Western region, Uganda
Donum Nakivale Health Centre: births, newborns and oxygen
Safe births, care for newborns, and oxygen for the whole settlement's clinics, in a place where whole wards have closed.
Planned project
This is a project we plan to build. None of the approvals it needs has been granted yet. Each one is listed below with its status, and nothing that needs an approval starts until it is granted.
Isingiro District, next to Nakivale Refugee Settlement. The exact plot is not yet bought.
50%
Neonatal deaths in Uganda from birth asphyxia
the main cause; skilled birth care targets it (WHO Africa, 2025)
5.1% to 2.9%
Child deaths with solar oxygen, Ugandan trial
within 48 hours; one life saved per 45 children treated (Conradi and others, 2024-02-24)
1,800
Births a year it is built for
and 45,000 visits; 600 to 1,000 births expected at first
$17.10
Running cost per visit
$4.40 once the government posts the staff
To build
$3,552,419
once
To run
$769,700
a year; $198,100 with the government partnership
Its share of the Donum Endowment
$19,242,500
running cost divided by 4%
In all
$22,794,919
opens October 2028 (planned)
$0 of $22,794,919
Pledge to this project Read the whole plan
If a project cannot go ahead, because an approval it needs is refused or its building has not begun within five years, everyone who gave to it is offered their money back or a move to another planned project.
Why it matters
- Health workers in Nakivale describe entire departments and wards closed, triage stopped, community nutrition services shut and orders to make only necessary referrals (Lee and others, 2026-05-26).
- Health facilities serving refugees in Uganda fell from 101 in 2024 to 89 in early 2026, because of the funding cuts (UNHCR, 2026-03-31); the district has asked for Nakivale Health Centre III to be upgraded because it cannot manage the numbers (Office of the Prime Minister, 2026-05).
- Births and the first days of life are where good care saves the most lives for the least money: half of newborn deaths in Uganda come from birth asphyxia (WHO Africa, 2025).
Read more
By January only 6% of the money needed for refugee health and nutrition in Uganda in 2026 had been secured (International Rescue Committee press release, 2026-01-26). The IRC closed health services in 11 settlements; stock-outs reached up to 30%, and acute malnutrition rose from 5.4% to 7.8% across 12 of 14 refugee locations (International Rescue Committee, 2026-01-26). Health facilities serving refugees fell from 101 in 2024 to 89 in early 2026 (UNHCR, 2026-03-31).
A 2026 study counted about 10 public health facilities in Nakivale, 8 of them assessed: 6 Health Centre IIIs and 2 Health Centre IVs, 7 of them more than 10 km from the town council (Tropical Medicine and Health, 2026). One Health Centre III was reported to serve about 94,000 people and about 400 antenatal clients a week (European Commission ECHO, undated). HIV prevalence in the settlement is 2.4%, and the OPM fears it will rise as rations are cut (Office of the Prime Minister, 2026-05).
Uganda's maternal mortality is 189 per 100,000 live births and neonatal mortality 22 per 1,000. Half of newborn deaths are from birth asphyxia, 18% from prematurity and 7% from sepsis (WHO Africa, 2025). Uganda's health workforce is at about 34% of its approved structure (New Vision, 2026-09-02); staff homes are how a remote centre keeps trained midwives.
No source we found records how much oxygen Nakivale's clinics have. The baseline survey records it.
What the evidence says
Oxygen saves children. In a trial at 20 Ugandan health facilities, solar-powered oxygen cut 48-hour deaths among children with low oxygen from 5.1% to 2.9%: one life saved for every 45 children treated (Conradi and others, 2024-02-24). After adjusting for differences between the two periods, the odds of dying were halved. The trial sites were larger facilities than a Health Centre III, so supplying other clinics needs cylinders, a pickup, pulse oximeters and trained nurses: all in this budget.
Read more
Skilled births and newborn care save babies. Because half of newborn deaths come from asphyxia, a midwife at every birth, resuscitation and a newborn unit aim at the largest cause (WHO Africa, 2025). In a Ugandan newborn programme, survival of babies under 1,500 g rose from 79% to 95% with training and quality improvement (Healthy Newborn Network, 2025).
What it is
An outpatient block, a maternity block with four delivery beds, 24 postnatal beds and a newborn unit for ten babies, wards for 28 patients, a laboratory, a pharmacy, a nutrition clinic for malnourished children and mothers, and a shelter where families staying with patients can cook.
Read more
An oxygen plant fills cylinders for the health centre and for other clinics across the settlement, with 250 cylinders and a pickup that delivers full ones and brings back the empty ones.
Sixteen homes for health workers, so trained staff can live where they work. An ambulance, and two motorcycles for immunisation visits.
When it happens
Opens October 2028 (planned).
- The land
- Studies and approvals
- The builder
- Foundations
- Walls and roof
- Finishes, power and water
- Equipment
- Opening
Read more: approvals and stages
Approvals
| Approval | From whom | Status | Date |
|---|---|---|---|
| The campus approvals (land, consultations, district, environmental certificate) | See the campus chance | Not yet granted | |
| Registration and licence as a private not-for-profit health facility | Ministry of Health and the Isingiro District Health Office | Not yet granted | |
| Licence for the pharmacy | National Drug Authority | Not yet granted | |
| Registration of the laboratory, nurses and midwives | Allied Health Professionals Council; Uganda Nurses and Midwives Council | Not yet granted | |
| Agreement on staff posting and government supplies (the partnership) | Isingiro District Health Office and Ministry of Health | Not yet granted |
Its stages
- The land. Done means: Land in a place with at least 20,000 people within 5 km, checked against Office of the Prime Minister and UNHCR population figures; its title, or a written allocation from the Office of the Prime Minister, in Donum Foundation's name, checked by our lawyer.
- Studies and approvals. Done means: Surveys, the environmental and social impact certificate, approved drawings, and every approval this project needs, each recorded on the chance page.
- The builder. Done means: Three written quotes from builders our team has checked; one chosen and the reason written down. The chosen quote replaces this estimate on the page.
- Foundations. Done means: Foundations and floor slabs inspected and signed off by the supervising engineer.
- Walls and roof. Done means: Walls up and roof on, inspected and signed off.
- Finishes, power and water. Done means: Doors, windows, plaster, paint, wiring, plumbing, power and water working, inspected.
- Equipment. Done means: Furniture and equipment in place and checked against the list.
- Opening. Done means: The confirmation of delivery signed by the community's leaders, with photos, and the running costs in place.
What it costs, and why
Where the building money goes
- $1.07 million for about 2,810 m2 of clinical buildings: outpatients, a maternity block with 4 delivery beds, 24 postnatal beds and a 10-cot newborn unit, wards of 30 beds, laboratory and pharmacy, nutrition clinic, kitchen, a family shelter and walkways.
- $0.38 million for 16 staff homes and the in-charge's house: without them a remote centre cannot keep midwives at night.
- $0.46 million for equipment, beds, solar vaccine fridges, records and a backup battery; $0.34 million for the oxygen plant, 250 cylinders, pipes and a delivery pickup; $0.12 million for the ambulance and outreach motorcycles.
- $1.06 million for design and supervision, a 6% price-rise allowance, VAT, import charges and a 10% contingency, all counted rather than hoped away.
Where the running money goes
- $365,500 a year for 55 health workers on the government's Health Centre III structure, including 2 doctors, and the oxygen technicians. This is the part the government can take over by posting staff.
- $236,000 for medicines and birth supplies at full capacity; $49,800 for upkeep; $68,100 saved every year to replace the ambulance, the oxygen plant and equipment as they wear out.
Running this place costs $769,700 a year. At 4% a year, that needs $19,242,500 invested in the Donum Endowment, which is never spent: only its returns pay the running costs, every year. If the government takes on the staff it can pay, Donum's yearly share falls to $198,100, and the returns that paid for those salaries go to the next need.
Every part
None yet. Choose All to see everything.
The health centre buildings $1,073,972 · still needs $1,073,972 · Planned
-
Outpatient block: 6 consultation rooms, triage, emergency room, immunisation, HIV and TB clinic, counselling
$197,260 · still needs $197,260 · Planned
How we reached this figure: 450 m2 at UGX 1,600,000 per m2 (R_SVC)
-
Maternity block: antenatal clinic, 4 delivery beds, 24 postnatal beds, a newborn unit for 10 babies, a kangaroo care room
$284,932 · still needs $284,932 · Planned
How we reached this figure: 650 m2 at UGX 1,600,000 per m2 (R_SVC)
-
Wards: 16 beds for women and children, 12 for men, 2 isolation rooms
$197,260 · still needs $197,260 · Planned
How we reached this figure: 450 m2 at UGX 1,600,000 per m2 (R_SVC)
-
Laboratory, pharmacy and medical stores
$109,589 · still needs $109,589 · Planned
How we reached this figure: 250 m2 at UGX 1,600,000 per m2 (R_SVC)
-
Nutrition clinic for malnourished children and mothers
$42,740 · still needs $42,740 · Planned
How we reached this figure: 120 m2 at UGX 1,300,000 per m2 (R_STD)
-
Administration, records and staff room
$53,425 · still needs $53,425 · Planned
How we reached this figure: 150 m2 at UGX 1,300,000 per m2 (R_STD)
-
Kitchen and laundry
$53,425 · still needs $53,425 · Planned
How we reached this figure: 150 m2 at UGX 1,300,000 per m2 (R_STD)
-
Shelter with a cooking area for families staying with patients
$45,205 · still needs $45,205 · Planned
How we reached this figure: 150 m2 at UGX 1,100,000 per m2 (R_LIGHT)
-
Body holding room
$17,534 · still needs $17,534 · Planned
How we reached this figure: 40 m2 at UGX 1,600,000 per m2 (R_SVC)
-
Toilets and showers for patients and visitors
$35,616 · still needs $35,616 · Planned
How we reached this figure: 100 m2 at UGX 1,300,000 per m2 (R_STD)
-
Covered walkways between the blocks
$36,986 · still needs $36,986 · Planned
How we reached this figure: 300 m2 at UGX 450,000 per m2 (WALK)
-
Homes for the health workers $384,384 · still needs $384,384 · Planned
-
16 two-bedroom homes for nurses, midwives and clinicians
$352,877 · still needs $352,877 · Planned
How we reached this figure: 1,120 m2 at UGX 1,150,000 per m2 (R_HOUSE)
-
House for the health centre's in-charge
$31,507 · still needs $31,507 · Planned
How we reached this figure: 100 m2 at UGX 1,150,000 per m2 (R_HOUSE)
-
Outside works $55,617 · still needs $55,617 · Planned
-
Medical waste: a double-chamber incinerator, placenta pit, sharps pit and ash pit
$23,288 · still needs $23,288 · Planned
How we reached this figure: Our estimate
-
Fence and gate around the health centre, 600 m
$21,370 · still needs $21,370 · Planned
How we reached this figure: 600 m at UGX 130,000 a metre
-
Ambulance bay and paved parking
$10,959 · still needs $10,959 · Planned
How we reached this figure: Our estimate
-
Medical equipment and furniture $457,240 · still needs $457,240 · Planned
-
Medical equipment: delivery beds, newborn warmers and resuscitation, bubble CPAP, phototherapy, monitors, two ultrasound machines, suction, sterilisers
$220,000 · still needs $220,000 · Planned
How we reached this figure: Our estimate from supplier lists
-
Laboratory: blood count and chemistry analysers, 4 microscopes, centrifuges, fridges
$70,000 · still needs $70,000 · Planned
How we reached this figure: Our estimate
-
60 hospital beds with mattresses and lockers, and baby cots
$46,020 · still needs $46,020 · Planned
$767 a bed set, 60 needed
How we reached this figure: 60 sets at UGX 2,800,000
-
2 solar vaccine fridges (WHO approved)
$13,000 · still needs $13,000 · Planned
$6,500 a vaccine fridge, 2 needed
How we reached this figure: 2 at USD 6,500
-
Furniture and shelving for every room
$41,096 · still needs $41,096 · Planned
How we reached this figure: Our estimate
-
Electronic patient records: 12 computers, a server and the network
$24,658 · still needs $24,658 · Planned
How we reached this figure: Open-source UgandaEMR; our estimate
-
A battery that keeps maternity, the newborn unit and the oxygen controls running if the main power fails
$32,877 · still needs $32,877 · Planned
How we reached this figure: About 30 kWh with its inverter; our estimate
-
Cold chamber for the body holding room
$9,589 · still needs $9,589 · Planned
How we reached this figure: Our estimate
-
Ambulance $116,165 · still needs $116,165 · Planned
-
A four-wheel-drive ambulance, fully equipped
$109,589 · still needs $109,589 · Planned
How we reached this figure: Uganda price with taxes; our estimate
-
2 motorcycles for outreach and immunisation visits
$6,576 · still needs $6,576 · Planned
$3,288 a motorcycle, 2 needed
How we reached this figure: 2 at UGX 12,000,000
-
Oxygen for the whole settlement $339,452 · still needs $339,452 · Planned
-
An oxygen plant (about 15 cubic metres an hour) with cylinder filling
$220,000 · still needs $220,000 · Planned
How we reached this figure: Installed; our estimate from supplier lists
-
250 oxygen cylinders, so clinics across the settlement can be supplied
$40,000 · still needs $40,000 · Planned
$160 an oxygen cylinder, 250 needed
How we reached this figure: 250 at USD 160
-
Oxygen pipes to the maternity block, the newborn unit and the wards
$16,438 · still needs $16,438 · Planned
How we reached this figure: Our estimate
-
A pickup that delivers full cylinders to other clinics and brings back the empty ones
$63,014 · still needs $63,014 · Planned
How we reached this figure: Uganda price with taxes; our estimate
-
Getting ready to open $68,493 · still needs $68,493 · Planned
-
First 3 months of medicines and supplies
$49,315 · still needs $49,315 · Planned
How we reached this figure: Our estimate
-
Hiring the team and training it before opening: emergency births and newborn care
$16,438 · still needs $16,438 · Planned
How we reached this figure: Our estimate
-
Registration and licences: health ministry, drug authority, professional councils
$2,740 · still needs $2,740 · Planned
How we reached this figure: Our estimate
Can start before approvals
-
Fees, taxes and contingency $1,057,096 · still needs $1,057,096 · Planned
-
Architect, engineers, quantity surveyor and site supervision (10% of the building work)
$153,041 · still needs $153,041 · Planned
How we reached this figure: 10% of $1,530,411 building and outside works; usual practice in Uganda
Can start before approvals
-
Allowance for prices rising before building starts (6%)
$91,836 · still needs $91,836 · Planned
How we reached this figure: 6% of building and outside works. Uganda inflation was 4.6% a year to Sep 2026, and energy and fuel 14.5% (UBOS)
-
VAT on the builder's contract and fees (18%), unless Donum obtains an exemption
$319,562 · still needs $319,562 · Planned
How we reached this figure: 18% of works, price allowance and fees. If an exemption is granted, this line is returned to the project's other items
-
Shipping, insurance and clearing of imported equipment (8%)
$45,041 · still needs $45,041 · Planned
How we reached this figure: 8% of $563,000 imported equipment; our estimate
-
Import declaration fee and infrastructure levy (2.5%)
$15,205 · still needs $15,205 · Planned
How we reached this figure: 1% import declaration fee and 1.5% infrastructure levy on customs value (External Trade (Amendment) Act 2025)
-
VAT on imported equipment (18%), unless it is exempt
$109,452 · still needs $109,452 · Planned
How we reached this figure: 18% of customs value. Deep-cycle batteries are VAT-exempt since 1 July 2025 and carry no VAT here
-
Contingency for what nobody can see yet (10%)
$322,959 · still needs $322,959 · Planned
How we reached this figure: 10% of everything above. Whatever is not used goes to this project's running costs (its endowment)
-
Keeping it running: its share of the Donum Endowment $19,242,500 · still needs $19,242,500 · Planned
-
Staff pay, for good: paid every year from the endowment's returns
$9,137,500 · still needs $9,137,500 · Planned
How we reached this figure: $365,500 a year divided by 4%
-
Medicines and supplies, for good: paid every year from the endowment's returns
$5,900,000 · still needs $5,900,000 · Planned
How we reached this figure: $236,000 a year divided by 4%
-
Upkeep and servicing, for good: paid every year from the endowment's returns
$1,245,000 · still needs $1,245,000 · Planned
How we reached this figure: $49,800 a year divided by 4%
-
Fuel, supplies and services, for good: paid every year from the endowment's returns
$800,000 · still needs $800,000 · Planned
How we reached this figure: $32,000 a year divided by 4%
-
Audits, licences and surveys, for good: paid every year from the endowment's returns
$102,500 · still needs $102,500 · Planned
How we reached this figure: $4,100 a year divided by 4%
-
Insurance, for good: paid every year from the endowment's returns
$355,000 · still needs $355,000 · Planned
How we reached this figure: $14,200 a year divided by 4%
-
Replacing equipment as it wears out, for good: paid every year from the endowment's returns
$1,702,500 · still needs $1,702,500 · Planned
How we reached this figure: $68,100 a year divided by 4%
-
Read more: running costs, line by line
In 2026 prices. Lines marked government are the ones the partnership could move to the government.
| Running cost | A year |
|---|---|
| 55 health workers on the government's Health Centre III structure, including 2 doctors, midwives, nurses, laboratory and pharmacy staff (the government's own wage bill for this structure is UGX 1.1 billion a year), plus NSSF and medical cover (government) | $346,600 |
| Oxygen plant technician and equipment technician | $18,900 |
| Medicines for about 45,000 outpatient visits a year (UGX 9,000 a visit) (government) | $111,000 |
| Supplies for about 1,800 births a year (UGX 70,000 each) (government) | $34,500 |
| Medicines for about 2,500 admissions a year (UGX 60,000 each) (government) | $41,100 |
| Laboratory reagents and tests (government) | $38,400 |
| Nutrition supplies for malnourished children and mothers | $11,000 |
| Servicing the oxygen plant: filters, sieve beds, service contract (4% of its cost) | $8,800 |
| Ambulance fuel, servicing and insurance | $12,300 |
| Servicing and calibrating medical equipment (4% of its cost) | $18,300 |
| Building upkeep (1.5% of building cost) | $22,700 |
| Cleaning, laundry, waste fuel, food for inpatients without family | $16,400 |
| Internet and phones | $3,300 |
| Licences, quality audits and reporting | $4,100 |
| Insurance (0.4%) | $14,200 |
| Replacing medical equipment over its life (10 years) | $45,700 |
| Replacing the ambulance and pickups over their life (8 years) | $22,400 |
| Total | $769,700 |
| Donum's share if the government takes on the lines marked government | $198,100 |
These are estimates, in 2026 prices. Before anything is bought, a quote from a builder or seller we checked replaces each one, and this page shows the change.
Who runs it, who pays, and who else is there
Model B. Donum builds and owns the health centre and registers it as a private not-for-profit facility. It asks the district and the health ministry to post and pay its staff on the Health Centre III structure (55 health workers, including two doctors) and to include it in the government's supply of medicines. Private not-for-profit facilities in Uganda already receive government grants (International Journal for Equity in Health, 2018-10-05). Until that happens, Donum pays every cost from the endowment, so the health centre never waits on the government to open.
- The government and UNHCR's partners run about 10 public health facilities in Nakivale (Tropical Medicine and Health, 2026); the district wants more capacity, not less (Office of the Prime Minister, 2026-05). Donum's centre registers as a private not-for-profit facility under the district, joins its referral system and asks the government to post staff, the same route other private not-for-profit facilities use (International Journal for Equity in Health, 2018-10-05).
- A Health Centre III does not do caesareans, so a written referral and ambulance agreement with a Health Centre IV or Mbarara is a condition of opening.
Read more: keeping it running
Donum owns the health centre and keeps it in repair. It is registered as a private not-for-profit facility, and Donum asks the district health office and the health ministry to post and pay its 55 health workers on the Health Centre III structure and to supply medicines. Until they do, every cost is paid from the endowment: staff, medicines and supplies for about 45,000 visits and 1,800 births a year, laboratory reagents, oxygen plant servicing, the ambulance, equipment servicing, building upkeep at 1.5% a year and insurance. Every year an amount is saved to replace the medical equipment after about ten years and the vehicles after about eight.
Running it costs $769,700 a year, paid from the returns of its share of the Donum Endowment.
What it will achieve
- 600 to 1,000 births a year in the first three years, growing toward 1,800 as the centre becomes the maternity point for the zones around it.
- Up to 45,000 outpatient visits a year, refugees and hosts alike.
- Oxygen for the settlement's clinics every week: the plant makes about 360 cubic metres a day, enough for about 125 children on 2 litres a minute at once.
- A newborn unit, 24-hour maternity, an ambulance and a referral agreement for caesareans.
Read more: how we worked these numbers out
The catchment. Uganda plans one Health Centre III for about 20,000 people (Ministry of Health, 2016). Donum's rule of at least 20,000 people within 5 km is exactly one Health Centre III's population.
Births. Refugee health facilities recorded 9,711 live births in the first quarter of 2026 among 1,999,576 refugees (UNHCR, 2026-03-31), about 19 births per 1,000 people a year. We plan on 18 to 20 per 1,000. On that rate, 20,000 people have about 370 to 390 births a year, and 1,800 births needs about 90,000 to 100,000 people. So 1,800 is the centre's capacity, not its first-year number: we plan for 600 to 1,000 and grow as the settlement's zones come to it. The supplies budget is sized at full capacity, so the centre never turns a mother away for lack of supplies, and anything unused in the early years stays in the endowment.
Visits. Refugee health facilities recorded 301,265 outpatient consultations in the first quarter of 2026 (UNHCR, 2026-03-31), about 0.6 a refugee a year. At that rate, 45,000 visits a year means serving about 75,000 people, close to the 94,000 one Nakivale Health Centre III was reported to serve (European Commission ECHO, undated). It is realistic because the settlement's centres are overwhelmed and facilities have closed (Office of the Prime Minister, 2026-05) (UNHCR, 2026-03-31); for the nearest 20,000 people alone it would be high.
Lives. At Uganda's neonatal mortality rate, 1,000 births carry about 22 newborn deaths, about 11 of them from asphyxia (WHO Africa, 2025). These are the deaths a midwife, a resuscitation corner and a newborn unit are there to prevent. We will publish what actually happens, not what this arithmetic suggests.
Cost per visit. $769,700 a year over 45,000 visits is about $17.10 a visit, with births, oxygen, the ambulance and the staff homes inside it. Once the government posts the staff, Donum's share is $198,100, about $4.40 a visit.
How we will know
- Births with a skilled midwife
- Newborns treated in the newborn unit, and how they did
- Oxygen cylinders delivered to other clinics
- Days any essential medicine was out of stock
- Staff posts filled, and who pays for them
Read more: what could go wrong
- The government does not post or pay staff. The endowment is sized to pay every health worker without the government. If the partnership comes, the money it frees goes to the next most pressing running cost, and the change is published.
- Trained staff will not move to a remote place. Sixteen homes are part of the building, and pay follows the government scale.
Questions people ask
Why a whole health centre and not just medicines for existing clinics?
Medicines run out in a year; the existing clinics are short of rooms, beds, staff housing and oxygen as well. A building with its own staff homes, oxygen plant and an endowment for medicines keeps working when grants stop.
Why plan for 1,800 births if you expect 600 to 1,000?
The buildings last decades and the settlement keeps growing. Four delivery beds and 24 postnatal beds is what 1,800 births need; building smaller now and extending later costs more.
What if the government never posts staff?
Donum pays them, from the endowment, at $769,700 a year. The endowment is sized for Donum paying everything.
Why an oxygen plant at a Health Centre III?
Because the settlement's clinics have no steady supply, and the evidence that oxygen halves deaths among children with low oxygen is among the strongest in global health. One plant fills cylinders for all of them.
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