Buhoma Health Centre III serves approximately 15,000 people in the parishes adjacent to the northern sector of Bwindi Impenetrable National Park. It has a maternity ward, an outpatient department, a laboratory, a pharmacy, and in-patient beds. It is staffed by two clinical officers, three nurses, and a midwife. Before it was upgraded from a basic dispensary in 2009 — funded in large part by gorilla tourism revenue — the nearest equivalent facility was 35 kilometres away on a road that becomes impassable after rain. This post tells the story of how gorilla permit fees became healthcare infrastructure, and what that means for the people who live alongside the gorillas that tourism is built around.
The Healthcare Crisis Before the Upgrade
In 2005, a community needs assessment conducted by a Ugandan NGO identified healthcare as the top priority for communities adjacent to Bwindi. The assessment found infant mortality rates above 80 per 1,000 live births in the Buhoma area — well above the national average, which was itself high. Maternal mortality was a particular concern: women in labour who required obstetric intervention had no realistic option for emergency care closer than Kisoro town, a journey that in rainy season could take three to four hours on unpaved roads.
The link between poor healthcare and conservation attitudes was direct: communities that bore the economic costs of living alongside a national park while receiving no visible healthcare benefit were communities with reasons to resent conservation. Infant mortality and maternal death are not abstract statistics in communities where every family has been touched by them. They are daily evidence of a social contract that is not working.
How Gorilla Revenue Funded the Upgrade
The upgrade of Buhoma dispensary to Health Centre III status was funded through a combination of Community Revenue Sharing allocations from UWA, a matched grant from an international conservation NGO, and a contribution from several gorilla trekking operators — including us — who saw community health investment as both a moral obligation and a practical conservation tool. The construction ran from 2007 to 2009 and cost approximately USD 180,000 for the building, equipment, and initial pharmaceutical stocking.
The ongoing operational costs of the health centre are shared between the Ugandan Ministry of Health (which provides staffing through the national civil service) and supplementary CRS allocations that fund medicines, equipment maintenance, and the training costs of rotating clinical staff. As permit revenues have grown, the CRS allocation to Buhoma health infrastructure has increased to fund expansion of the maternity ward and the addition of a basic diagnostic laboratory.
What the Health Centre Has Achieved
By 2027, Buhoma Health Centre III delivers approximately 400 births per year. Infant mortality in the Buhoma area has fallen to 42 per 1,000 live births — still above Uganda’s urban average, but dramatically lower than the pre-2009 baseline and attributable in part to the availability of skilled birth attendance at the health centre. Malaria, the leading cause of death in the area, is now treated at the centre using ACT combination therapy that was not available locally before 2009.
The health centre has also become a source of community employment. Both of the clinical officers are from communities adjacent to Bwindi. They received bursaries from a conservation NGO to complete their clinical training, with the explicit understanding that they would return to serve their communities. Their employment at the health centre represents both a service delivery investment and a return of educated community members who now have a professional stake in the healthcare — and by extension conservation — ecosystem they live within.
Conservation and Healthcare: The Inseparable Connection
The conservation community has learned, sometimes slowly, that protected-area management cannot be divorced from community welfare. Communities that are sick, under-served, and economically marginalised do not prioritise the welfare of wildlife. Communities that have healthcare, education, and economic opportunity have the capacity and incentive to participate in conservation as agents rather than adversaries.
Buhoma Health Centre III is one of the most concrete examples in Bwindi of this principle operating in practice. When you book a gorilla trekking permit for 2027, part of what you are funding is the medicines in the pharmacy of that health centre, the salary supplements that keep its staff in a remote posting, and the infrastructure that means babies are born safely in Buhoma rather than on the road to Kisoro. That is not incidental to gorilla conservation. It is central to it.
