A national spatial prioritisation framework for the targeted expansion of essential sickle cell disease services across health-facility catchments in Uganda

BACKGROUND: Sickle cell disease causes substantial childhood morbidity and premature mortality in sub-Saharan Africa, while access to essential services remains uneven. In Uganda, geographic variation in inherited SCD risk supports spatially targeted service planning. METHODS: We conducted a national facility-linked ecological spatial planning analysis using 280 eligible higher-level public facilities. Populated cells were assigned to the nearest eligible facility within a modelled 60-minute travel-time boundary. Epidemiological context was represented by a study-specific co-risk index combining standardised haemoglobin S (HbS) allele frequency and Plasmodium falciparum parasite rate among children aged 2 to 10 years (PfPR2-10). Reported availability was assessed for newborn screening, hydroxyurea, blood transfusion, and specialised SCD clinic care. We derived service-deficit, structural-vulnerability, programme-priority, service-specific priority, and coverage-to-need measures and assessed sensitivity to alternative weighting specifications. RESULTS: Among 280 planning zones, 122 (43.6%) had none of the four reported services and 205 (73.2%) had no more than one. Co-risk ranged from 0.003 to 0.934 and service-mediated SCD structural vulnerability from 0.000 to 0.905. Higher programme-priority scores were concentrated mainly in northern, north-eastern, eastern, and parts of central Uganda, while lower-priority tiers were more common in the south-west. Newborn-screening and hydroxyurea priorities were closely aligned, transfusion priorities extended more broadly into northern and central Uganda, and specialised-clinic priorities were more spatially mixed. The overall coverage-to-need gap had a mean of 0.190 and median of 0.205. The 56 zones comprising the national top 20% of programme priority contained approximately 7.0 million people, representing 17.3% of the population within the analytic framework. Priority concentration was strongest in Lango, Teso, Acholi, Karamoja, and Busoga. CONCLUSIONS: The framework identified a concentrated set of candidate service-strengthening nodes under the specified assumptions, mainly in northern, north-eastern, and eastern Uganda. The findings can support further programme assessment and stakeholder review for phased, regionally coordinated, and service-specific expansion of SCD care.