A cross-sectional survey of service delivery for infertility in Uganda: gaps, opportunities and a way forward

BACKGROUND: Infertility affects approximately one in six adults globally and is associated with significant emotional and social burdens. In Uganda, where the prevalence is estimated at 6.4%, access to affordable and comprehensive infertility services remains limited. This study aimed to assess the availability and scope of infertility care across hospitals in Uganda. METHODS: A cross-sectional national health facility assessment was conducted in 115 hospitals, comprising 53 public, 38 private not-for-profit (PNFP), and 24 private for-profit (PFP) hospitals. A structured questionnaire, adapted from Afferri et al. 2022, was administered through face-to-face or virtual interviews with facility administrators, obstetricians, and medical officers. Descriptive statistics were used to summarize the availability of infertility services and facility readiness across sectors. RESULTS: Of the 115 hospitals surveyed, 112 reported offering infertility services (public: 51; PNFP: 37; PFP: 24); screening and diagnostic services were available in all 112 hospitals. Female Sexually Transmitted Infection testing was common; however, high vaginal swabs were reported less frequently in public hospitals (77%; 97% in private hospitals). Hormonal testing and hysterosalpingography were less available in public hospitals (31.4% and 15.7%, respectively) compared to PFP hospitals (91.7% and 62.5%). Semen analysis was available in 43.1% of public and 91.7% of PFP hospitals. While female infertility treatments were commonly provided, reproductive surgery and intrauterine insemination were primarily limited to PFP hospitals. Assisted reproductive technologies were reported in six (25%) PFP hospitals and one (2%) public hospital, mainly provided by obstetrician-gynecologists (88.4%), with limited involvement of endocrinologists and embryologists. Counseling services (79%) and ethical protocols were more frequently reported in PFP hospitals (67%; 26% public hospitals; 27% of PNFP hospitals). Across all sectors, male infertility care was less prioritized and data on infertility are neither collected nor reported in the HMIS. Overall, 52.7% of hospitals offered comprehensive care, with most advanced services concentrated in the Central region and PFP sector. CONCLUSION: Infertility services in Uganda are predominantly basic, with limited availability of advanced treatments and male-focused care. Addressing these gaps will require targeted policy interventions and health system strengthening to improve equitable access.