Uganda: Healthcare Implementing Partner for UNHCR at Kiryandongo Refugee Settlement

PROJECT OVERVIEW
 
Project Statement

RMF is pleased to announce being selected as an official implementing partner for UNHCR at the Kiryandongo Refugee Settlment.

This project seeks to address two goals of emergency operations and care and maintenance of 24,722 (20,269 new caseload and 4,453 old caseload) refugees and asylum seekers in Kiryandongo Refugee Settlement through the delivery of quality healthcare services.
 

Photo: A South Sudanese woman brings her grandchild for immunizations at the RMF-UNHCR medical outreach clinic at Kiryandongo Refugee Settlement, Uganda

Operational Context       

The project shall be implemented in Kiryandongo Refugee Settlement as part of the emergency response to the South Sudanese refugee influx. Health services will be provided through the established health centres namely Panyadoli Hill Health Centre II, Panyadoli Health Centre III, at Reception Centre and community-based care health supporting both refugee and host community.
 
The operational assumption here is that the project shall receive funding from UNHCR as the influx of refugees and asylum seekers population into Kiryandongo Refugee Settlement is projected to increase to about 60,000 from the current 24,722 due to the political instability in South Sudan since the cease fire agreement signed in Ethiopia has not yielded peace as anticipated.
 
The operation shall be structured in a way that Real Medicine Foundation (RMF) shall hire a programme manager who will be responsible for the overall implementation and coordination of planned interventions whereas OPM and UNHCR will do oversight functions.  Activities will be planned, coordinated and reviewed on a weekly, monthly and quarterly basis through coordination meetings chaired by OPM at settlement level.
 
Problem(s), Objective(s) and Intended Impact

Kiryandongo Refugee Settlement has two health centers-Panyadoli H/CIII and Panyadoli Hill H/CII. However, Panyadoli H/CIII experiences huge numbers of clients from within and outside the settlement simply because of relatively better service delivery arising from concerted efforts of KDLG, UNHCR, RMF, and now ACF, IRC and UNICEF. But even with the above support, there are still gaps/ unmet needs in the areas of human resources (staffing), referral facilitation, capacity building and medical equipment/supplies and other logistical needs for optimal operation in light of the increasing numbers of refugees.  It should be noted that Real Medicine Foundation is currently supporting Panyadoli Health Centre III with quarterly provision and support of medicines and medical supplies; monthly payment of staff salaries for 01 data clerk, 03 cleaners, 02 compound caretakers and 01 watchman; installment of a modern solar pump for running water; painting, when needed, of buildings, wards and beds; installment of a solar system for lighting in the wards; provision of blankets, bed sheets, beds, mattresses, and mattress covers; procurement of utensils and supplementary food for (mal)nutrition department; provision of annual end-of-year incentives to all staff.
 

Key health indicators as per HIS report Jan-March 2014;

• Crude Mortality Rate (CMR)(/100/month) 0.0 against standard of <0.75
• Under-five Mortality Rate (U5MR)(/1000/month) 0.2 against standard of <1.5
• Measles vaccination coverage 17.6% against >95%
• Proportion of outbreaks investigated within 48 hours was 0% against 100%
• Consultations per trained clinician per day 32 against <50
• Health utilization rate (new visits/refugees/year) 0.9 against 1.4
• Proportion of host population consultations 35%

*Figures adopted from UNHCR Summary Report, Jan-Mar 2014
 
Objective: Health status of the population improved.
Intended impact at the end of implementing period (31/12/2014) is to improve or maintain the above indicators.
 
Problem Analysis: Access to reproductive health and HIV services.
The number of PoCs receiving ART as of March 2014 was 18 persons, and the prevalence of HIV was 8.2%; PMTCT coverage was 74% (std 100%), antenatal care coverage was 56% (>90%) which calls for preventive measures in form of community sensitization. This can partly be realised by recruiting community reproductive health workers, training and facilitating them to ensure that they identify pregnant mothers, encourage them to come to the centres for antenatal services and deliver from the health centre, and pass rightful information on HIV prevention to the community. There is also need to facilitate health staff with motorbikes for transport during community outreaches.

• Proportion of births attended by skilled personnel was 35% against standard of ≥90%
• Crude birth rate (/1000/month) was 0.5
• Proportion of births conducted by caesarean section 0% against 5-15%
• Proportion of new-born infants with low birth weight (<2500gs) (weighed within 72hours) 13% against 15%
• Number of PoCs receiving ART 18

 
OPM Based at Kiryandongo will assume responsibility for the physical security of refugees, maintenance of law and order, regulation of public information, determination of the status of new arrivals, facilitating the acquisition of land, where applicable and appropriate, work permits for refugees.
 
UNHCR Field office will monitor project implementation and give advisory support.
 
Risk Management
The unstable political situation in South Sudan poses a big risk of many refugees crossing to Uganda in search of asylum. This may lead to a further increased population of refugees that has not been budgeted for, thus cause a strain on the health system in the settlement. Therefore, there is a need to have a contingency plan in place.Objective: Population has optimal access to reproductive health and HIV services.
Intended impact is to ensure PoCs have optimal access to reproductive health and HIV/AIDS services.
 
Problem Analysis: Operations management and coordination.
With the increasing number of PoCs, coordination of planned intervention by RMF and in conjunction with other actors will be critical.
 
Objective: Operations management, coordination and support strengthened and optimized.
 
Intended impact: Effective programme management and coordination for better service delivery to PoCs

 
POPULATION OF CONCERN/OTHER SUPPORTED ENTITIES
The project aims to provide basic and essential services to 24,722 refugees and asylum seekers.
 
Project’s Population of Concern

Of the 24,722 individuals registered with UNHCR in Kiryandongo Refugee Settlement, 418 are asylum seekers and 24,304 refugees mainly from South Sudan, Kenya, DRC, Burundi, Somalia and Rwanda.

Demographic Data
 

Other Supported Entities
 
IMPLEMENTATION ARRANGEMENTS
 
Implementation
A tripartite agreement has been signed between the Office of the Prime Minister (OPM), the UNHCR Representation in Uganda and Real Medicine Foundation. The project will benefit from the technical support of the District Health Officers who will ensure that health services are delivered in accordance to the National Health Policy and guidelines of the Ministry of Health, and in conformity with UNHCR health and protection policies.
 
A number of activities including staff recruitment, capacity building in collaboration with other health partners, medical referrals and essential medicines, preventive reproductive and HIV services will be implemented. RMF will recruit a medical doctor at Panyadoli H/CIII as well as other essential medical staffs to provide quality health services to Persons of Concern (PoC) at the health centres and the Reception Centre (RC). Availability of adequate staff and medical supplies will go a long way to reduce congestion at Panyadoli H/C III since Panyadoli Hill HCII will be well equipped to offer quality services to refugees and nationals.
 
The presence of the medical doctor at Panyadoli H/C III will help cut down on the rate of referrals to Mulago National Referral Hospital, thus reducing expenses involved as well as a creating a future focus for the establishment of a minor theatre to handle minor surgeries.
 
Medical equipment/supplies/materials/goods such as drip stands, bed screens, mattresses, plastic sheeting, bed sheets and blankets, protective wear for cleaners, cleaning materials, solar bulbs, and staff uniforms will also be procured under the emergency operation or directly provided by UNHCR.