The refugee population of Uganda has been growing since 2013, currently amounting to a staggering 1.3 million. Though Uganda stands out in refugee hospitality, this huge inflow of refugees can place a lot of pressure on the country’s healthcare system. Against this backdrop, in an ongoing study, we are examining the access, utilisation, and costs of key sexual, reproductive, and maternal health (SRMH) services for South Sudanese refugee & host populations in Uganda; assessing the financial impact of refugee populations on local healthcare systems; and evaluating the impact of BRAC’s Empowerment and Livelihood for Adolescents (ELA) program on the SRMH knowledge, life skills, teenage pregnancy, and economic empowerment levels of refugee and host adolescent girls. Our study draws evidence from a cross-sectional survey of 2,533 refugee and host women and adolescent girls in Arua and Kiryandongo districts; 35 focus group discussions (FGDs) and 131 in-depth-interviews (IDIs); and baseline/endline surveys of 1,800 refugee and host adolescent girls across 15 ELA clubs in Kiryandongo district.
Researchers: Sandra Mounier-Jack; Dr. Munshi Sulaiman
Partners: London School of Hygiene & Tropical Medicine (LSHTM); United Nations Population Fund (UNFPA)
Timeline: 2018-2021
Status: Ongoing
Contact: Dr Munshi Sulaiman; munshi.sulaiman@brac.net
Context
Uganda is one of the largest refugee-hosting nations in the world, currently home to 1.3 million refugees. Most of these refugees are from neighbouring countries, especially South Sudan. This unprecedented influx of refugees can engender enormous pressure on the ability of Uganda’s national healthcare system to finance and provide inclusive, efficient, and quality healthcare services. For a low-income country like Uganda, this challenge of ensuring universal healthcare provision for both host and refugee populations is exacerbated by its colossal capacity and resource constraints. Optimising resource use in such settings, therefore, is quintessential for the healthcare system to function properly and requires holistic solutions. This study aims to generate a body of knowledge to support preparedness and response to humanitarian crisis and epidemics.
This study is relevant to SDG 3 (Good Health and Well-Being) and SDG 5 (Gender Equality), particularly to ensure healthy lives and promote well-being for all at all ages, as well as achieve gender equality and empower all women and girls and reduce inequality within and among countries.
Research Questions
- What are the financing arrangements present for healthcare, including SRMH health services for South Sudanese refugees and host populations in Kiryandongo and Rhino camp settlement in Arua?
- How accessible are SRMH services, such as family planning (FP), antenatal care (ANC), delivery, etc., in Kiryandongo and Arua and how access varies within refugees and host communities?
- What impact does BRAC’s ELA programme have on the knowledge about the sexual and reproductive health, financial literacy, life skills, teenage pregnancy of the adolescent girls?
- Do digital or cash modes of payment affect IPV and WEE outcomes differently?
Methodology
The study draws evidence from a cross-sectional survey of 2,533 refugee and host young females in Arua and Kiryandongo districts; 35 focus group discussions (FGDs) and 131 in-depth-interviews (IDIs); and baseline/endline surveys of 1,800 refugee and host young females across 15 ELA clubs in Kiryandongo district. In addition, experimental design will engage 2,000 couples 20-45 (4,000 respondents) in 869 villages with host communities and 45 villages with refugees in the Kiryandongo and Kyegegwa districts to explore the differential impact of cash v mobile money transfers on WEE and IPV. Cross-sectional assessments will explore the determinants and preferences about the cash- and food-aid packages based on a sample of 1,229 South Sudanese refugee women in Kiryandongo and Rhino refugee settlements.
