## Preface (tarea2024104-print-pdf)

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---

### Mission background and participants
- Technical mission in response to a request from the Ugandan Ministry of Finance, Planning and Economic Development (MoFPED), conducted during February 28 – March 18, 2022 in virtual meetings to assess spending associated with making substantial progress along the SDGs for human and physical capital development.
- Mission head: Tewodaj Mogues; team members: Piergiorgio Carapella and Julieth Pico Mejia (all FAD).
- Mission financed by the European Union (EU) under the EU-IMF Public Financial Management Partnership Program.
- IMF engagement with MoFPED staff including Dr. Albert Musisi (Commissioner, Macroeconomic Policy) and technical discussions with Prime Minister’s Delivery Unit, National Planning Authority, Uganda Bureau of Statistics, MoES, MWE, MEMD, Uganda National Roads Authority, ERA, MoH, and other agencies.
- Development partner participants: African Development Bank, EU, UNICEF, UNFPA, UN Resident Coordinator’s Office, World Bank, and others.
- Administrative/logistical support acknowledged: Izabela Karpowicz, Wilson Asiimwe, Pelga Origasha, Daine Hale.

### Procedural notes and appendices
- Pre-mission meeting presented methodology; post-mission meeting enabled discussions after the Aide Mémoire.
- Appendices I–VI: Poverty Statistic; Health Care; Education; Water and Sanitation; Electricity; Road Infrastructure.
- Acronyms list includes: COVID-19, EAC, EdStats, EME, ERA, EU, FAD, GDP, GoU, HIV, IEA, IMF, IRENA, kWh, LIDC, LMIC, MEMD, MoES, MoFPED, MoH, MoWT, MW, MWE, NDC, NDP, PPP, RAI, SDG, SSA, UBOS, UGX, UN, UNDP, UNESCO, US$, USE, WASH, WEF, WEO.

*Italicized: Content unit derived from "tarea2024104-print-pdf - Preface" (IMF Technical Assistance Report – Uganda).*

### Executive Summary — overall cost and sector shares
- Total additional annual spending required by 2030 to make substantial progress in selected SDG sectors in Uganda: 18.4 percent of GDP.
- Sectoral additional spending (percent of 2030 GDP):
  - Education: 6.7 percent
  - Health: 7.4 percent
  - Electricity: 0.4 percent
  - Roads: 2.8 percent
  - Water and sanitation: 1.1 percent
  - Human capital (education + health): 14.1 percent
  - Physical capital (electricity + roads + water and sanitation): 4.3 percent
  - Total additional spending: 18.4 percent
- Comparative observations:
  - Additional spending higher in social sectors and lower in infrastructure sectors relative to LIDCs.
  - Uganda’s overall additional spending is above the median LIDC and similar to the median SSA country.
- Note: analysis assesses spending needs to achieve high performance in selected SDGs and does not include financing options.

### Key methodological points
- Uses IMF SDG costing methodology (Gaspar et al. 2019).
- Estimates expressed as additional total (public plus private) annual spending in 2030 relative to current spending, in percentage points of GDP.
- Benchmarks Uganda’s 2030 input and cost-driver targets to current levels of strongly performing peers and good practices.
- Comparators for descriptive analysis: SSA; EAC; LIDCs; LMICs.
- Well-performing social-sector peers defined as countries with GDP per capita below US$3,000 and SDG 3 and SDG 4 index values above 72 and 88, respectively.

### Introduction — growth, poverty, policy framework
- Historical poverty and income trends:
  - Poverty rate (US$1.90 a day, 2011 PPP) rose from 58.3 percent to 67.5 percent through the 1990s; number of poor rose from 9.8 million to 15.5 million in that period (see Appendix I).
  - Poverty declined from 67.5 percent in 1999 to 35.7 percent in 2012.
  - Over the last 8 years up to the report, extreme poverty rose again, adding more than 6 million people; drivers included a devastating drought in 2016 and COVID-19 economic effects.
- Policy framework:
  - Vision 2040 and six 5-year NDPs (2010–2040); NDP III (2021–2025) focuses on industry, governance, environment.
  - Mid-2021 roadmap (Office of the Prime Minister with UNDP) to align SDG implementation with NDP III, including institutional infrastructure (SDG Secretariat, SDG working groups).

### COVID-19 effects on planning and public finances
- NDP III developed early 2020 as COVID-19 gained momentum.
- Pandemic effects:
  - Constrained government revenue mobilization.
  - Stalled external financing.
- Resulting prioritization criteria for retained interventions:
  - Public investment character;
  - Direct impact on reducing poverty and food security;
  - Strong spillovers;
  - Aiding economic recovery.
- Largest shares of planned interventions cut: manufacturing, petroleum development, housing and urban development, human capital development.
- SDG index coverage: data for 16 Goals; no data for SDG 14.
- SDG performance: ahead in seven SDGs, lagging in nine SDGs; ahead notably in SDG 2, SDG 9, SDG 13; lagging in SDG 1 and SDG 7.
- Caution: higher SDG index scores relative to peers do not imply low additional spending needs; costing uses its own benchmarks.

### Human capital — Health

Findings on outcomes and financing
- Under-five mortality fell from 182 to 46 deaths per 1,000 live births between 1990 and 2018 (75 percent reduction).
- Women attending four ante-natal care visits: increased from 42 percent in 2000 to 60 percent in 2016.
- Hospital deliveries rose from 57 percent in 2011 to 60 percent in 2016.
- Maternal mortality reduced by 35 percent between 2000 and 2017.
- Malaria incidence (per 1,000 people at risk) in Uganda: 289 (compared to Kenya 70; Tanzania 124; SSA 219).
- Over 60 percent of the population are at risk of catastrophic health expenditures for surgical care (out-of-pocket costs = 10 percent or more of income).
- Uganda’s SDG 3 index similar to the LIDC median but far from well-performing peers.

Health financing and input gaps
- Total health spending: 4.2 percent of GDP.
- Government health spending: 0.8 percent of GDP; represents 17.2 percent of total health expenditure.
- Government health share of total government expenditure fell from 7 percent in 2010 to 3 percent in 2019.
- 41.4 percent of total health expenditure comes from international development partners.
- Doctors per 1,000 population: current 0.109 (target 1.849 — more than 16-fold increase).
- Other medical personnel per 1,000 population: current 1.743 (target 5.288 — approximately triple).
- Per capita health spending (USD 2018): current US$33.5; target US$127.7 in 2030.

Additional spending required for SDG 3 by 2030
- Total additional health spending required in 2030: 7.4 percent of GDP (total public plus private).
- Per capita health spending needs: increase from US$33.5 to US$127.7 in 2030.
- Other recurrent and capital spending in 2030 needs to be 4.3 times today’s analogous spending.
- Decomposition of additional spending (percent of GDP):
  - More doctors (keeping current salaries and adjusting other recurrent/capital to peers): +3.4 percent
  - More other medical personnel to good performers: +5.0 percent
  - Doctors’ salaries adjustment reduces additional spending by 1.0 percent
  - Total additional: 7.4 percent (2019 baseline total health spending 4.2 percent -> 2030 total 11.6 percent of GDP)

Health system financing and priorities (policy implications)
- Domestic government sources represent 17.2 percent of total health expenditure; heavy reliance on external and off-budget resources.
- National Health Insurance Bill passed by parliament in March 2021 but not assented by the president.
- Health insurance coverage: 4 percent of the population; public awareness of health insurance basics: 13.4 percent.
- COVID-19 preparedness plan budget (March 2020–June 2021): 1.8 percent of GDP; as of mid-2021 only 35 percent of resources were committed.
- Fully vaccinated share of the population as of March 9, 2022: 6.7 percent.
- Climate and health risks:
  - 130 health facilities damaged by a natural hazard in recent past.
  - By 2030 an additional 56,200 people may be at risk of inland river flooding (more than half attributable to climate change).
  - Malaria risk projected to increase to around 93.3 percent of the population in next 50 years even in a low emissions scenario.
  - Heat-related deaths among elderly: around 20 per 100,000 per year in 2030 and up to 80 per 100,000 per year in 2080, up from 0.5 on average in 2014–2019.
- Implied policy directions:
  - Increase domestic government funding for health to improve preventive care and address non-communicable diseases.
  - Advance political commitment and outreach to enact and implement the National Health Insurance Bill and raise public awareness.
  - Prioritize continuity of essential health services during pandemic responses.
  - Develop and fund explicit health adaptation projects and budget lines for climate-related health risks.

### Human capital — Education

Recent progress and gaps
- Gross enrollment rate (all levels): increased from 44.1 percent in 2007 to 55.6 percent in 2019.
- Average years of schooling increased by one year over the period analyzed.
- Adult literacy (over 15 years): rose from 68.1 percent in 2003 to 76.5 percent in 2018.
- About 60 percent of the population are of school age.
- Nearly half of the school-age population — close to 12 million children and youth — do not receive any formal education.
- Quality gaps:
  - Sixth-graders not proficient in reading: about 50 percent (compared to Kenya 20 percent, Mauritius 20 percent, Tanzania 10 percent).
  - Sixth-graders not proficient in mathematics: 70 percent (compared to Tanzania 45 percent, Kenya 40 percent).
  - Primary education completion rate in 2016: 43.6 percent (compared to Tanzania 79.5; Kenya 84.1; Burundi 53.3; Rwanda 54.3).
- Teacher presence and absenteeism:
  - Teachers present in the classroom only 40 percent of the time they are paid to teach.
  - Evidence suggests each additional 5 percent increase in teacher absenteeism reduces learning by 4 to 8 percent of the average student’s learning in a year.

Education financing and additional resource needs to reach SDG 4 by 2030
- Current public spending on education: 2.8 percent of GDP (total current public spending on education reported later as 7.1 percent of GDP when including private).
- To achieve good SDG 4 performance by 2030, total spending (public plus private) in education must increase by 6.7 percent of GDP in 2030 from current spending of 7.1 percent of GDP.
- Total spending in education in 2030 would need to be 3.6 times current spending in real monetary terms.
- Capital and non-teacher-wage recurrent spending would need to triple.
- Key drivers:
  - Increase enrollment to about 80 percent of the school-age population by 2030 (universal coverage: two years of pre-primary, full primary and secondary, and two years of tertiary).
  - Reduce students per teacher from 27.6 to 19 students per teacher by 2030 (public schools average 45 students per teacher).
  - Increase teacher compensation from 2.3 times the average income to 3.1 times average income.
- Phased decomposition (additional spending percent of GDP):
  - Increasing enrollment while keeping current spending per student: +1.6 percent
  - Raising teachers' wages while reducing other recurrent and capital as a share: +0.8 percent
  - Reducing class sizes: +4.3 percent
  - Total additional: 6.7 percent

Role of PPPs and policy levers
- PPP program: more than 800 schools; in 2016 one-third of secondary students attended a PPP school.
- PPP participation associated with lower repetition rates and somewhat better student progress in participating schools.
- Policy levers to reduce absenteeism and improve learning: improve teacher monitoring, training, professional progression, reduce workload inequalities, incentivize hardship postings.
- COVID-19 impacts on education:
  - School closures March 2020 to January 2022: 83 weeks (longest in the world).
  - Internet penetration (age 10+ using internet for any purpose): 6.1 percent — limiting remote learning.
  - Consequences: exacerbated learning inequalities; likely increased dropout rates.
  - Policy priorities: ensure adequate resources for education and invest in digital literacy.

### Water and sanitation (WASH)

Performance and trends
- Vision 2040 target: provide all people access to safe piped water by 2040.
- Presidential directive: one improved water source per village.
- Safely managed water: increased from 2 percent (2000) to 17 percent (2020).
- Basic improved water: increased from 27 percent to 56 percent (2000–2020).
- Sanitation: access to basic sanitation services hardly improved over 20 years.
- Uganda lags LMICs, LIDCs, SSA, and all EAC countries other than South Sudan on SDG 6.

Cost to close WASH gap by 2030
- Unserved population until 2030: 53.5 (millions).
- Total cost to provide water and sanitation services for the unserved population by 2030: US$9,361.3 million.
- Cost per unserved person: US$175.0.
- Annualized investment need: US$720.1 million.
- Total annual additional cost as percent of 2030 GDP: 1.11.
- Major cost drivers:
  - Safely managed water in rural areas: nearly half of annual additional cost; unit cost US$109 per person; rural population to be provided access by 2030: 41 million.
  - Safely managed sanitation for rural areas: 22 percent of annual additional investment; population to be served by 2030: 39 million.

Supply-side, COVID-19, climate implications
- Technology gaps: in 102 of 135 districts, widely used improved sources are lower-quality types; 44 percent of districts use no large-scale purification prior to distribution; one-third of districts do not promote household water-boiling.
- COVID-19 effects:
  - FY2020/21 budget reallocation away from water, sanitation and environment sector by over 9 percent.
  - Water-testing labs operated with only 10 percent staffing at times.
  - National Water and Sewerage Corporation saw a 12 percent decline in household connections in the pandemic fiscal year.
- Climate projections suggest seasonal drying and increased floods by century end; impacts may raise WASH infrastructure costs and require climate-resilient technologies.
- Policy orientation: adaptation-focused; NDC priorities include water efficiency, resilient water and sanitation facilities, and public hygiene awareness.

### Electricity

Capacity, access, and consumption
- Installed capacity: 1,347 MW (2021).
- Hydropower share of installed capacity: 80 percent.
- Transmission network: expanded from 1,178 km in 2016 to 3,431 km in 2021.
- Transmission losses averaged 3.9 percent over last five years.
- Umeme distribution losses reduced from 34.2 percent in 2008 to 17.9 percent in 2021.
- Peak demand: 793 MW.
- Total consumption rose from 780 GWh (two decades ago) to 3,918 GWh (latest available).
- Per capita consumption: 83 kWh (latest available).
- Electricity access: 41.3 percent of the population.
- Rural population share: more than 74 percent.
- Authorities’ objective: ensure 60 percent access by 2027.
- Upfront grid connection cost: about US$160 (equivalent to over two months of the average income).
- Clean cooking access: 1 percent of the population; household air pollution from cooking estimated to have caused over 12,000 deaths every year (WHO 2018).
- Renewable share of generation: 98.7 percent (primarily hydropower).

Investment needs to 2030 (IMF staff calculations)
- Population projection 2020 to 2030: 47.1 to 59.4 million.
- GDP per capita projection 2020 to 2030: US$862 to US$1,221.
- Electricity consumption per capita projected: 83 kWh in 2020 to 289 kWh by 2030.
- Additional consumption (GWh): 13,251.
- Unit cost including generation, transmission and distribution (US$ per kW): 1,188.
- A*B/(hours per year)=Total investment (US$ billion): 1.795.
- Aggregate investment required to expand the electricity network (including replacement costs): US$1.8 billion (annual equivalent 0.4 percent of GDP).
- Total annual investment plus depreciation (percent of 2030 GDP): 0.400.

Sectoral vulnerabilities and COVID-19 impacts
- Approximately 47 percent of health centers connected to grid electricity.
- Lockdowns and supply-chain disruptions slowed construction and delayed equipment acquisition.
- Climate vulnerability: high reliance on hydropower creates long-run drought risks; authorities plan to diversify toward more solar.

### Roads

Network, access, and quality
- Total road network: 159,364 km; 76 percent subnational roads.
- Community access roads: 79,948 km (non-paved); all-season community access roads: 2,239 km (2.8 percent).
- Rural Access Index (RAI): 53 percent; IMF target for LIDCs: RAI of 75.
- Table by class (latest available):
  - National total: 20,854 km (paved 6,107 km; non-paved 14,747 km; all-season roads 10,561 km).
  - District total: 38,603 km (paved 107 km; non-paved 38,497 km; all-season roads 6,447 km).
  - Urban total: 19,959 km (paved 1,230 km; non-paved 18,729 km; all-season roads 3,074 km).
  - Community access total: 79,948 km (paved 0 km; non-paved 79,948 km; all-season roads 2,239 km).
  - Total network: 159,364 km; all-season roads 22,320 km.

Investment and maintenance needs to reach RAI 75 by 2030
- Additional roads required (thousand km): 20.4.
- Unit cost (US$/km): 716,042.
- A*B = Total investment (US$ billion): 14.6.
- Total annual investment plus depreciation (percent of GDP): 2.8.
- Maintenance backlog:
  - Rehabilitation/removal backlog cost increased from US$1,154.3 million in FY 2019/2020 to US$1,160.7 million in 2020/2021.
- Climate exposure: 2,180 km exposed to landslide risk; 2,850 km at risk of flooding.

COVID-19 impacts and policy implications
- COVID-19 slowed maintenance backlog resolution and asset-life deterioration; supply-chain disruptions stalled projects and increased contractor pricing.
- Closing the gap to RAI 75 by 2030 requires about 20.4 thousand additional kilometers of all-season roads and US$14.6 billion in investment (2.8 percent of GDP annually including depreciation).
- Policy attention needed to rebalance spending toward maintenance over new construction to avoid accelerated asset degradation.

### Conclusion — fiscal and policy considerations

Aggregate and composition
- Uganda’s additional annual SDG spending needs in 2030: 18.4 percent of GDP.
- Over three quarters of additional needs come from human capital development.
- Report notes composition where physical capital and human capital shares are highlighted.

Sensitivity, cross-sectoral effects, and timing
- Estimates assume improved efficiency to levels of well-performing peers; if efficiency remains lower, expenditure needs would be higher.
- Cross-sectoral benefits (e.g., health gains from improved WASH) are not fully captured and could reduce overall costs.
- Timing of spending is policy choice: gradual, frontloaded, or backloaded trajectories possible; infrastructure spending estimates are average yearly targets up to 2030.

Climate-change emphasis
- Adaptation prioritized over mitigation given very low emissions and high reliance on renewable electricity (98.7 percent hydropower).
- Adaptation needs imply additional costs across sectors: resilient health facilities, resilient WASH, climate-resilient roads.

Financing and reform options (areas for further analysis)
- Explore:
  - (i) more vigorous domestic revenue mobilization through revenue administration and tax policy measures and structural reforms,
  - (ii) grants,
  - (iii) concessional loans,
  - (iv) expenditure reallocation and increasing efficiency,
  - (v) strengthening the business environment to enable private financing.
- Evidence example: an IMF study found Rwanda and Nigeria could cover one-third and 35 percent, respectively, of their SDG financing needs through steps (i), (iv), and (v), indicating need for significant international assistance (grants and concessional loans).

Managerial and policy constraints to address
- Strengthen system resilience exposed by COVID-19 (health system, education continuity, road maintenance, electricity diversification).
- Improve managerial approaches to reduce teacher absenteeism and boost service delivery efficiency.
- Rebalance road sector resource allocation between new construction and maintenance.
- Diversify energy mix (increase solar share) to reduce hydropower drought vulnerability.

*Italicized: Content unit derived from "tarea2024104-print-pdf - Preface" (IMF Technical Assistance Report – Uganda).*

### Preface ................................................................................................................

### Preface

### Mission background and participants
- A technical mission, in response to a request from the Ugandan Ministry of Finance, Planning and Economic Development (MoFPED), took place during February 28 – March 18, 2022 in virtual meetings to assess spending associated with making substantial progress along the Sustainable Development Goals (SDGs) for human and physical capital development.
- Mission head: Tewodaj Mogues; team members: Piergiorgio Carapella and Julieth Pico Mejia (all in the Fiscal Affairs Department (FAD)).
- The technical mission was financed by the European Union (EU) under the EU-International Monetary Fund (IMF) Public Financial Management Partnership Program.
- The IMF team engaged with MoFPED staff including Dr. Albert Musisi (Commissioner, Macroeconomic Policy) and other MoFPED officers, and held technical discussions with officials from Prime Minister’s Delivery Unit, National Planning Authority, Uganda Bureau of Statistics, Ministry of Education and Sports (MoES), Ministry of Water and Environment (MWE), Ministry of Energy and Mineral Development (MEMD), Uganda National Roads Authority, Electricity Regulatory Authority (ERA), Ministry of Health (MoH), and other agencies.
- Development partner participants included staff from the African Development Bank, European Union, United Nations agencies (UNICEF, UNFPA, UN Resident Coordinator’s Office), World Bank, and others.
- Administrative and logistical support acknowledged: Izabela Karpowicz (IMF Resident Representative), Wilson Asiimwe (Senior Economic Modeller, MoFPED), Pelga Origasha (IMF Resident Representative’s Office), and Daine Hale (administrative assistance).

### Preface-related procedural notes
- A pre-mission meeting presented methodology; a post-mission meeting enabled discussions after the Aide Mémoire was completed.
- The mission expressed appreciation for cooperation from government officials and partner organizations.

### Appendices and acronyms included in the source
- Appendices I–VI covering Poverty Statistic; Health Care; Education; Water and Sanitation; Electricity; Road Infrastructure.
- Acronyms include COVID-19, EAC, EdStats, EME, ERA, EU, FAD, GDP, GoU, HIV, IEA, IMF, IRENA, kWh, LIDC, LMIC, MEMD, MoES, MoFPED, MoH, MoWT, MW, MWE, NDC, NDP, PPP, RAI, SDG, SSA, UBOS, UGX, UN, UNDP, UNESCO, US$, USE, WASH, WEF, WEO.

---

### Executive Summary

### Overall cost estimate
- The mission estimates that making substantial progress in critical SDG sectors in Uganda would require additional annual spending of about 18.4 percent of gross domestic product (GDP) by 2030.
- Relative to low-income developing countries (LIDCs), additional spending in Uganda is higher in the social sectors and lower in the infrastructure sectors.
- Overall, Uganda’s additional spending is above the median LIDC and similar to the median Sub-Saharan African (SSA) country.
- Note: This analysis assesses spending to achieve high performance in selected SDGs and does not include financing options.

### Health — expanding the supply of medical staff
- Current total health care spending: 4.2 percent of GDP.
- Estimated additional required health spending by 2030: 7.4 percent of GDP (gradual increase relative to today’s spending).
- Key driver: need to substantially increase supply of doctors—more than 16-fold—and to nearly triple the number of other health personnel.
- Observation: substantial room to increase efficiency; health outcomes are below those of several other countries with similar spending.

### Education — strengthening quality and quantity
- Demographics: 60 percent of the population are school-aged, a higher share than in the East African Community (EAC) and LIDC peers.
- Objectives: increase enrollment and improve education quality.
- Required operational change: reduce student-teacher ratio from 28 to 19 by hiring more teachers.
- Current public spending on education: 7.1 percent of GDP.
- Estimated additional required education spending by 2030: 6.7 percent of GDP (i.e., public spending would need to triple as a share of GDP to deliver these goals).

### Water and sanitation — safely managed services for all
- Uganda lags regional and income-group peers in water and sanitation; sanitation services have hardly improved in two decades.
- Estimated additional annual spending required: 1.1 percent of GDP, including maintenance to counteract depreciation.
- Bulk of cost: safely managed water in rural areas due to relatively high unit costs and a large unserved rural population.

### Electricity — transmission and distribution investment to increase access
- Primary generation: vast majority from renewable energy (hydropower).
- Current electricity consumption per capita: 83kilowatt-hour (kWh).
- Installed capacity: 1,347 megawatts (MW); peak demand: 793 MW.
- Gap: transmission and distribution networks lag installed capacity; consumption per capita strongly lags LIDCs and is below expectations given GDP per capita.
- Estimated annual investment required by 2030 to expand access, serve future population, and increase consumption in line with growth: 0.4 percent of GDP.

### Roads — increasing rural access and upgrading poor-quality roads
- Current rural road access: 53 percent of the rural population.
- Target rural access by 2030: 75 percent.
- Required expansion: about 20.4 thousand additional kilometers of all-weather roads.
- Observation: road quality lags subregional peers; expansion must include upgrading roads in poor condition.
- Estimated annual investments required by 2030: 2.8 percent of GDP.

### Summary of sectoral additional spending (percent of 2030 GDP)
- Education: 6.7 percent
- Health: 7.4 percent
- Electricity: 0.4 percent
- Roads: 2.8 percent
- Water and sanitation: 1.1 percent
- Human capital (education + health): 14.1 percent
- Physical capital (electricity + roads + water and sanitation): 4.3 percent
- Total additional spending: 18.4 percent

---

### I. Introduction

### Growth, poverty, and recent trends
- Uganda enjoyed sustained increase in income per capita since the mid-1980s after the end of armed conflict.
- Despite income growth, reductions in extreme poverty lagged: poverty rate (US$1.90 a day, 2011 PPP) rose from 58.3 percent to 67.5 percent through the 1990s; the number of poor people rose from 9.8 million to 15.5 million in that period (see Appendix I for details).
- In the 2000s through early 2010s, poverty declined from 67.5 percent in 1999 to 35.7 percent in 2012.
- Over the last 8 years up to the report, extreme poverty rose again, adding more than 6 million people; factors included a devastating drought in 2016 and economic effects of the COVID-19 pandemic.

### Policy framework and SDG alignment
- Uganda’s long-term strategy: Vision 2040 with six 5-year National Development Plans (NDPs) covering 2010–2040.
- NDP III (2021–2025) focuses on industry, governance, and the environment; priorities informed by a simulation model used to cost NDP III programs and assess their potential to advance the 17 SDGs.
- Uganda conducted Voluntary National Reviews of SDG progress in 2016 and mid-2020.
- In mid-2021, the Office of the Prime Minister, with UNDP support, developed a four-year roadmap to align SDG implementation with NDP III and identify resource mobilization strategies; the roadmap emphasizes institutional infrastructure such as creating an SDG Secretariat in the Office of the Prime Minister and revitalizing SDG working groups.

*Italicized: Content unit derived from "tarea2024104-print-pdf - Preface" (IMF Technical Assistance Report – Uganda).*

### 3.      The Coronavirus disease 2019 (COVID-19) forced a reprioritization of the latest five-year

### 3.      The Coronavirus disease 2019 (COVID-19) forced a reprioritization of the latest five-year development plan

### COVID-19 impact on NDP III
- Uganda’s current plan (NDP III) was developed in early 2020 as COVID-19 was gaining momentum in Uganda.
- Pandemic effects on public finances and external financing:
  - Constrained government revenue mobilization.
  - Stalled external financing as international partners coped with COVID-19 impacts domestically.
- As a result, Uganda cut back many planned NDP III interventions, prioritizing activities that met all the following criteria:
  - having a public investment character,
  - having a direct impact on reducing poverty and food security,
  - having strong spillovers on other areas,
  - aiding the economic recovery from the pandemic.
- Largest shares of planned interventions cut included:
  - manufacturing,
  - petroleum development,
  - housing and urban development,
  - human capital development.

### SDG performance overview
- SDG index coverage and methodology:
  - Uses the UN-developed SDG index aggregated to range from 0 to 100 (worst to best).
  - Uganda has data for 16 Goals; no data for SDG 14.
- Uganda’s relative performance (compared to regional and income-group averages):
  - Ahead of peers in seven SDGs and lags in nine SDGs.
  - Particularly ahead in:
    - SDG 2 (ending hunger and achieving food security),
    - SDG 9 (infrastructure and industrialization),
    - SDG 13 (combating climate change) — a strikingly high score in absolute terms.
  - Notably lagging in:
    - SDG 1 (ending poverty),
    - SDG 7 (affordable and clean energy).
- Caution on descriptive comparisons:
  - Higher SDG index scores relative to peers (e.g., health and education) do not imply low additional spending needs to perform well by 2030; costing uses its own benchmarks and targets.

### SDG costing methodology and benchmarks
- Focus of costing:
  - Selected SDGs in human capital development (health and education) and infrastructural development (water and sanitation, electricity, road infrastructure).
  - Estimates total (public plus private) additional annual spending in 2030 relative to current spending, expressed in percentage points of GDP.
- Methodological approach:
  - Uses IMF SDG costing methodology (Gaspar et al. 2019).
  - Benchmarks Uganda’s 2030 input and cost-driver targets to current levels of strongly performing peers and established good practices.
  - Targets informed by 2030 projections: population size, rural-urban composition, age distribution, GDP.
- Comparators used:
  - Descriptive analysis comparators: SSA; EAC; LIDCs; LMICs.
  - For social-sector SDG cost assessment, well-performing peers are defined as countries with GDP per capita below US$3,000 and SDG 3 and SDG 4 index values above 72 and 88, respectively.
- Scope limitations:
  - Report focuses on additional spending needs; analysis of financing options is outside scope (briefly engaged in concluding Section VI).

### Human capital development — Health: progress and gaps
- Health outcome progress:
  - Under-five mortality fell from 182 to 46 deaths per 1,000 live births between 1990 and 2018, a reduction of 75 percent.
  - Proportion of women attending four ante-natal care visits increased from 42 percent in 2000 to 60 percent in 2016.
  - Proportion of hospital deliveries rose from 57 percent in 2011 to 60 percent in 2016.
  - Maternal mortality reduced by 35 percent between 2000 and 2017.
- Persistent challenges:
  - High burden of communicable diseases — malaria incidence (per 1,000 people at risk) in Uganda is 289, compared to 70 in Kenya, 124 in Tanzania, and 219 in SSA countries.
  - Heavy reliance on household out-of-pocket health expenditures:
    - More than 60 percent of the population are at risk of facing catastrophic health expenditures for surgical care (defined as out-of-pocket costs = 10 percent or more of income).
  - Uganda’s SDG 3 index is similar to the LIDC median but far from well-performing peers.

### Health financing and spending patterns
- Total health spending:
  - Uganda’s total health spending is 4.2 percent of GDP.
  - This is lower than averages for LMICs, LIDCs, well-performing peers, and all but one EAC country.
- Government health spending:
  - Government spending on health is 0.8 percent of GDP and represents 17.2 percent of total health expenditure.
  - Government expenditure on health as a proportion of total government expenditure fell from 7 percent in 2010 to 3 percent in 2019.
- External and partner financing:
  - 41.4 percent of total health expenditure comes from international development partners, a significantly larger share than in Uganda’s peers.
  - Heavy reliance on external sources increases volatility and may reduce efficiency because much support is off-budget and dedicated to specific interventions.

### Health inputs, efficiency, and staffing
- Health inputs and staffing gaps:
  - Doctors per 1,000 population: current 0.109 (presented also as 0.50 per 1,000 in peer table context and 0.11 in other panels), target 1.849 (more than 16-fold increase stated).
  - Other medical personnel per 1,000 population: current 1.743, target 5.288 (approximately triple).
  - Uganda spends similarly per capita in PPP terms to other LIDCs but achieves slightly better health-adjusted life expectancy.
- Efficiency potential:
  - Large vertical distance to the health spending efficiency frontier indicates many LIDCs achieve higher health-adjusted life expectancy with similar or lower per-capita spending, implying potential for efficiency gains.

### Additional health spending required for strong SDG 3 performance
- Overall additional spending need:
  - Total additional health spending required to perform well on SDG 3 in 2030: 7.4 percent of GDP (total public plus private).
- Per-capita and recurrent/capital needs:
  - Per capita health spending needs to increase from current US$33.5 to US$127.7 in 2030 (quadruple).
  - Other recurrent and capital spending in 2030 needs to be 4.3 times today’s analogous spending.
- Key adjustments driving cost increases:
  - Raising number of health workers:
    - Doctors per 1,000 population increase from 0.109 to 1.849 (more than 16-fold).
    - Other health personnel per 1,000 population increase from 1.743 to 5.288 (approximately triple).
  - Doctors’ wages adjustment:
    - Reducing doctors' wages as a ratio to GDP per capita from 10.6 to 9.7 would prevent higher resource needs.
    - This adjustment still implies doctors’ salaries increase in real monetary terms by 26.4 percent, though slower than average incomes.
- Decomposition of additional spending (percent of GDP):
  - To increase doctors while keeping current salaries and adjusting other recurrent/capital spending to peers: additional 3.4 percent of GDP.
  - Increase in other medical personnel to good performers: additional 5.0 percent of GDP.
  - Adjustment of medical personnel salaries reduces additional spending by 1.0 percent of GDP.
  - Sum total: additional 7.4 percent of GDP (compared to 2019 baseline total health spending of 4.2 percent of GDP).
- Table and panel summary values (selected):
  - Uganda 2019 GDP per capita: 1,360.9
  - 2030 GDP per capita (low-performance / high-performance contexts shown): 1,232.6; 2,241.0; 797.2; 1,101.2 (table provides multiple cells by group)
  - High-cost population (<1 and 60+), percent of total population: 10.0; 9.0; 16.9; 6.8; 6.9 (table context)
  - Doctors per 1,000 population (various entries): 0.5; 0.3; 1.8; 0.1; 1.8 (table context)
  - Other medical personnel per 1,000 population (various entries): 2.0; 1.5; 5.2; 1.7; 5.3 (table context)
  - Doctor wages (ratio to GDP per capita): 22.2; 24.4; 9.7; 21.0; 9.7 (table context)
  - Other recurrent and capital health spending (% total health spending): 67.4; 68.2; 62.3; 75.1; 62.3 (table context)
  - Results shown in table for total health spending (percent of GDP): 5.4; 5.2; 6.6; 34.2; 11.6 (table context)
  - Per capita health spending (USD 2018) entries: 73.3; 64.1; 148.6; 33.5; 127.7 (table context)
  - SDG3 index entries: 49.3; 45.4; 75.8; 47.9; >72 (table context)
  - Uganda current total health spending reiterated as 4.2 percent of GDP.
- Charted decomposition (2019 spending to 2030 spending):
  - 2019 spending: 4.2 percent of GDP.
  - More doctors: adds 3.4 percent of GDP.
  - More other medical personnel: adds 5.0 percent of GDP.
  - Doctors' salaries adjustment: reduces additional spending by 1.0 percent of GDP.
  - 2030 spending total: 11.6 percent of GDP (2019 spending + additional spending = 4.2 + 7.4 = 11.6).

*Source: https://www.imf.org/-/media/files/publications/tar/2024/english/tarea2024104-print-pdf.pdf*

### 12.        A rebalancing of the system seems necessary, with the government playing an important

### 12.        A rebalancing of the system seems necessary, with the government playing an important role.

### Health system financing and priorities
- Government spending from domestic sources represents only 17.2 percent of total health expenditure.
- Uganda’s health expenditure relies heavily on external resources (with a large proportion coming from off-budget support) and private expenditure.
- Only a limited share of off-budget resources are dedicated to preventive activities; none of the off-budget projects in FY2019/20 targeted non-communicable diseases and associated risk factors.
- The number of persons reporting having one of the three most common non-communicable diseases in Uganda (diabetes, high blood pressure, and heart disease) has increased in recent years.

### Universal health insurance: status and challenges
- The National Health Insurance Bill was passed by parliament in March 2021 but has not yet been assented to by the president.
- Only 4 percent of the Ugandan population is covered by any form of health insurance, with the highest levels of coverage in urban areas.
- Only 13.4 percent of the population in Uganda is currently aware of what health insurance is and how it works in the most basic sense.
- Ensuring the financial sustainability of the insurance system is identified as a necessary condition for successful implementation.

### COVID-19 impact on health services
- The country’s COVID-19 preparedness plan for March 2020 to June 2021 reports a total budget for the multisectoral response to COVID-19 of 1.8 percent of GDP; as of mid-2021, only 35 percent of resources were committed.
- As of March 9, 2022, only 6.7 percent of the population was fully vaccinated.
- Of the committed budget, 4.9 percent was used to increase human resources, 14.2 percent to improve health infrastructure, and 0.8 percent to ensure the continuity of essential health services.
- The shift in priorities to respond to COVID-19 strongly impacted the provision and use of reproductive, maternal and child health services and HIV services, leading to the loss of some progress made in the previous five years.

### Climate change risks to health
- In the recent past, 130 health facilities in Uganda were damaged by a natural hazard.
- It is projected that by 2030, an additional 56,200 people may be at risk of inland river flooding, of which more than half can be attributed to climate change.
- The number of people at risk of malaria will increase to around 93.3 percent of the population in the next 50 years, even in a low greenhouse gas emissions scenario.
- In a high emissions scenario, heat-related deaths among the elderly in Uganda are expected to be around 20 per 100,000 per year in 2030 and up to 80 per 100,000 per year in 2080, up from 0.5 on average in the period 2014-2019.
- Although Uganda has a national strategy for health adaptation to climate change, there is currently no project or program whose ultimate objective is such an adaptation, no apparent funds for that objective, and the budget does not include a line dedicated to financing health systems adaptation.

### Health implications: key policy directions (implied by analysis)
- Increase government domestic funding for health (current share 17.2 percent of total health expenditure) to improve priority preventive healthcare interventions and to address non-communicable diseases.
- Advance political commitment and outreach to enact and implement the National Health Insurance Bill and to increase public awareness of health insurance (only 13.4 percent currently aware).
- Prioritize continuity of essential health services in pandemic responses to avoid reversals in reproductive, maternal and child health and HIV service delivery.
- Develop and fund explicit health adaptation projects and budget lines to address climate-related health risks (flooding, malaria risk expansion, heat-related mortality).

---

### Education: recent progress and remaining gaps

#### Recent improvements and indicators
- The gross enrollment rate (for all levels) increased from 44.1 percent in 2007 to 55.6 percent in 2019, with the most significant increase at the pre-primary education level.
- Average years of schooling increased by one year over the period analyzed.
- Adult literacy (people over 15 years of age) rose from 68.1 percent in 2003 to 76.5 percent in 2018.
- Uganda’s performance on the SDG 4 index is similar to the LIDC median.

#### Coverage shortfalls and demographics
- About 60 percent of the population is of school age.
- Nearly half of the school-age population—close to 12 million Ugandan children and youth—do not receive any formal education.
- While Uganda performs better than the average of EAC countries on some metrics, it still lags income-group peers.

#### Quality of learning and completion rates
- About 50 percent of sixth-graders are not proficient in reading, compared to 20 percent in Kenya and Mauritius and 10 percent in Tanzania.
- 70 percent of sixth-graders are not proficient in mathematics, compared to 45 percent in Tanzania and 40 percent in Kenya.
- High dropout rates in primary school: only one out of every three students who enter primary school completes the last grade of the primary level.
- Primary education completion rate in Uganda in 2016 was 43.6 percent, compared to 79.5 in Tanzania, 84.1 in Kenya, 53.3 in Burundi, and 54.3 in Rwanda.

#### Education financing and household burdens
- Public spending on education in Uganda is 2.8 percent of GDP, significantly lower than the average expenditures of EAC countries (3.5 percent of GDP) and LIDCs (4.0 percent of GDP).
- Households incur large expenditures to access education services; high costs are the third most common reason for not attending school.
- 68 percent of 6–24-year-olds who drop out of school state high personal spending on educational resources as the reason for dropping out.

### Resource needs to achieve SDG 4 by 2030
- To achieve a good performance in SDG 4 by 2030, Uganda’s total spending (public plus private) in education would need to increase by 6.7 percent of GDP in 2030 from the current spending of 7.1 percent of GDP.
- In real monetary terms, total spending in education in 2030 would need to be 3.6 times current spending.
- Capital and non-teacher-wage recurrent spending would need to triple.
- Key drivers behind these estimates:
  - Increase enrollment to about 80 percent of the school-age population by 2030 (universal coverage of two years of pre-primary, full primary and secondary, and two years of tertiary education).
  - Reduce students per teacher from 27.6 to 19 students per teacher by 2030 (public schools average 45 students per teacher).
  - Increase teacher compensation from 2.3 times the average income to 3.1 times average income.

### Phased approach to additional spending (decomposition)
- Increasing enrollment rates while keeping current spending per student would require an additional 1.6 percent of GDP.
- Raising teachers' wages while reducing other recurrent and capital expenditures as a percentage of total spending would require an additional 0.8 percent of GDP.
- Reducing class sizes would require an additional 4.3 percent of GDP.
- Total additional spending to reach high SDG 4 performance: 6.7 percent of GDP.

### Role of public-private partnerships (PPPs)
- More than 800 schools are currently part of a PPP program launched after adopting the USE plan in 2007.
- In 2016, one-third of students enrolled in secondary education attended a PPP school.
- Participation in the PPP program led schools to have a lower repetition rate and somewhat better student progress than government USE schools.
- For private schools, PPP participation resulted in higher enrollment rates and better student performance.

### Teacher presence, absenteeism, and policy levers
- Uganda’s teacher absenteeism is one of the highest in the region; teachers are present in the classroom for only 40 percent of the time they are paid to teach.
- Evidence from other African LIDC contexts suggests that each additional 5 percent increase in teacher absenteeism reduces learning by 4 to 8 percent of the average student’s learning in a year.
- Policy measures to reduce absenteeism include improving teacher monitoring, training, and professional progression; reducing inequalities in teacher workload; and incentivizing hardship postings.

---

*IMF | Technical Assistance Report – Uganda*

### 24.        School closures and cuts in the education budget due to COVID-19 have exacerbated

### 24.        School closures and cuts in the education budget due to COVID-19 have exacerbated learning inequalities and are likely to have increased dropout rates

### Education: pandemic impact and policy needs
- Uganda’s school closure period was the longest in the world: From March 2020 to January 2022, schools were closed for 83 weeks.
- Internet penetration constraint: only 6.1 percent of people aged 10 and above use the internet for any purpose, limiting remote learning reach.
- Consequences noted:
  - Exacerbated learning inequalities.
  - Likely increased dropout rates.
- Policy recommendations and priorities:
  - Ensure adequate resources for education.
  - Invest in digital literacy.

*Source: IMF Technical Assistance Report – Uganda (excerpt).*

### Water and sanitation: progress and persistent gaps
- Vision and targets:
  - Vision 2040 aims to provide all people access to safe piped water by 2040.
  - Presidential directive mandates one improved water source per village (defined as piped water, boreholes, tube wells, protected dug wells, protected springs, and packaged or delivered water).
- Progress over two decades (2000–2020):
  - Safely managed water increased from 2 percent of the population in the year 2000 to 17 percent in 2020.
  - Basic sources of improved water increased from 27 percent to 56 percent.
  - Rural and urban increases in hygiene (handwashing) and safely managed water rose by 27 to 29 percentage points.
- Stagnation in sanitation:
  - Access to basic sanitation services hardly improved over the past 20 years.
  - Supply-side constraints: poor terrain and soil type complicating facility installation.
  - Demand-side constraints: low-income inability to pay sanitation fees and cultural norms.

### Benchmarking and SDG performance
- Regional and peer comparison:
  - Among EAC countries, only South Sudan has a lower share of population with access to basic water and sanitation than Uganda.
  - Uganda lags LMICs, LIDCs, SSA, and all EAC countries other than South Sudan on the broader SDG 6 performance.
  - Uganda also has lower performance than the weakest EME on SDG 6.

### Cost to close WASH infrastructure gap by 2030 (model and results)
- Methodology:
  - Estimates use a World Bank WASH model and updated Uganda data prepared for the MWE and Environment.
  - Accounts for unserved population, additional population growth through 2030, cost per capita by facility type, maintenance costs, and separate urban/rural estimates.
- Aggregate results:
  - Closing the infrastructure gap to provide water and sanitation services for the unserved population of 53.5 million by 2030 will require an estimated US$9.4 billion, or US$175 per unserved person, by 2030.
  - Annualized investment need: $720 million, or about 1.1 percent of 2030 GDP, to achieve universal coverage of water and sanitation.
- Major cost drivers:
  - Provision of safely managed water in rural areas:
    - Makes up nearly half the annual additional cost.
    - Unit cost of US$109 per person.
    - Rural population to be provided access by 2030: 41 million.
  - Safely managed sanitation for rural areas: another 22 percent of the annual additional investment.
    - Population to be served with such facilities by 2030: 39 million.
- Table 3 highlights (selected exact figures as presented):
  - Total unserved population until 2030: 53.5 (millions).
  - Cost (per capita, US$): 175.0 (total average per unserved person).
  - Total additional cost (US$ million): 9,361.3.
  - Annual additional cost (US$ million): 720.1.
  - Total cost (% of 2030 GDP): 1.11.

### Supply-side issues and technology uptake
- Technology and treatment gaps:
  - Stocktaking in 102 of 135 districts found widely used improved sources are lower-quality types (protected springs, shallow wells).
  - About 44 percent of districts used no technology for large-scale purification or treatment of water prior to distribution.
  - One-third of districts do not promote water-boiling at household level.
  - NGOs are primary actors supporting point-of-use water treatment and purification technologies.
- Planned responses:
  - MWE and Environment plans to promote water source protection guidelines more strongly and initially support urban areas in preparing related plans.

### COVID-19 effects on WASH sector operations and financing
- Budget and operational impacts:
  - Reallocation of the budget during FY2020/21 to fight the COVID-19 pandemic led to a reallocation in funds away from the water, sanitation and environment sector by over 9 percent.
  - Monitoring and technical supervision of water and sanitation projects were greatly affected by pandemic restrictions on movement.
  - Water testing laboratories operated with only 10 percent of staffing at times.
  - Foreign experts could not carry out activities in-country due to travel restrictions.
- Service delivery and financial consequences:
  - Functionality of piped water supply, especially in urban areas, declined.
  - Water utilities accumulated arrears as households could not pay tariffs and a directive of “no disconnection” was in place during lockdown.
  - National Water and Sewerage Corporation saw a decline by 12 percent in the number of household connections in the pandemic fiscal year due to movement restrictions.
  - Local governments strengthened water and sanitation committees to support pandemic hygiene standards.
- Institutional innovation:
  - MWE is exploring introduction and development of remote monitoring approaches.

### Climate change implications for WASH
- Climate projections and impacts:
  - Regional climate models suggest seasonal drying over most parts of Uganda by the end of this century.
  - Expected impacts include increased floods and a drop in water levels due to diminishing groundwater sources and drying up of surface water.
  - These changes could exacerbate water scarcity and raise WASH infrastructure costs because of the need for climate-resilient technological alternatives.
- Policy orientation:
  - Uganda’s climate strategy in the water and sanitation sector centers on adaptation.
  - NDC priorities relevant to WASH:
    - Improving water efficiency (promoting water harvesting and storage).
    - Better management of water resource systems, including wetlands.
    - Designing resilient water and sanitation facilities.
    - Implementing public awareness programs on hygiene to limit water-borne diseases.
  - Standard national climate change indicators include measures reflecting the water–sanitation interface; close and timely monitoring of these indicators is recommended to track climate impacts on water quality.

### Electricity: expansion, access, and implications
- Capacity and infrastructure:
  - Installed capacity increased more than threefold from 400 MW (2000) to 1,347 MW (2021).
  - Hydropower accounts for 80 percent of installed capacity.
  - Transmission network expanded from 1,178 km in 2016 to 3,431 km in 2021.
  - Transmission losses averaged 3.9 percent over the last five years.
  - Main distributor Umeme reduced distribution losses from 34.2 percent in 2008 to 17.9 percent in 2021.
  - Planned capacity additions include Karuma and Isimba dams expected to increase capacity by 783 MW.
  - Peak demand is currently at 793 MW, below current installed capacity.
- Consumption and access metrics:
  - Total consumption rose from 780 GWh (two decades ago) to 3,918 GWh (latest available).
  - Current per capita consumption: 83 kWh.
  - Per-capita comparisons (latest available): Kenya 172 kWh, Tanzania 113 kWh, Uganda 83 kWh.
  - Electricity access: 41.3 percent of the population.
  - Rural population share: more than 74 percent of total population.
- Policy targets and affordability:
  - Authorities’ objective: ensure 60 percent of the population have access to electricity by 2027 (still below SDG 7.1 target of universal access).
  - Upfront grid connection costs: about US$160, equivalent to over two months of the average income, limiting affordability.
  - Electricity Connection Policy establishes a roadmap to connect 300,000 people per year from 2018 to 2027 and fully subsidize consumers’ upfront connection costs.
- Strategic rationale:
  - Expanding electricity access increases welfare and expands demand, helping avoid costs of excess generation.

*Source: IMF Technical Assistance Report – Uganda (excerpt).*

### 35.        Electricity generation needs to rise to support universal access as well as needs to keep

### Electricity generation needs to rise to support universal access as well as needs to keep

### Electricity demand and investment needs
- Population projected to increase from 47.1 to 59.4 million between 2020 and 2030.
- GDP per capita projected to increase from US$862 to US$1,221 between 2020 and 2030.
- Electricity consumption per capita projected to rise from 83kWh in 2020 to 289kWh by 2030.
- Additional consumption (GWh): 13,251.
- Unit cost including generation, transmission and distribution costs (US$ per kW): 1,188.
- A*B/(hours per year)=Total investment (US$ billion): 1.795.
- Total annual investment plus depreciation (percent of 2030 GDP): 0.400.
- Aggregate investment required to expand the electricity network (including replacement costs): US$1.8 billion (annual equivalent 0.4 percent of GDP).

### Current performance, vulnerabilities, and sectoral impacts of COVID-19
- Approximately 47 percent of health centers connected to grid electricity; limited connectivity constrained the health response to COVID-19.
- Two lockdowns and global supply-chain disruptions slowed construction projects and delayed acquisition of critical electrical equipment, causing a slowdown in planned network expansion under the Electricity Connection Policy.
- Only 1 percent of the population has access to clean fuel technology for cooking.
- Household air pollution from cooking in Uganda is estimated to have caused over 12,000 deaths every year (WHO 2018).
- Practically all electricity generation: 98.7 percent from renewable sources (primarily hydropower), the highest reliance on renewables among peers.
- Climate vulnerability: high reliance on hydropower creates long-run risks in case of drastic climate events (in particular drought); authorities plan to diversify the energy mix, primarily by increasing the share of solar power.
- Uganda is among the 20 largest deficit countries in terms of population without access to clean cooking and shows slower progress on cooking access.

### Key implications
- Electricity generation must increase to: (i) extend access to reach the entire population, (ii) accommodate population growth between now and 2030, and (iii) meet higher demand from income growth.
- Transition risks and adaptation needs point to diversification away from sole reliance on hydropower and investments in resilient generation and grid infrastructure.

*Source: IMF staff calculations.*

### Road infrastructure

#### Current network and quality
- Total road network nearly 160 thousand km; 76 percent pertains to subnational roads.
- Half of the total network consists of community access roads (feeder roads), entirely non-paved.
- Community access roads considered all-season roads: 2.8 percent (2,239 km).
- Table of network by class (latest year available):
  - National: Paved 6,107 km; Non-Paved 14,747 km; Total 20,854 km; Of which, all-season roads 10,561 km.
  - District: Paved 107 km; Non-Paved 38,497 km; Total 38,603 km; Of which, all-season roads 6,447 km.
  - Urban: Paved 1,230 km; Non-Paved 18,729 km; Total 19,959 km; Of which, all-season roads 3,074 km.
  - Community access: Paved 0 km; Non-Paved 79,948 km; Total 79,948 km; Of which, all-season roads 2,239 km.
  - Total: Paved 7,443 km; Non-Paved 151,921 km; Total 159,364 km; Of which, all-season roads 22,320 km.
- Rural Access Index (RAI): 53 percent (somewhat more than half of rural population with access to an all-season road), ahead of LIDCs and LMICs averages but below IMF target for LIDCs (RAI of 75).

#### Investment and maintenance needs
- Additional roads required (thousand km): 20.4.
- Unit cost (US$/km): 716,042.
- A*B = Total investment (US$ billion): 14.6.
- Total annual investment plus depreciation (percent of GDP): 2.8.
- Unit cost estimates consider rehabilitation/upgrading and new construction costs as reported by MoWT.
- Maintenance backlog: total unconstrained cost for rehabilitation or removal of backlog of all roads increased from US$1,154.3 million in FY 2019/2020 to US$1,160.7 million in 2020/2021.

#### Climate exposure and COVID-19 impacts
- Authorities estimate 2,180 km of roads exposed to landslide risk and 2,850 km at risk of flooding.
- Climate hazards (flooding, landslides) make climate-resilient infrastructure and improved drainage and vegetation stabilization important adaptation steps.
- COVID-19 consequences:
  - Slowed resolution of road maintenance backlog and asset-life deterioration.
  - Supply-chain disruptions stalled implementation of road projects; many contractors and materials are foreign.
  - Contractors are pricing in pandemic-related risks, raising future construction costs.
  - Construction of new roads slowed by lockdowns; land acquisition for road building was impeded.

### Key implications for roads
- Closing the infrastructure gap to reach an RAI of 75 by 2030 requires about 20.4 thousand additional kilometers of all-season roads and US$14.6 billion in investment (2.8 percent of GDP annually including depreciation).
- Greater spending on road maintenance is required to avoid accelerated asset degradation; current allocation favors new construction over maintenance and needs policy attention.

*Source: IMF staff calculations.*

### Conclusion — fiscal and policy considerations

#### Aggregate SDG spending needs and composition
- Uganda’s additional annual spending needs to perform well in these SDGs in 2030 amount to 18.4 percent of GDP.
- Over three quarters of this comes from spending on human capital development.
- Composition of additional annual spending (percent of GDP):
  - Physical capital: 7.4
  - Human capital: 6.7
  - Other components shown sum to a total of 18.4 percent of GDP in the report’s figure.

#### Sensitivities and efficiency considerations
- Estimates assume Uganda raises efficiency in transforming inputs into outcomes to levels of well-performing peers; if efficiency remains lower, expenditure needs would be even higher.
- The analysis does not fully capture cross-sectoral effects (for example, health benefits from improved water and sanitation), which could reduce overall costs.
- The timing of additional spending is not prescribed: policymakers can choose gradual, frontloaded, or backloaded trajectories; infrastructure spending estimates are average yearly targets up to 2030.

#### Climate-change emphasis
- For Uganda, climate change adaptation will be a higher priority than mitigation given very low greenhouse gas emissions and near-universal reliance on renewable electricity (98.7 percent hydropower).
- Adaptation needs imply additional costs across social and infrastructure sectors: resilient health facilities, resilient WASH infrastructure, climate-resilient roads.

#### Financing and reform options
- Further analysis should explore financing options, including:
  - (i) more vigorous domestic revenue mobilization through revenue administration and tax policy measures and through structural reforms,
  - (ii) grants,
  - (iii) concessional loans,
  - (iv) expenditure reallocation and increasing efficiency,
  - (v) strengthening the business environment to enable private financing.
- Example evidence: an IMF study found Rwanda and Nigeria could cover one-third and 35 percent, respectively, of their SDG financing needs through steps (i), (iv), and (v), signaling need for significant international development assistance in grants and concessional loans.

#### Managerial and policy constraints to address
- Strengthening system resilience exposed by COVID-19 (health system, education continuity, road maintenance, electricity diversification).
- Improve managerial approaches to reduce teacher absenteeism and increase service delivery efficiency.
- Rebalance resource allocation between new construction and maintenance in road sector; analyze and overcome policy constraints leading to underinvestment in maintenance.
- Diversify energy mix (increase solar share) to reduce hydropower vulnerability to drought.

*Source: IMF staff calculations.*

### Appendix I. Poverty Statistics

### Appendix I. Poverty Statistics

### Poverty statistics (table summary)
- Table AI.1 reports poverty rate (A), population (B), and number of poor people (millions) (computed value).
- Formula used for computing number of poor people (millions) shown in the table:
  - 9.772852903 = (A / 100) * (B / 1,000,000)

- Yearly records (Value columns copied exactly as in source):
  - 1989 — A: 58.3; B: 16,763,041; Number of poor people: 9.772852903
  - 1992 — A: 64.4; B: 18,561,668; Number of poor people: 11.953714192
  - 1996 — A: 63.4; B: 21,032,817; Number of poor people: 13.334805978
  - 1999 — A: 67.5; B: 22,952,406; Number of poor people: 15.492874050
  - 2002 — A: 65.6; B: 25,167,261; Number of poor people: 16.509723216
  - 2005 — A: 57.0; B: 27,684,590; Number of poor people: 15.780216300
  - 2009 — A: 45.3; B: 31,411,096; Number of poor people: 14.229226488
  - 2012 — A: 35.7; B: 34,558,700; Number of poor people: 12.337455900
  - 2016 — A: 41.3; B: 39,649,173; Number of poor people: 16.375108449
  - 2019 — A: 41.0; B: 44,269,587; Number of poor people: 18.150530670
  - 2020 — A: 41.1 (UBOS (2021). The Uganda National Household Survey 2019/2020. See Box 6.2: "The poverty headcount at US$1.9 per person per day (2011 purchasing‑power parity -PPP$) is 41.1 percent" (p. 114).); B: 45,741,000; Number of poor people: 18.799551000

### Data sources and series definitions
- Poverty rate series (A) source and definition:
  - World Development Indicators, World Bank, https://databank.worldbank.org/source/world-development-indicators# (accessed March 2022; data available only through 2019).
  - Series: Poverty headcount ratio at $1.90 a day (2011 purchasing-power parity - PPP$) (% of population) (SI.POV.DDAY).
  - More details on the series: https://data.worldbank.org/indicator/SP.POP.TOTL
- Population series (B) source and details:
  - World Development Indicators, World Bank, https://databank.worldbank.org/source/world-development-indicators# (accessed March 2022).
  - Series: Population, total (SP.POP.TOTL).
  - More details on the series: https://data.worldbank.org/indicator/SI.POV.DDAY
- 2020 poverty rate source:
  - UBOS (2021). The Uganda National Household Survey 2019/2020. Box 6.2 (p. 114) states: "The poverty headcount at US$1.9 per person per day (2011 purchasing-power parity -PPP$) is 41.1 percent".

*IMF | Technical Assistance Report – Uganda — Appendix I. Poverty Statistics*

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_Source: https://www.imf.org/-/media/files/publications/tar/2024/english/tarea2024104-print-pdf.pdf_