The journey of strengthening mortality surveillance in Uganda through multisectoral guideline development

Background Understanding who dies, where and from what causes is central to improving public health and responding to emerging threats. While this requires a strong mortality surveillance system, Uganda has long faced fragmented data systems, poor coordination, and underreporting of deaths. In response, the Ministry of Health developed national mortality surveillance (MS) guidelines to enhance data collection and use. This paper presents Uganda’s experience in strengthening its mortality surveillance system and offers insights that may inform the design and implementation of similar initiatives in other countries. Methods A national situational analysis and desk review of existing mortality data systems and tools were conducted. The systems reviewed included the Health Management Information System (HMIS), electronic Integrated Disease Surveillance and Response (eIDSR), Mobile Vital Registration System (MVRS), electronic Community Health Information System (eCHIS) and the District Health Information System (DHIS2). The mortality data reported in DHIS2 between January and June 2025 were analysed via Excel and are reported in tables. Additionally, partner-led mortality audit mechanisms, mortality-related policy documents and relevant outbreak reports were reviewed. Eight (08) workshops were convened between November 2024 and June 2025 involving stakeholders from government ministries, civil society, academia, and development partners. A national technical writing team comprising 20 people was created, with existing paper and digital tools for mortality data reviewed and new tools developed. The guidelines were aligned with global and regional frameworks, validated and endorsed. Results Four major gaps were identified: 1) weak governance and uncoordinated leadership; 2) fragmented and incomplete mortality data flows; 3) inadequate data management tools and inconsistent indicator definitions; and 4) a lack of interoperability and feedback in digital systems. The guidelines established mortality surveillance coordination committees, all-cause death review forms, mortality registers, dead body gate passes, and interoperability of eIDSR, eCHIS, MVRS and DHIS2. Non-health actors (Uganda Police Force and funeral services) were incorporated into national reporting systems, and quarterly mortality data reviews were institutionalized to promote evidence use. Conclusion The development of national MS guidelines addresses gaps in coordination, data quality and use for health system improvement and epidemic preparedness. It offers a replicable model for other countries seeking to strengthen MS and use data to inform public health policy and action.