A Scoping Review of the National Surgical, Obstetric, and Anesthesia Plan Implementation Process in Ugandan District Hospitals, 2004

National Surgical, Obstetric, and Anaesthesia Plans (NSOAPs) are strategic frameworks for strengthening surgical systems in low- and middle-income countries. Uganda developed an NSOAP to address gaps in care. The implementation process at the district hospital level, a primary point of access, is not well documented. This scoping review aimed to map and synthesise existing literature on the implementation process of Uganda’s NSOAP in district hospitals. Objectives were to identify key stages, actors, and activities; describe reported barriers and facilitators; and highlight gaps in documentation. A scoping review was conducted using established frameworks. A systematic search was performed across relevant electronic databases and grey literature sources. Included materials described any aspect of NSOAP implementation in Ugandan district hospitals. Data were charted and analysed thematically. The review identified a limited but informative body of literature. Implementation was a multi-phase process involving national policy dissemination and variable local adoption. A prominent theme was the critical challenge of sustainable financing, with most sources citing insufficient and unpredictable funding as a major barrier to procuring equipment and maintaining infrastructure. The implementation of Uganda’s NSOAP in district hospitals is a complex, multi-stakeholder process facing significant systemic challenges. While the plan provides strategic direction, its translation into sustained practice is inconsistent and constrained by structural factors. Future implementation should prioritise secure, ring-fenced financing mechanisms and strengthen district-level management capacity. Further primary research is required to evaluate the fidelity and adaptation of the NSOAP process across different district contexts. National Surgical, Obstetric, and Anaesthesia Plan; Uganda; district hospitals; implementation; process evaluation; health systems strengthening. This review consolidates current knowledge on NSOAP implementation in Uganda, clarifying the process and its challenges to inform policymakers and future research.