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Uganda: Healthcare Implementing Partner for UNHCR at Bidibidi Refugee Settlement

Construction of Permanent Health Facilities: October-December 2017

January 24, 2018

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Foundation being constructed for the general ward at Bidibidi Health Centre III


Current Situation

Bidibidi Refugee Settlement is now the largest refugee settlement in the world. Current statistics indicate that there are at least 284,927 refugees and asylum seekers now living in the settlement, and including other South Sudanese refugees in the area, as well as the host population of Yumbe, RMF’s health project targets over 400,000 people. The settlement is filled to capacity and has been closed to new arrivals, except for reuniting family members.

 

Urgent Need

As Bidibidi Refugee Settlement is transitioning from an emergency situation to a stable operation, the need to construct permanent health facilities has become urgent. The temporary structures currently housing the settlement’s health centers are composed mainly of plastic sheets that have outlived their lifespan. These compromised temporary structures have become a threat to the safe storage of medical supplies and quality of health services. There is also a need for stable housing and additional WASH facilities to maintain the health and morale of staff members.

 

Construction of Permanent Health Facilities

In August 2017, it was announced that UNHCR had secured funding for the construction of permanent core structures for health facilities in Bidibidi Refugee Settlement. However, construction could not begin immediately due to the need for discussions on who would implement the project. There were two prominent opinions concerning the project: the first opinion was that UNHCR should undertake construction through direct implementation, and the second opinion was that implementing partners should undertake the construction. After a series of discussions, it was resolved that RMF would undertake the construction of 4 health centers in the 3 zones where RMF was UNHCR Health Implementing Partner at the time (we have since grown to cover 4 of Bidibidi Refugee Settlement’s 5 zones).

 

Project Planning

In October 2017, UNHCR gave RMF the green light to begin construction of these 4 health centers: 

  • Bidibidi Health Centre III

  • Jomorogo Health Centre III

  • Bangatuti Health Centre III

  • Komgbe Health Centre III

  
 
Construction of the OPD building has almost reached the ring beam

 

Construction Progress

Bangatuti Health Centre III
Progress achieved:
  • Site clearance

  • Mobilization of materials such as bricks, sand, trees, cement, aggregates, etc.

  • Construction of provisional structures for the builders

  • Setting out the structures for the General ward, Maternity ward, OPD, and staff house

  • Excavation of the foundations for the General ward, Maternity ward, OPD, and staff house

  • Blinding and stripping of the General ward, Maternity ward, OPD, and staff house

  • Construction of the plinth walls for the General ward, Maternity ward, OPD, and staff house

  • Backfilling and compacting for both buildings

  • Slab building and casting for both buildings

  • Construction of walls started for both buildings

Employment of RMF’s vocational training graduates:

Ben and Dok Enterprises Ltd has hired 4 graduates of RMF’s Panyadoli Vocational Training Institute (PVTI) located in Kiryandongo Refugee Settlement, Uganda to work on the construction of Bangatuti Health Centre III.  There is great enthusiasm among trainees of PVTI’s Bricklaying and Concrete Practice program, and 11 additional graduates have traveled to Bidibidi in hopes of joining in the construction work.

Challenges:

When RMF Uganda’s team spoke with this contractor, the following challenges were highlighted: 

  • Increase in the price of bricks: When the villagers learned of large-scale construction in the settlement, they increased the price of bricks from UGX 130 to UGX 300. This extra cost has been a challenge for the contractors.

  • Failure of UNHCR to stick to the site plan: For instance, according to the site plan given to the contractors, distance from the road to the building was supposed to be 10m. However, after the contractors had started the excavation work, UNHCR engineers proposed an 18m distance from the road. Then, during the next inspection visit, the UNHCR field team proposed a 30m distance from the road to the buildings. This forced contractors to repeat the same stage of excavation several times and caused additional spending on the side of the contractors.

  • The UNHCR engineer is not readily available to contractors: Often, when the contractors need the UNHCR engineer for basic guidance, he is unavailable. This gives the impression that the engineer enjoys finding errors, rather than helping to avoid them. For instance, at the time of setting out a building, the engineer should be available to confirm and make any alterations that may be applicable for the site. Alterations that require shifting a structure from one spot to another are not only an inconvenience, but also lead to increased cost and wasted resources.

  • This site was being used by some nationals and refugees to grow food. They required compensation, but UNHCR had not considered this. Resolving this issue delayed the work by one week, because the farmers rose up and stopped the contractor from continuing with construction until they had been satisfied.

  • High cost of feeding the workers: Since the area does not have enough food production, feeding the construction workers has become expensive for the contractors. This was also not considered.

  • Lack of water to use for construction: The area has no nearby streams, and the refugees have refused to allow their treated water from a motorized source to be used for construction. Transporting water was becoming expensive for the contractors. This challenge had not been considered.

  • Poor road network for transporting construction materials: Whenever it rains, the roads become impassible.

 

Contractor Lebubu Brothers Ltd solving the challenge of water access at the Komgbe Health Centre III construction site
Komgbe Health Centre III
Progress achieved:
  • Mobilization of adequate building materials such as bricks, aggregate, cement, BRCs, etc.

  • Mobilization of sufficient manpower

  • All buildings have been set out and the foundations excavated

  • Blinding and stripping of the foundation for the Maternity ward

  • Work is progressing at the desired speed

  • Construction of shelters for the workers, who are staying on-site

Challenges:
  • This site is on a slope, and it needed to be graded. It was agreed that UNHCR would first do the grading and leveling so that the contractor could begin construction. UNHCR did not fulfill its commitment of grading the site until 3 weeks after the official launch of construction. This delayed the work and caused frustration for the contractor, because he had to provide necessities, such as food, to his workers while they waited to begin work.

  • The site is rocky; thus, achieving the 3-foot depth for the foundation was impossible. This required the UNHCR and Yumbe District engineers to grant permission for a 1.5-foot depth for the foundation. They could not arrive quickly to discuss the situation with the contractor, which would have allowed the work to move on pace.

  • The distance to reach local building materials, such as bricks, is farther than the other sites. This was not taken into consideration.

 
Some of the materials mobilized by the contractor, United Africa Enterprises Ltd
Jomorogo Health Centre III
Progress achieved:
  • Mobilization of sufficient building materials such as bricks, cement, and sand

  • Mobilization of sufficient manpower

Challenges:
  • The land is on a slope, and part of it is touching a swamp. The engineer’s recommendation is that the land should be graded, cut, and filled. UNHCR committed to undertake this task, but has been slow to complete it.

  • An RMF staff tent is located on part of the area that needs to be graded; thus, the staff quarters must be relocated.

  • The new temporary structures being constructed for the staff were not completed in time, and shifting other installations, such solar electricity systems, to the new staff tents was delayed.

  • Currently, the grader has only cleared the brush, but cutting and filling are still necessary before the contractor can begin construction. The contractor is, however, very ready to begin the work.


 The grader clearing the site at Bidibidi Health Centre III
Bidibidi Health Centre III 
Progress achieved:
  • Clearing of the brush (completed by contractor)

  • Mobilization of building materials such as bricks, sand, cement, and aggregates

  • Mobilization of sufficient manpower

  • Setting out the structures of all buildings

  • Excavation of the foundations

  • Blinding and stripping

  • Building the plinth walls

Challenges:
  • The soils are weaker, and a deeper foundation is required. This involves higher cost.

  • The contractor started construction, but was advised to demolish after finishing the plinth walls because the distance from the roadside was not considered sufficient. The contractor has now put a distance of 30m from the road to buildings.

 

Conclusion

Observation
  • Our team found that all of the contractors were well intentioned and committed to delivering the work as agreed.

  • The Yumbe District engineer is supportive and responding to the contractors completing the work.

  • The UNHCR engineer does not readily or quickly respond to the contractors completing the work.

  • Inspection visits from the UNHCR field team, OPM, and Yumbe District are not coordinated. Each of these stakeholders comes with contradicting recommendations, which are confusing to the contractors. RMF has urged and recommended coordinated inspection visits so that helpful recommendations are made in agreement.

  • RMF has encouraged the contractors to stick to the specifications in the plans, so as to avoid undocumented alterations, which would have financial implications.

  • Ben and Dok Enterprises Ltd (the contractor who completed work for RMF in Kiryandongo) has performed very well. Their rate of work is admirable, and they are likely to deliver on the deadline.

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Background

Since 2009, RMF has been working to help the people of South Sudan recover from decades of civil war, which destroyed much of the country’s infrastructure and healthcare system. RMF initiated, co-founded, and continues to support the Juba College of Nursing and Midwifery, supports the Juba Teaching Hospital, and in December 2014, became the UNICEF implementing partner for malnutrition treatment and prevention in Jonglei State and the greater Pibor Administrative Area. Even after renewed fighting broke out in July 2016, RMF’s in-country teams have continued these programs. RMF has also been providing health services, school support for children, and vocational training to South Sudanese refugees in Uganda’s Kiryandongo Refugee Settlement since 2008, and was appointed UNHCR Health Implementing Partner in 2014.

To accommodate the large numbers of South Sudanese refugees fleeing to Uganda (between July 1, 2016 and September 21, 2016, there were 163,540 new arrivals), the Ugandan Office of the Prime Minister (OPM) and the UNHCR, in partnership with RMF and other organizations, opened the new Bidibidi Refugee Settlement on August 5, 2016. Bidibidi is located near the South Sudanese border in the Yumbe district of West Nile, Uganda, and has the capacity to support 180,000 refugees. Bidibidi is being built from the ground up, and during August 2016, 31,902 refugees were relocated to the settlement. Real Medicine Foundation is the main UNHCR Health Implementing Partner for Bidibidi Refugee Settlement, and between August 5, 2016 and August 31, 2016, 5,331 patients were treated at RMF’s health clinic.


Objectives
  • To provide residents of Bidibidi Refugee Settlement with high quality primary health care
  • To maintain easily accessible, fully staffed, fully stocked health clinics
  • To provide referrals to secondary and tertiary care centers when needed
  • To provide health education and early detection through health outreaches
  • To provide support to Yumbe District Hospital

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