Evaluating the Integration of Palliative Care in Uganda’s Referral Hospitals: A Case Study of Fort Portal Regional Referral Hospital

Background The integration of palliative care into public health services is a global priority, but it remains uneven in low-income settings. This study evaluated palliative care unit attendance, utilisation relative to need, and the model of care at Fort Portal Regional Referral Hospital (FPRRH) between 2019 and 2025. Methods A retrospective descriptive case study was conducted at FPRRH, a referral‑level hospital serving the Rwenzori subregion of Uganda. Facility records and palliative care unit documentation were reviewed to quantify patient attendance by diagnosis and age group, estimate the proportion of patients receiving specialist palliative care relative to those likely to need it, and describe the unit’s model of care. Data sources included HMIS 008 registers (2019–2024), the EAFYA electronic medical records system (2024/2025), and District Health Information System (DHIS2) reports. Attendance was analysed using descriptive statistics, and the model of care was derived through thematic analysis of reported activities. Results Between July 2019 and June 2025, 1,773 patients attended the palliative care unit. Of these, 959 (54.1%) had cancer and 814 (45.9%) had non‑cancer diagnoses. Overall, 89% of cancer patients accessed the unit compared with 5.1% of sickle cell disease patients and 1.4% of those with HIV‑related complications. Children comprised 6% of attendees. Attendance increased in 2024–2025, primarily driven by outpatient visits (73.6%). Across the hospital, 4,807 patients were identified as potentially requiring palliative care, of whom 1,108 (23%) accessed services. The hospital‑based model emphasised symptom control, collaborative care planning, psychosocial support, care continuity, and mentorship. Conclusion FPRRH has made measurable progress in integrating specialist palliative care, achieving higher coverage than commonly reported national and global estimates. Persistent gaps include low paediatric access, limited inpatient utilisation, and under‑representation of non‑cancer conditions. The hospital’s model offers a replicable framework for strengthening palliative care in referral hospitals.