This Brief highlights USAID Uganda Sanitation for Health Activity's (USHA) governance framework actualized through an Institutional Strengthening Index (ISI) tool. It describes the ISI conceptual framework, process, the results district local governments have so far achieved having conducted progress ISI assessments in March 2021 following baseline assessments conducted in May 2020; and presents key takeaways from 13 districts in the Central East and Central West of Uganda. It builds on an earlier USHA Brief titled: “Strengthening District-level WASH Governance: Critical to Sustainable Service Delivery,” from December 2020.