At least 216 illegal private mental health facilities are operating across Uganda without accreditation or supervision by the Ministry of Health, exposing millions of vulnerable patients to unsafe and unregulated care.
The alarming revelation is contained in a Value for Money audit by Auditor General Edward Akol assessing government interventions in mental health service delivery between Financial Years 2021/22 and 2023/24.
Akol warns that the unaccredited rehabilitation centres are functioning without oversight, professional staff, or proper treatment frameworks, posing serious safety risks to an estimated 14 million Ugandans living with mental disorders.
“216 unaccredited private rehabilitation centres were operating without oversight, posing safety risks to patients,” Akol states in the report. “Many facilities lack professional mental health staff, struggle to provide proper treatment and rehabilitation, and are hardly supervised.”
The audit comes against the backdrop of a rapidly escalating mental health burden.
Globally, mental disorders account for approximately 13 percent of the disease burden. Uganda ranks among the top six African countries with the highest prevalence of mental health conditions. As of 2022, an estimated 32 percent of Uganda’s population, about 14 million people, were living with some form of mental disorder, yet only about 10 percent were receiving treatment.
The audit further reveals a 27 percent increase in reported Mental, Neurological, and Substance use (MNS) cases between 2021 and 2023, underscoring a growing public health emergency.
“Uganda’s mental health services remain underdeveloped and fragmented,” Akol notes. “Service coverage is limited, staffing levels are critically low, and funding allocations remain inadequate.”
Uganda has only 53 psychiatrists, roughly one per million people, far below the World Health Organization’s recommendation of one psychiatrist per 10,000 people.
Most regional referral hospitals and district health facilities lack trained mental health personnel, essential medicines, and specialized equipment to manage conditions effectively.
Health facilities also suffer from inadequate infrastructure, with limited specialized clinics for children and pregnant mothers, weak rehabilitation programmes, and minimal psychosocial follow-up services.
Supervision by the Ministry’s Mental Health Division and regional referral hospitals was found to be irregular, with incomplete monitoring reports.
Despite the enactment of the Mental Health Act, 2019 (Cap 308), the audit found that critical regulations required to operationalize the law remain undeveloped six years later.
The Mental Health Advisory Board and District Mental Health Focal Persons were not fully constituted for most of the audit period. As a result, mental health units in regional hospitals operated without standardized infrastructure, safety protocols, or clear management frameworks.
The Ministry, through its Division of Mental Health and Substance Abuse, is mandated to promote mental well-being and coordinate stakeholders in preventing and managing MNS conditions. However, the audit suggests implementation gaps remain significant.
During the three-year review period, only 2 percent (UGX1.1 billion) of the total mental health budget of UGX58.5 billion was allocated directly to the Mental Health Division responsible for implementing MNS activities.
Meanwhile, only 19 of the 65 sampled health facilities (29 percent) conducted mental health outreach activities.
The Ministry did not implement targeted awareness programmes for faith leaders, traditional healers or local government structures. As a result, stigma and misinformation persist, over 60 percent of patients reportedly seek care first from traditional healers.
Most facilities and schools lacked Information, Education and Communication (IEC) materials to promote mental health awareness.
Akol cautions that without substantial investment in policy implementation, human resources, community-based care and inter-sectoral coordination, Uganda risks failing to meet both national health objectives and international commitments on mental health.
“The Ministry of Health has made good progress in developing laws, policies, and awareness programmes,” Akol acknowledged. “However, there are still areas that need attention to improve the provision of mental health services. Implementation of the recommendations in this report will go a long way in strengthening service delivery.”
The audit now places the spotlight on government’s regulatory capacity, funding priorities and enforcement mechanisms, raising urgent questions about who is protecting millions of Ugandans seeking mental health care.
