First Mile program: North-South partnership experience with health system strengthening in Mbarara, Uganda

Abstract

Uganda’s public healthcare system faces significant systemic challenges in delivering care, contributing to poor health outcomes. In response, a North-South partnership between Massachusetts General Hospital (MGH), Mbarara University of Science and Technology (MUST), and Mbarara Regional Referral Hospital (MRRH) implemented the First Mile Project, a seven-year initiative (2018–2024) designed to strengthen the regional health system in southwestern Uganda. Guided by local priorities, the program aimed to improve access to care, enhance clinical capacity, expand medical education, and promote research and innovation. Project activities were devised collaboratively between investigators at MGH and MUST/MRRH, with robust local leadership and oversight. Key initiatives included clinical staffing in critical departments, construction of a regional isolation ward and oxygen plant. Additionally, the program provided scholarships for medical training, support for community-based care and continuing medical education, and provision of research and innovation grants. The program trained over 1500 health workers, supported 93 scholarships, increased access to specialized clinical services, and facilitated community outreach to thousands of households. The project also awarded 74 research grants and supported over 30 locally incubated innovations. Through this comprehensive, equityfocused approach, First Mile demonstrated how collaborative, locally driven partnerships can effectively strengthen health systems in low-resource settings. Lessons from the initiative underscore the importance of sustained local leadership and integrated clinical and research efforts. A 20-year history of collaboration and mutual trust ensured open dialogue between partners and helped support the success of the project. The First Mile model provides a promising example for future health system strengthening initiatives globally. PAPER CONTEXT ● Main findings: Driven by local priority-setting, a North-South partnership significantly strengthened healthcare delivery, education, and innovation capacity in southwestern Uganda through a seven-year coordinated health systems strengthening initiative. ● Added knowledge: This work demonstrates that through equitable priority setting and integrating clinical care, education, and research within a health system strengthening framework, North-South partnerships can achieve broad, sustainable improvements in care delivery in low-resource settings. ● Global health impact for policy and action: The First Mile model offers a replicable, equity-focused blueprint for North-South partnerships to design future health system investments that center on local ownership, long-term partnership, and integrated service delivery.