Pastoralist Mobility and the Fragmentation of Chronic Disease Care in Karamoja, Uganda: A Qualitative Study

This qualitative study investigates how the high mobility of pastoralist communities disrupts continuity of care for chronic diseases in the Karamoja region of Uganda. It addresses a critical gap in understanding how nomadic lifestyles intersect with long-term healthcare delivery within a fragile health system. Between 2023 and 2024, we conducted in-depth interviews and focus group discussions with 42 purposively sampled participants, including patients with hypertension or diabetes, their caregivers, community health workers, and clinical staff from static and mobile units. Thematic analysis revealed a profound fragmentation of care characterised by disrupted medication adherence, lost patient records, and missed follow-ups due to seasonal migration. Patients reported resorting to harmful practices like medication rationing, while health workers described insurmountable challenges in tracking individuals across vast territories. The analysis demonstrates that the prevailing static healthcare model is fundamentally misaligned with the mobile reality of pastoralist life, thereby exacerbating health inequities. This research underscores the urgent need for a paradigm shift in service delivery. It concludes that developing context-specific, mobile health strategies, supported by interoperable health information systems, is imperative for Uganda and similar settings to progress towards Sustainable Development Goal targets for non-communicable diseases and universal health coverage.