This study identified four major gaps in the readiness of health facilities in Nakivale Refugee Settlement to provide comprehensive NTD services, which included inadequate diagnostic supplies despite the presence of basic laboratory infrastructure, absence of essential medicines such as praziquantel and ivermectin, weak reporting systems, and geographical inaccessibility of most facilities. These limitations constrain the effectiveness of NTD prevention, diagnosis, and management, despite some encouraging strengths such as universal availability of laboratories, technicians, and microscopes.

Whereas all the facilities assessed reported having a designated laboratory technician and a functional microscope, critical diagnostic supplies were either inconsistently available or completely absent. When compared to other studies done in similar remote settings, the stronger baseline diagnostic infrastructure was an improvement, unlike similar studies in Tanzania and Burundi, where laboratory capacity was far more limited (44-45). However, although centrifuge tubes and syringes were available in all facilities, essential tools for WHO-recommended procedures such as urine sedimentation, centrifugation, and the Kato–Katz method (e.g., Kato-Katz templates, cellophane, and malachite green) were unavailable. This pattern mirrors findings from Tanzania, where facilities relied heavily on urine dipsticks and direct smear microscopy due to similar supply gaps (44). While urine dipsticks and direct smears are useful for rapid screening, their low sensitivity undermines accurate disease burden estimation, especially in high-risk refugee populations.

There was a noted absence of praziquantel and ivermectin across all facilities, despite their inclusion in the WHO Model List of Essential Medicines for schistosomiasis and onchocerciasis control (45). In contrast, albendazole and mebendazole were widely available (87.5%), reflecting an imbalance in NTD drug procurement. This finding is particularly concerning given the high prevalence of schistosomiasis in refugee-hosting regions of Uganda (46). Similar stock-outs have been documented in other low-resource settings, where fragmented supply chains and donor-driven drug distribution lead to inconsistent medicine availability (47). Without praziquantel and ivermectin, facilities in Nakivale Refugee Settlement remain unable to deliver integrated, guideline-based NTD care.

There were inconsistencies with the reporting infrastructure, with only 62.5% of facilities having HMIS reporting forms. This inconsistency limits systematic data capture, surveillance, and accountability. Similar reporting gaps have been observed in other sub-Saharan African health systems, where underreporting of NTD cases undermines programmatic planning and resource allocation (48). Strengthening reporting mechanisms is particularly critical in refugee settlements, where disease dynamics differ from national averages due to overcrowding, poor sanitation, and frequent mobility.

With regards to facility location, 87.5% of facilities were located more than 10 km from the town council, with only one HCIV within 10 km. This distance barrier adds to the structural challenges refugees face in accessing care. Previous studies have consistently highlighted that increased distance to health facilities reduces care-seeking behaviour, increases delays, and contributes to poor adherence to long-term treatment regimens (48). For NTDs that require periodic preventive chemotherapy, such barriers undermine programme reach and effectiveness.

This study’s strengths include its ability to identify the available diagnostic infrastructure in a refugee setting; however, the use of a single refugee settlement as a study site limits generalizability to other refugee settings. Availability of supplies and equipment was based on staff reports rather than direct observation or inventory checks, introducing a risk of reporting bias. The study also did not assess the quality of diagnostic practices or adherence to guidelines in daily use.

Future qualitative studies could explore the reasons behind the lack of specific laboratory consumables and reporting forms, as well as the challenges faced by health facility staff in maintaining these resources. Investigating the impact of facility distance on patient access to NTD services would also provide valuable insights.

In conclusion, this assessment shows that while Nakivale Refugee Settlement’s health facilities have a solid foundation for NTD management with labs, microscopes, and essential medicines in place, critical gaps remain. The lack of specific diagnostic supplies like Kato-Katz templates and cellophane, gaps in reporting systems, and the remote location of most facilities all pose significant challenges to effective NTD control. To address these, a regular supply of key laboratory consumables should be ensured through quarterly procurement reviews and better stock management. Strengthening and digitizing NTD reporting systems is also essential to improve surveillance and planning. Practical solutions to overcome remoteness, such as mobile outreach clinics or community-based diagnosis, should be prioritized.

Finally, future research should include qualitative studies to explore how distance and other barriers affect service use. Such insights will help tailor interventions to strengthen service delivery and accelerate progress toward NTD elimination in this vulnerable setting.