Abstract

Purpose: Uganda’s digital health transformation anchored on District Health Information Software 2 (DHIS2) and the FAIR 
(Findable, Accessible, Interoperable, Reusable) Data Principles has reshaped health data governance. Nevertheless, systemic con
straints in privacy, infrastructure, and human resources threaten sustainability and equity.
Objective: To compare DHIS2 and FAIR-based approaches on (i) privacy protection, (ii) interoperability and data usability, and (iii) 
regulatory/institutional readiness for privacy-preserving health data analytics in Uganda.
Methods: Systematic review of 84 peer-reviewed and grey-literature sources (2010–2025) following PRISMA 2020; extracted 
indicators on reuse, interoperability, privacy, and institutional readiness.
Results: 36% of included studies were Uganda-specific; 50% were published in 2020–2024. DHIS2 reached near-national coverage, 
~12,000 trained users, and integration across >20 programmes. Persistent gaps include limited rural internet (≈12% of facilities with 
stable connectivity), high staff turnover (~35%), and low analytics literacy (~25% with intermediate skills). FAIR efforts (since ~2019) 
remain early: ~10% of institutions with formal policies; low dataset reuse (~22%), machine-readable metadata (~18%), and 
documented digital consent (<10%). Privacy infrastructure is weak: <30% of facilities with formal privacy frameworks/secure 
platforms and <10% with Data Protection Officers.
Conclusion: DHIS2 improved reporting and availability, while FAIR initiatives began enabling governed, interoperable reuse. To 
achieve ethical analytics at scale, priorities are legal enforcement, secure rural ICT, standardized machine-readable metadata/consent, 
and workforce development.