The infrastructure crisis in Ugandan public universities has been repeatedly acknowledged in policy documents yet persistently unaddressed in practice, representing a defining contradiction of Uganda's higher education governance over the past three decades. This study investigated the nature, magnitude, structural determinants, and institutional consequences of infrastructure inadequacy across six purposively selected Ugandan public universities — Makerere University, Kyambogo University, Mbarara University of Science and Technology, Busitema University, Gulu University, and Kabale University — which collectively enrolled approximately 78% of all public university students in Uganda as of 2023. Adopting a cross-sectional explanatory design, the study drew on primary data collected through structured surveys and facility audits administered to 420 stratified randomly sampled departmental and administrative units, supplemented by secondary data from audited financial statements, National Budget Framework Papers (2018/19–2023/24), and Uganda Bureau of Statistics higher education abstracts. Analysis proceeded through three analytically progressive stages: univariate descriptive statistics, bivariate chi-square and correlation tests, and multivariate ordinary least squares regression, culminating in Propensity Score Matched Analysis (PSM) to generate quasi-causal estimates of the effect of infrastructure adequacy on key institutional outcomes. The univariate results revealed a mean Infrastructure Deficit Score of 72.6 (SD = 11.4), lecture hall occupancy at 148.3% of designed capacity, an ICT Equipment Index of 34.7 out of 100, a Library Resource Sufficiency Score of 38.4, and a student-tosanitation ratio of 87:1 — all substantially exceeding internationally acceptable thresholds. Bivariate analyses identified statistically significant associations (all p < 0.001) between infrastructure adequacy and government funding category (Cramér's V = 0.36), student enrolment size (V = 0.32), existence of an infrastructure master plan (V = 0.29), and university location (V = 0.26), among other factors. The OLS regression model, which explained 47% of variance in infrastructure deficit scores [F(8, 411) = 47.32, p < 0.001, Adjusted R² = 0.47], identified government funding (β = 0.48, p < 0.001) and student enrolment size (β = −0.31, p < 0.001) as the dominant predictors, with rural location, absence of a master plan, and low maintenance budget utilisation also emerging as significant independent determinants. PSM results, derived from 178 well-matched departmental pairs with post-matching standardised mean differences below 0.10, produced Average Treatment Effects on the Treated of 14.3 points in student academic outcomes (p < 0.001), 16.6 points in student satisfaction (p < 0.001), 16.2 percentage points in staff retention (p = 0.003), and 11.6 points in research output (p = 0.011), all robust to Rosenbaum sensitivity analysis at Γ ≤ 1.8. The study concluded that the infrastructure crisis in Ugandan public universities is a structurally determined, causally consequential, and policy-reversible failure of state governance, and recommended the establishment of a ring-fenced University Infrastructure Development Fund, mandatory Infrastructure Master Plans as an accreditation condition, and a statutory Infrastructure Readiness Threshold mechanism to decouple enrolment expansion from infrastructure capacity. These findings carry direct implications for higher education policymakers, budget authorities, university administrators, and development partners committed to transforming Uganda's public universities from institutions of managed decline into engines of sustainable national development.