This study examined the relationship between access to finance and the performance of small and medium enterprises (SMEs) in Kabale Municipality, Uganda. The study was motivated by the persistent challenges faced by SMEs in accessing adequate and affordable finance, and the consequent limitations on their growth and contribution to economic development. A descriptive cross-sectional design was adopted, and data were collected from a sample of 150 SME owners and managers selected through stratified random sampling. Structured questionnaires measured access to finance across three dimensions — access to bank credit, access to microfinance, and access to equity/informal finance — and SME performance across financial performance, operational efficiency, and market growth dimensions. Descriptive, correlation, and regression analyses were conducted. Results showed that access to bank credit (β = 0.412, p < 0.001), access to microfinance (β = 0.287, p < 0.001), and access to equity and informal finance (β = 0.219, p = 0.003) were all significant positive predictors of SME performance, with the regression model explaining 71.8% of performance variance (R² = 0.718). The study concluded that financial access is a critical determinant of SME performance and recommended reforms in collateral requirements, expansion of SME-focused financial products, and strengthening of credit guarantee schemes to unlock growth potential of SMEs in Kabale Municipality.