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

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. 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. 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. 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.