Cultural Competence and Financial Sustainability in Faith-Based Hospitals in Kampala, Uganda

Faith-based hospitals, as a core component of Uganda’s private-not-for-profit (PNFP) health sector, play a pivotal role in delivering healthcare to underserved populations, particularly in Kampala. However, these institutions face persistent challenges to financial sustainability due to fluctuating donor support, limited government funding and the need to maintain affordable, high-quality care. This article investigates the intersection of cultural competence and financial sustainability in Kampala’s faith-based hospitals, presenting original mixed-methods evidence from surveys of 12 PNFP hospitals, 240 patient exit interviews and 24 key informant interviews. The findings demonstrate that targeted cultural competence interventions encompassing staff training, organizational policy reforms and patient-centered care significantly improve patient retention, diversify revenue streams and enhance donor confidence. Quantitative results reveal increases in outpatient retention rates, fee recovery and donor diversification, while qualitative insights highlight strengthened patient trust, cultural alignment and philanthropic giving. The study integrates Resource Dependence Theory and leading Cultural Competence Frameworks to elucidate how faith-based hospitals can strategically leverage cultural competence for operational resilience and sustainability. Policy recommendations are offered for hospital leaders, donors and government stakeholders to institutionalize cultural competence as a driver of both equitable care and financial viability in Uganda’s PNFP health sector.

Keywords

Cultural competence; financial sustainability; faith-based hospitals; PNFP; patient retention; donor diversification

Downloads

PDF JATS XML

References

1. Albougami A.S, Pounds K.G, Alotaibi J.S (2016). Comparison of Four Cultural Competence Models in Transcultural Nursing, a Discussion Paper. International Archives of Nurses and Health Care 2:053, DOI; 10.23937/2469-5823/1510053, available at [Google Scholar] [Crossref]

2. https://clinmedjournals.org/articles/ianhc/international-archives-of-nursing-and-health-care-ianhc-2-053.php [Google Scholar] [Crossref]

3. Alshareef, M.N. (2024). Ownership Structure and Financial Sustainability of Saudi Listed Firms. Sustainability, 16, 3773. [Google Scholar] [Crossref]

4. Alshareef, M.N. and Sulimany, H.G.H. (2024). Board Financial Expertise and Financial Sustainability: Evidence from Saudi-Listed Firms. Sustainability, 16, 7100. [Google Scholar] [Crossref]

5. Amouzesh, N., Moeinfar, Z. and Mousavi, Z. (2011). Sustainable Growth Rate and Firm Performance: Evidence from Iran Stock Exchange. International Journal of Business and Social Sciences, 23, 249–255. [Google Scholar] [Crossref]

6. Ansmann L, Vennedey V, Hillen H.A, Stock S, Kuntz L, Pfaff H, Mannion R and Hower K.I (2021). Resource dependency and strategy in healthcare organizations during a time of scarce resources: evidence from the metropolitan area of cologne. Journal of Health Organizations and Management, [Google Scholar] [Crossref]

7. Vol. 35 No. 9, doi: https://doi.org/10.1108/JHOM-12-2020-0478 [Google Scholar] [Crossref]

8. ATLAS.ti. (n.d). Thematic Analysis for Interviews; Guide and Examples. Available at; [Google Scholar] [Crossref]

9. https://atlasti.com/guides/thematic-analysis/thematic-analysis-interviews [Google Scholar] [Crossref]

10. Balcazar, F., Suarez-Balcazar, Y., Taylor-Ritzler, T., Juleen Rodakowski, O.T.D., Willis, C. & Portillo, N. (2009). Cultural competence assessment instrument (CCAI). Center for Capacity Building on Minorities with Disabilities Research. Retrieved from https://miota. org/docs/CCAI. pdf. [Google Scholar] [Crossref]

11. Bella Williams (n.d). How to analyze themes from culture interviews. Insight7. Available at; https://insight7.io/how-to-analyze-themes-from-culture-interviews/ [Google Scholar] [Crossref]

12. Birkhäuer J, Gaab J, Kossowsky J, Hasler S., Krummenacher P., Werner C., et al. (2017). Trust in the health care professional and health outcome: A meta-analysis. PLoS ONE 12(2): [Google Scholar] [Crossref]

13. e0170988.https://doi.org/10.1371/journal.pone.0170988. [Google Scholar] [Crossref]

14. https://htdhealth.com/insights/cultural-awareness-and-competence-in-healthcare/ [Google Scholar] [Crossref]

15. Bore, M.K. and Macharia, I. (2022). Strategic Direction and Financial Sustainability of Faith based Organizations. International Journal of Scientific and Research Publications, Vol. 12, Issue 5. [Google Scholar] [Crossref]

16. Bowman, W. (2011b). Financial Capacity and Sustainability of Ordinary Nonprofits. Nonprofit management and leadership, 22(1), 37-51. [Google Scholar] [Crossref]

17. Cancer Prevention and Control Research Network [CPCRN] (n.d). Resource Dependency Theory Overview. Available at; https://cpcrn.org/cms/files/Resource Dependency Theory [Google Scholar] [Crossref]

18. ClinRegs. (n.d). Clinical Research Regulation for Uganda. Available at https://clinregs. [Google Scholar] [Crossref]

19. niaid.nih.gov/country/uganda [Google Scholar] [Crossref]

20. cphl.go.ug. (n.d). DHIS2 User Manual Uganda. Available at; https://www.cphl.go.ug/web/sites/ default/files/2024-10/DHIS2 USER MANUAL UGANDA.pdf [Google Scholar] [Crossref]

21. Curry, L. and Nunez-Smith, M. (2014). Mixed methods in health sciences research: A practical primer (Vol. 1). Sage publications. Available at; [Google Scholar] [Crossref]

22. https://methods.sagepub.com/book/mono/preview/mixed-methods-in-health-sciences-research-a-practical-primer.pdf [Google Scholar] [Crossref]

23. Dang, K., Ngoc, T., Van Nguyen, D. and Le, H.T.P. (2022). How Innovation and Ownership Concentration Affect the Financial Sustainability of Energy Enterprises: Evidence from a Transition Economy. Heliyon, 8, e10474. [Google Scholar] [Crossref]

24. Ebenezer, A.A., Musah, A. and Ahmed, I.A. (2020). Determinants of Financial Sustainability of Non-Governmental Organizations in Ghana. The Journal of Accounting and Management, 10(1). [Google Scholar] [Crossref]

25. FasterCapital (2025). Specialty Hospital Diversity: Cultural Competence in Healthcare Marketing: Lessons from Specialty Hospitals. Available at; [Google Scholar] [Crossref]

26. https://fastercapital.com/content/Specialty-Hospital-Diversity--Cultural-Competence-in-Healthcare-Marketing--Lessons-from-Specialty-Hospitals.html [Google Scholar] [Crossref]

27. Funds for NGOs (2026). 10 Key Metrics to Share with Donors and Grant Agencies. Available at; https://www2.fundsforngos.org/articles-listicles/10-key-metrics-to-share-with-donors-and-grant-agencies/ [Google Scholar] [Crossref]

28. Government of Uganda (2001). National Policy on Public Private Partnership in Health. [Google Scholar] [Crossref]

29. https://library.health.go.ug/sites/default/files/resources/National Policy on Public Private Partnerships in Health Final Print_0.pdf [Google Scholar] [Crossref]

30. Hansei Solutions (2026). Healthcare Patient Retention: Importance, Strategies, & Calculation. Available at; https://hanseisolutions.com/healthcare-patient-retention-importance- strategies-calculation/ [Google Scholar] [Crossref]

31. Health Journalists Network Uganda (2025). Church Founded Health Facilities Warn of Financial Crisis as Donor Declines, December 9th. Available at. https://hejnu.ug/church-founded- health-facilities-warn-of-financial-crisis-as-donor-funding-declines/ [Google Scholar] [Crossref]

32. Lee, Y., Sung, S. and Fan, X. (2025). Cultural competency education for healthcare professionals: an umbrella review. BMC Medical Education, 25(1), 1445. [Google Scholar] [Crossref]

33. Liane S., Pia Theresa S., Beck, P., Zohra K, Lisa P. and Meryam S. (2022). Organisational and staff-related effects on cultural competence in the hospital setting: a cross-sectional online survey of nursing and medical staff. BMC Health Services Research, 22, 644. https://doi.org/10.1186/s12913-022-07947; Available at https://link.springer.com/article/10.1186/s 12913-022-07947-x [Google Scholar] [Crossref]

34. Lubaga Hospital (2022). Annual Report 2021/2022. Available at; https://lubagahospital.org/reports/ [Google Scholar] [Crossref]

35. Majda, A., Bodys-Cupak, I.E., Zalewska-Puchała, J. and Barzykowski, K. (2021). Cultural Competence and Cultural Intelligence of Healthcare Professionals Providing Emergency Medical Services. Int. J. Environ. Res. Public Health, 18, 11547. [Google Scholar] [Crossref]

36. Mawudor, B.G. (2016). Financial Sustainability of Church related Organizations: An Empirical Study on Kenya. University of Basel. [Google Scholar] [Crossref]

37. Mengo Hospital (n.d). Directorate of Finance. Available at [Google Scholar] [Crossref]

38. https://mengohospital.org/directorate/directorate-of-finance/ [Google Scholar] [Crossref]

39. Milelu, E. (2018). Factors Affecting Financial Sustainability for Non-governmental Organizations in Nairobi, Kenya. United States International University-Africa. [Google Scholar] [Crossref]

40. Ministry of Health Uganda (2024). Annual Health Sector Performance Report 2023/24. Available at; https://library.health.go.ug/sites/default/files/resources/Annual Health Sector Performance Report FY 2023_24.pdf [Google Scholar] [Crossref]

41. Ministry of Health Uganda (2024). Health Sub Programme Grant, Budget and Implementation Guidelines for Local Governments. https://pallisa.go.ug/sites/default/files/Health Sub Programme Budget and Grant Guidelines 01.06.2023.pdf [Google Scholar] [Crossref]

42. Ministry of Health, Ministry of Finance, Planning & Economic Development, World Bank and Makerere University (2000). Facility Patient Exit Poll Questionnaire. Available at; [Google Scholar] [Crossref]

43. https://microdata.worldbank.org/catalog/860/download/19322 [Google Scholar] [Crossref]

44. Mubeen, M. and Hanif, M.N. (2017). Sustainable Growth of Nonfinancial Firms: Micro econometric Evidence from Pakistan. Pakistan Bussiness Review, 19, 630–648. [Google Scholar] [Crossref]

45. Mugisha, J. (2004). Reduction of user fees in the private-not-for-profit hospitals in Uganda: Implications for equity and sustainability. Health Policy and Development Journal, Vol. 2, No. 3, pp.209-216. https://ir.umu.ac.ug/items/29e37b5b-68f3-4738-b2f6-0e3a8893cd08 [Google Scholar] [Crossref]

46. Nyongesa S. (2024). The Best Mission Hospitals in Uganda. Uganda Living. Available at; https://www.ugandaliving.com/241/the-best-mission-hospitals-in-uganda/ [Google Scholar] [Crossref]

47. Orach, S.O. (n.d). Is there a case for contracting health services delivery to PNFPs in Uganda. Available at; https://ucmb.co.ug/?smd_process_download=1&download_id=1562 [Google Scholar] [Crossref]

48. Pfeffer, J., & Salancik, G. R. (1978). The External Control of Organizations: A Resource Dependence Perspective. Harper & Row. [Google Scholar] [Crossref]

49. Przychodzen, J. and Przychodzen, W. (2013). Corporate Sustainability and Shareholder Wealth. Journal of Environment Planning and Management, 56, 474–493. [Google Scholar] [Crossref]

50. Purnell, L. (2024). Purnell Model for Cultural Competence. EBSCO. Available at; https://www.ebsco.com/research-starters/nursing-and-allied-health/purnell-model- cultural-competence [Google Scholar] [Crossref]

51. Quality Interactions (2024). The Business Case for Cultural Competence in Healthcare. Available at; https://www.qualityinteractions.com/blog/the-business-case-for-cultural-competence- in-healthcare [Google Scholar] [Crossref]

52. Question (2025). How Can Ngo Diversify Funding Sources? Available at; https://esg.sustainability-directory.com/question/how-can-ngo-diversify-funding-sources/ [Google Scholar] [Crossref]

53. Rana, K. and Chimoriya, R. (2025). A Guide to a Mixed-Methods Approach to Healthcare Research. Encyclopedia, 5(2), 51. https://doi.org/10.3390/encyclopedia5020051. [Google Scholar] [Crossref]

54. Renoir, M. and Guttentag, M. (2018). Facilitating Financial Sustainability: Understanding the Drivers of CSO Financial Sustainability. Retrieved from [Google Scholar] [Crossref]

55. Ryszawska, B. (2016). Sustainability Transition Needs Sustainable Finance. Copernican Journal of Finance & Accounting 5 (1): 185–94. [Google Scholar] [Crossref]

56. Sequence Health (2025). What is Patient Retention in Healthcare & Why It's Important. Available at; https://www.sequencehealth.com/blog/what-is-patient-retention-and-why- does-it-matter-for-your-practice [Google Scholar] [Crossref]

57. Siobhán O., Ciarán, M. and Aoife, F. (2026). Cultural competence and its effect on patient trust and satisfaction in multicultural healthcare environments. Journal of Patient Care and Nursing Practice; 1(1): 55-62. Available at; https://www.nursingcarejournal.info/archives/2026/vol1issue1/PartA/1-1-9-642.pdf [Google Scholar] [Crossref]

58. Uganda National Council for Science and Technology (UNCST, 2025). National Guidelines for Research Involving Humans as Research Participants. Available at; https://www.uncst.go. ug/files/downloads/National Guidelines For Research Involving Humans As Research Participants 2025.pdf [Google Scholar] [Crossref]

59. UNHCR (n.d). Key Informant Interview Guide-I-TECH. Available at; [Google Scholar] [Crossref]

60. https://www.go2itech.org/HTML/TT06/toolkit/assessment/print/AssessTrnNeeds/KeyInformantGuide.doc [Google Scholar] [Crossref]

61. UNHCR Africa (n.d). Key informant interview tool. Available at; [Google Scholar] [Crossref]

62. https://www.unhcr.org/africa/publications/key-informant-interview-tool [Google Scholar] [Crossref]

63. Weech-Maldonado, R., Dreachslin, J.L., Epané, J.P., Gail, J., Gupta, S., and Wainio, J.A. (2018). Hospital cultural competency as a systematic organizational intervention: Key findings from the national centre for healthcare leadership diversity demonstration project. Health Care Management [Google Scholar] [Crossref]

64. Review, 43(1), 30–41. https://www.jstor.org/stable/48516391; [Google Scholar] [Crossref]

65. Wu, Z., Gao, J., Luo, C., Xu, H. and Shi, G. (2024). How Does Boardroom Diversity Influence the Relationship between ESG and Firm Financial Performance? Internation Review in Economics and Finance, 89, 713–730. [Google Scholar] [Crossref]

66. Zarzycka, D., Chrzan-Rodak, A., Niedorys-Kaczmarczyk, B. and Slusarska, B. N. (2020). Cultural Competence-cultural adaptation and validation of the Polish version of the Nurse Cultural Competence Scale and preliminary research results. PLoS ONE, 15, e0240884 [Google Scholar] [Crossref]

Cultural Competence and Financial Sustainability in Faith-Based Hospitals in Kampala, Uganda

Authors

Article Information

Publication Timeline

Abstract

Keywords

Downloads

References

Metrics

Views & Downloads

Similar Articles