Frontline Surveillance Practices and Healthcare Project Performance in a Decentralized Health System: A Mixed Methods from Kayunga District, Uganda

Introduction: Effective health worker surveillance practices are vital for strengthening health system performance and achieving project objectives in resource constrained settings. While the national surveillance capacities have received increasing attention, far less is known about how frontline surveillance functions translated into routine service delivery performance in decentralized health systems. This study assessed the relationship between healthcare worker surveillance practices and the performance of healthcare projects in Kayunga District, Uganda. Methods A cross-sectional study design employing a mixed-methods approach was used. Quantitative data were obtained from frontline health workers using structured questionnaires, while qualitative insights were obtained from key informant interviews. Statistical Package for Social Sciences (SPSS) version 20 was used for descriptive statistics, correlation, and regression analyses. Qualitative data were analyzed thematically to complement quantitative findings. Results There was a strong positive correlation between surveillance practices and healthcare project performance (r = 0.690, p < 0.01). Regression analysis confirmed this relationship (β = 0.456, p < 0.002). Qualitative results emphasized the importance of timely reporting, data completeness, and feedback in supporting decision-making and service delivery. Barriers such as inadequate training, limited logistical support, and community mistrust were identified as key challenges for surveillance effectiveness. Conclusion Healthcare worker surveillance practices are integral to the success of healthcare projects in Uganda. Strengthening these practices through training, enhanced resource allocation, and active community engagement can substantially enhance health system performance. These findings provide district-level health systems evidence on how routine surveillance practices shape service delivery and epidemic preparedness in decentalized settings.