Ebola Virus Disease Preparedness in Subnational Health Systems: A Readiness Assessment of Jinja District, Uganda

Background: Ebola virus disease (EVD) remains a significant public health threat in sub-Saharan Africa. Jinja District in Uganda has experienced two EVD outbreaks in the recent past, first in November 2022 and again in February 2025, positioning it among the country's EVD hotspots during Uganda's eight recorded outbreaks. This study assessed the readiness of healthcare facilities by identifying existing gaps and strengths and providing evidence to inform targeted interventions to strengthen emergency preparedness and response. Methods: A cross-sectional study was done using the WHO EVD readiness checklist. Data were collected through observations, interviews, and document reviews, and indicators were scored accordingly. Thematic analysis was used to summarize strengths and weaknesses and to categorize EVD readiness response based on indicator scores. Results: A total of 36 healthcare facilities were assessed in Jinja District, yielding an overall district EVD readiness score of 82%. Among the key indicators, coordination scored highest at 93%, while community engagement scored lowest at 77%. Based on facility-level assessments, 20 facilities (55.6%) demonstrated high EVD readiness, 7 (19.4%) had medium readiness, and 9 (25%) showed low readiness. At the facility level, average scores across indicators were coordination (97.2%), surveillance (86.1%), case management and infection prevention and control (85.7%), community engagement (71.4%), logistics and supply chain (65.7%), and laboratory systems (60.0%). Conclusion: The assessment shows encouraging levels of Ebola readiness in a majority of Jinja District facilities, especially in coordination and surveillance. However, noticeable gaps remain in community engagement, IPC implementation, logistics, and laboratory systems, especially among low- and medium-performing facilities. These findings highlight the need for targeted support, regular assessments, supply chain strengthening, and continuous capacity-building to ensure all facilities can effectively respond to future EVD threats.