Health Policy and Planning Advance Access originally published online on December 7, 2005
Health Policy and Planning 2006 21(1):53-64; doi:10.1093/heapol/czj007
Published by Oxford University Press 2005.
Original article |
Integrating refugee and host health services in West Nile districts, Uganda
1 Makerere University, Institute of Public Health, Kampala, Uganda, 2 Institute of Tropical Medicine, Antwerp, Belgium and 3 Vrije Universiteit Brussel, Brussels, Belgium
Correspondence: Dr Christopher Garimoi Orach, Makerere University Institute of Public Health, P.O. Box 7072, Kampala, Uganda. Tel: +256 77 51 14 44; Fax: +256 41 53 18 07; E-mail: cgorach{at}iph.ac.ug
Refugees are a common feature in Africa and Uganda is no exception. However, Uganda does not have the resources to provide health care to all its own citizens, let alone to refugees. Refugee health services are therefore usually set up and provided separately by international organizations such as the United Nations High Commissioner for Refugees (UNHCR). However, such services often end up being the only available or reliable services in a particular location for both host and refugee populations. Yet the host populations are often denied access to these services because, in theory, other services are being provided by their government. The case study in the West Nile region of Uganda describes how host and refugee services were integrated in an attempt to address the concerns of inequity of access to care for host populations, when reasonably good health services were available to nearby refugee populations. The paper identifies and discusses the challenges encountered and those remaining.
Key Words: integration, health service, refugees, host population, Uganda
1The West Nile region of northern Uganda comprises five districts, namely Arua, Adjumani, Moyo, Yumbe and Nebbi. All now host refugees except for Nebbi.
2Key informants comprised four officials from the Office of the Prime Minister (Refugee Desk Officers Arua and Commissioner for Refugee Services); two Officers from the Ministry of Health (Commissioner for Community Health and Senior Principal Planner). At the district level, interviews were conducted with five district policy and administrative officers, namely the Chairman, District Local Council 5; Chief Administrative Officer (CAO); Assistant CAO In-charge of Health; Chairman, Health Committee LC5; Secretary for Health LC5. Four members of the district health management team (the DDHS, Refugee Reproductive Health Co-ordinator, District Health Visitor and Assistant DDHS or Head, Health sub-district serving refugee and host population situated in Terego County) were interviewed. Six UNHCR and NGO personnel comprising the UNHCR Health Co-ordinator, AHA-NGO Country Representative, Health Programme Co-ordinator and three Medical Officers were interviewed.
3Opio G. 2000. The influx of Sudanese refugees in northern Uganda. Adjumani Settlement Commandant, personal communication, September.
4Exchange rate in 2003: 1US$ = 1900 Ugandan shillings; rate in 2004: 1US$ = 1800 Ugandan shillings.
5The health sub-district corresponds to grade 4 health centres, which provide basic curative, preventive, promotive, maternity and laboratory services. In addition, they provide emergency obstetric and surgical interventions. The health sub-district is headed by a medical doctor.