Pig farming has gained momentum for most smallholder farmers in developing countries as a means of livelihood and household incomes. However, prospects of the pig enterprises are constrained by pig health management issues which affect both its productivity and profitability. Using a cross-sectional survey of 240 smallholder pig farmers, we assessed factors influencing farmers’ access to veterinary services and expenditure on pig health management in northern Uganda. Data was analysed using the binary logit and censored tobit regression models. Access to veterinary services was significantly influenced by pig herd size (p < 0.05), Village Savings and Loan Association (VSLA) membership (p < 0.1), breed (p < 0.05), production system (p < 0.05) and number of health issues recorded on farm (p < 0.01). Education level (p < 0.01), farming household members (p < 0.05), pig herd size (p < 0.01), breed (p < 0.05), previous disease incidences (p < 0.05), household labour available (p < 0.1) and access to veterinary services (p < 0.01) significantly influenced pig health expenditure. Efforts to improve access to veterinary services and improve pig health management should focus on promoting more intensive production systems and improved breeds that are associated with better access to veterinary services and reduced cost of pig health management.