use of electricity in P.O.W.E.R. intervention areas, health service usage declined, likely due to ongoing issues with quality and accessibility. Childcare services also remained underutilized, with many women still reluctant to use them due to deep-seated social stigma.
Policy Implications and the Way Forward
The findings of the EPRC study carry important policy implications for Uganda’s government. Investments in infrastructure alone are not enough to ensure widespread adoption of care services. Without affordable options and social norm shifts, households will continue to underutilize these facilities.
Experts argue that behavioral change campaigns are essential to challenge the stigma surrounding childcare services and promote shared household responsibilities between men and women. Expanding state-funded childcare facilities would also help reduce the unpaid labor burden on women, allowing them greater economic participation. Additionally, ensuring that care services are financially accessible, particularly for low-income rural households, remains a crucial priority.
Ultimately, the study highlights a fundamental truth: care infrastructure alone cannot drive change—policy interventions must also address social attitudes, gender roles, and financial barriers to maximize impact. As Uganda continues to develop its care economy, bridging these gaps will be essential to achieving a more inclusive and equitable society.