Introduction

While Uganda has hosted refugees continuously since 1945, the last five years have seen unprecedented increases in the caseload, particularly regarding refugees coming from South Sudan. As of December 2020, Uganda is host to 1,446,378 refugees and asylum seekers with 758,314 women of reproductive age, 824,255 adolescent girls and boys and 164,851 pregnant women (UNHCR, 2020)[1].  The refugees have been settled in 11 different locations in north western, mid-western and south-western Uganda, representing an average of 26 per cent of the population in hosting districts, with the proportion of refugees to nationals in West Nile reaching almost parity (47 per cent).[2]

National laws, policies and plans

Uganda has enshrined refugees’ rights within the 2006 Refugee Act and the 2010 Refugee Regulations. In addition, Uganda’s National Development Plan (NDP II 2015/16 - 2019/20) integrates refugees into national development planning through the Government of Uganda Settlement Transformation Agenda (STA). As a result, refugees live alongside host communities in settlements and have access to services on par with nationals.

 

Vulnerability and strained social services

Despite Uganda’s progressive refugee policy and the contribution of refugees to local economy, refugee-impacted areas remain vulnerable. The high rate of poverty among refugees and limited economic opportunities contribute to higher poverty levels in refugee-hosting areas, which are often remote and less developed. Refugees and host communities are disproportionately affected by changing livelihood patterns and pressure on the already constrained social services and resources such as land, water, housing, and education and healthcare services.[3] [4]

 

Shifting the paradigm

The perception that the needs of displaced persons can only be addressed through humanitarian means can impede or delay the achievement of sustainable solutions and lead to protracted displacements and a cycle of dependence on humanitarian assistance.[5] A framework for durable solutions must be put in place by providing both humanitarian and long-term development assistance to both refugee and host communities. The goal must be to strengthen their self-reliance and thereby increase their contribution to local development, decrease the need for long-term care and maintenance programs, and reduce the potential for conflict between hosts and refugees.[6] Health in particular has been identified as key area for joint refugee/ host provision.[7]

 

The New York Declaration and its aftermath

The 2016 New York Declaration for Refugees and Migrants consolidates a comprehensive multi-stakeholder response that strengthens the humanitarian-development nexus, facilitates cooperation across institutional mandates and, by helping to build self-reliance and resilience, lays a basis for sustainable solutions.[8] The Declaration set the basis for the Comprehensive Refugee Response Framework (CRRF) as a coordinated endeavor of the relevant States, UN agencies and other stakeholders that spans from reception and admissions to support for immediate and on-going needs, assistance for local and national institutions and communities receiving refugees; and expanded opportunities for solutions.[9]

 

In Uganda, the Refugee and Host Population Empowerment (ReHoPE) strategy, a multi-year joint framework for self-reliance and resilience programming for refugee and host communities in refugee-hosting districts, contributes to the implementation of the CRRF. The ultimate goal is to provide economic assistance and social service provision and for it to be mainstreamed through the district local governments in order to improve equity, relevance and cost effectiveness, in ways that support refugees and host communities without distinction. [10] [11]

 

The UNFPA approach

UNFPA’s engagement in development and humanitarian response derives from the International Conference on Population and Development (ICPD) Programme of Action (PoA), which placed women’s rights, empowerment and health at the center of development efforts.[12] The PoA affirmed that the right to sexual and reproductive health (SRH) and the right to live free of sexual and other forms of gender-based violence apply to all people at all times, including populations affected by or recovering from emergencies. Multiple international agreements and conventions, special sessions of the United Nations General Assembly, and Security Council Resolutions 1325, 1820, 1889, and 1960 reaffirm these rights and emphasize the central role of women in peace-building efforts and post-conflict reconstruction.

 

UNFPA Uganda’s engagement in development and humanitarian response is guided by the UNFPA Strategic Plan, 2018-2021 and its principle of strengthening cooperation and complementarity among development, humanitarian action and sustaining peace.[13] UNFPA Uganda is also guided by the Humanitarian Response Strategy, which mainstreamed humanitarian mechanisms across UNFPA programmes and operations for a coherent, well-coordinated, effective and sustainable response.[14]

 

The New York Declaration commits Member States to: “Ensure [that responses] mainstream a gender perspective, promote gender equality and the empowerment of all women and girls, combat sexual and gender-based violence, provide access to sexual and reproductive healthcare services, [taking] into consideration the different needs, vulnerabilities and capacities of women, girls, boys and men.”[15] Gender issues, particularly sexual violence and other forms of gender based violence (GBV) are often more acute in humanitarian, poor and vulnerable settings. The provision of emergency sexual and reproductive health and rights (SRHR) services is a key component of essential life-saving activities, as well as of the ongoing service provision that needs to be prioritized for vulnerable populations. This needs to be done in a manner that strengthens the resilience and addresses the needs of both refugee and host communities. 

 

In order to achieve this in the area of SRHR and GBV, UNFPA Uganda seeks to:

1. Promote humanitarian preparedness within health and social sectors development planning at national and district levels;
2. Support local and national ownership and capacity development of district local governments regarding service delivery in complex / mixed population settings, including transitioning of humanitarian health and social sector responses;
3. Provide life-saving as well as ongoing response to SRHR and GBV needs of refugee and host populations through a continuum of response approaches across the humanitarian-development nexus that include the Minimum Initial Services Package (MISP), the GBV minimum standards, health system strengthening and delivery of services using pre-existing district structures;
4. Strengthen multi-sectoral planning, programming and synergies, with a particular focus on integration of SRHR and GBV prevention and response in livelihood and other socio-economic interventions to enhance resilience-building for refugee and host populations;
5. Improve data availability, accessibility and analysis on population dynamics, SRHR and gender equality across the humanitarian-development nexus for evidence-based decision-making;  
6. Strengthen joint humanitarian-development coordination and institutional collaboration at national and sub-national level on SRHR and gender equality;
7. Lead and foster evidence-based advocacy and policy support on strengthening of the humanitarian-development nexus in SRHR and gender equality, including regarding legislation, financing, efficiently implementation and evaluation across the humanitarian-development nexus.
8. Foster the continued engagement of refugee and host communities in advocating, planning and monitoring SRHR and social sector service delivery in a participatory and empowering manner.

UNFPA Uganda’s approach to strengthening the Humanitarian-Development-Peace nexus

 

UNFPA is a key player in ensuring access to life-saving sexual and reproductive health (SRH) services; preventing and responding to gender-based violence (GBV); and empowering women, adolescent girls and young people, including in humanitarian settings. Accordingly, the focal thematic areas of UNFPA’s work include maternal health; adolescents and young people; prevention of and response to GBV as well as coordination among these areas.

 

UNFPA is working along the protracted refugee crisis situation in Uganda with a strategic eye on vulnerability. Refugees are generally considered a vulnerable population, however host communities in Uganda may be equally vulnerable. Several studies have documented this in Uganda and found similar health related adverse indicators across refugees in settlements and the adjacent host community population, nationals who often reside in particularly underserved and remote locations of the country with poor access to services.

 

By strengthening government health and protection systems and promoting district and community ownership across the nexus, UNFPA seeks to balance the refugee response and reduce inequalities which ultimately also serves to reduce tensions related to access to resources between refugees and host communities. Strategies that have proven effective in refugee settings are implemented by UNFPA in both settings. As a result, UNFPA is observing an increased resilience of systems and communities across the nexus and improving indicators across the nexus

Overall, ten strategic interventions areas employed by UNFPA Uganda to strengthen the humanitarian – development- peace nexus in the area of SRHR/GBV/HIV and Gender:

1. Promote Government leadership, ownership, and coordination by supporting integration of issues concerning refugee and host communities in the national, subnational development and budget frameworks to ensure resilience and sustainability; strengthening joint humanitarian-development coordination, coherence and institutional collaboration at national and sub-national level on SRHR and gender equality; develop nexus programmes informed by government priorities, and support transition to government oversight of humanitarian response wherever possible and appropriate;
2. Support systems strengthening and resilience building regarding prevention, protection and service delivery in a complex / mixed population settings; Support overall health and protection system strengthening and delivery of services using as much as possible pre-existing structures; Planning for comprehensive SRHR service integration into primary health care across the nexus; Developing capacity of district local government and local partners to improve resilience of host and refugee communities;  Initiate long-term strategies focused on policy development, by-laws and promotion of positive social and gender norms; Employ proven methodologies to empower women, girls and young people to reduce vulnerabilities and improve resilience across the nexus incl. economic empowerment;
3. Strengthen multi-sectoral planning, programming and synergies to enhance resilience for refugee and host populations by supporting multi-sectoral coordination platforms; Integrating SRHR, Gender and GBV prevention and response components in other sectors such as: education, WASH, livelihood, food, nutrition, land rights etc.; Consistently apply gender markers in all sectoral risk assessments to identify specific vulnerabilities in various sector responses; Ensure that funding sources of various development partners and international humanitarian donors complement each other to allow efficient and full systems strengthening; Identify the unique, demonstrated capacity and expertise of one individual, group, IP or institution to meet needs and contribute to risk and vulnerability reduction, over the capacity of another actor.
4. Promote humanitarian preparedness and risk reduction within health and social sectors development planning at national and district levels to mitigate fragility; incorporate vulnerability and risk reduction in programme design, implementation and monitoring; ensuring prepositioning of key relief items for urgent responses, address needs of very vulnerable populations (people with disabilities, key populations etc.) across the nexus to reduce risks.
5. Provide life-saving as well as ongoing response to SRHR and GBV needs of refugee and host populations through a continuum of response approaches across the humanitarian-development nexus guided by the context and situation. This includes: promoting the Minimum Initial Services Package (MISP) for acute emergencies; employing relevant components of MISP based on needs assessments in protracted crisis situations (e.g. training in EmNOC, CMR etc.); promoting the GBV minimum standards and clear GBV referral pathway not only in settlements but also in host community and development contexts. Overall, learning from successes in the humanitarian response (e.g. on high facility delivery rates) and apply methodologies to host community and development contexts where feasible;
6. Foster local community ownership and the continued engagement of refugee and host communities in advocating, planning and monitoring SRHR and social sector service delivery in a participatory and empowering manner; Leverage on the resources that refugees come with, i.e. skills, educational background for increased involvement, ownership and empowerment; Capitalize on the existing community leadership structures of refugees (e.g. refugee welfare committees) and host communities;
7. Contribute to peaceful coexistence by supporting young people’s participation and by promoting meaningful interactions and intentionally mixing groups (refugees, national, various tribes within the refugee communities) for key interventions and advocacy initiatives; Ensure that targeted support is based on vulnerability criteria rather than refugee status while being observant of the different forms of vulnerability between host community and refugees;
8. Improve data availability, accessibility and analysis on population dynamics, vulnerability, SRHR and gender equality across the humanitarian-development-peace nexus for evidence-based decision-making, transparency, accountability and advocacy; support harmonized national data platforms to integrate data on refugees,  promote disaggregation of data from protracted crisis situations on particularly sex, age and refugee status; lead and foster evidence-based advocacy and programming on strengthening of the nexus in SRHR and gender equality, including regarding legislation, financing, efficiently implementation and evaluation across the humanitarian-development nexus.
9. Apply a Multi-year timeframe, employ longer term programming that bridges humanitarian and development responses and ensures predictability of support for national and subnational partners;
10. Ensure Accountability and transparency

 

UNFPA’s approach to strengthening the humanitarian-development nexus in the area of SRHR and GBV is expected to deliver the following results:

Result 1: Increased access to, and utilization of, quality maternal and newborn health services

Response to reproductive health in crisis and vulnerable settings has been identified as a priority area for intervention within UNFPA’s Reproductive Rights and Sexual and Reproductive Health Framework (2008). UNFPA Uganda is therefore committed to coordinating and supporting the provision of basic but essential SRHR services in acute crisis while also setting foundation for the provision of a comprehensive set of SRHR services in the transition phase through investments in health system strengthening that include, among others, human resource investments for safe deliveries. Alignment of this strategy with the Global Programme to Enhance Reproductive Health Commodity Security (GPRHCS) facilitates pre-positioning of reproductive health commodities during preparedness, enhanced logistics support for timely delivery of commodities during crisis and sustainable comprehensive services in post-crisis situations. As part of disaster preparedness measures, UNFPA also supports national capacity building to integrate reproductive health and GBV prevention and response into disaster plans and responses. In particular, UNFPA has (1) trained OPM staff (as National Disaster Management Unit) and MOH on integration of SRH, HIV prevention, and GBV in disaster responses; (2) trained national trainers on the Minimum Initial Service Package for reproductive health in emergencies; (3) trained focal points in 13 Regional Referral Hospitals on MISP and (4) trained District Health Teams of selected districts on advocating and implementation of MISP for reproductive health in emergencies.  The country office through the Moroto DO has also provided technical support in the development of District Contingency Plans for the Karamoja region.

 

Result 2: Increased prevention of HIV and STIs, and enhanced access to quality HIV- and STI-prevention services especially for key populations at risk

Prevention of HIV and STIs and improved access to curative services especially for key populations in humanitarian and vulnerable settings has been identified as a priority area for UNFPA. UNFPA contributes to the coordinated efforts to respond to the HIV epidemic by providing emergency response through implementation of the Minimum Initial Services Package (MISP), while building the long-term capacity of the health system to prevent and treat HIV and STIs through training on clinical management of rape, other SRHR clinical areas, and logistical management and forecasting. In addition, UNFPA’s provision of equipment and supplies serves refugee and host populations from emergency to post-crisis situations. Finally, UNFPA plays an active role in HIV prevention and response coordination platforms for GBV and reproductive health, seeking to enhance synergies, continuum of care, and sustainability of the response.

 

Result 3: Advancement of gender equality and reproductive rights, particularly through advocacy and implementation of laws and policy

UNFPA spearheads efforts to determine the scope of sexual and other forms of gender-based violence affecting people in humanitarian and vulnerable settings, and to address them at every level. UNFPA Uganda spearheads a wide range of services, including counselling, post-rape treatment, legal support, assistance with livelihoods, and support through sexual and reproductive health programmes targeting both refugees and host communities. UNFPA also incorporates violence prevention in its humanitarian preparedness, emergency and post-crisis response, reaching out to vulnerable adolescents and youth, incorporating male and boy engagement in gender equality efforts, and working closely with faith-based networks and cultural leaders to reinforce support systems. UNFPA Uganda also works with partners to develop tools to help more effectively address gender-based violence in humanitarian and post-crisis contexts, including the National Gender Based Violence Database used across humanitarian and development settings.

 

Result 4: Improved data availability and analysis around population dynamics, SRHR and gender equality

Improved availability and integration of demographic, gender and health data across humanitarian and district-level development planning for more effective and sustainable response is a priority area for intervention for UNFPA Uganda. The UNFPA 2010 Guidelines on Data Issues in Humanitarian Crisis Situations provide a basis for strengthening data availability and utilization across preparedness, contingency planning, emergency response and recovery. In particular, UNFPA works to enhance the capacity of relevant national and district actors to ensure that timely and good quality data and information is produced, shared and used for decision-making for strengthened response across refugee and host communities and through all stages of humanitarian-development response.

 

Result 5: Improved coordination and sustainability of the humanitarian response in the area of SRHR and GBV.

UNFPA advocacy and programming in the areas of demography, SRHR and GBV are increasingly multi-year and multi-sectoral, support both host communities and refugees at household, community and systems level to increase resilience, strengthen the social service delivery system under government leadership, emphasize coordinated delivery through local governments, and foster active community participation. UNFPA’s approach is guided by the principles of the ReHoPE strategy. The nexus for the SRH and GBV integrated response is being strengthened across existing coordination mechanisms for refugee-hosting and other vulnerable areas where UNFPA plays an active role. This includes, in particular, government-led emergency tasks force activities including meetings and inter-agency joint needs assessments set up to respond to specific disasters and the Northern Uganda Recovery and Development (NURD) group.[16]

 

Result 6: Strengthen participatory approaches and innovative solutions that address the SRHR and GBV challenges faced by refugees and host communities across the humanitarian-development continuum

UNFPA Uganda is committed to leveraging innovation, whether related to technology, products and processes, new forms of partnership, and the use of the ideas and coping capacities of crisis-affected people (whether refugees or host communities) to adapt and improve the humanitarian and development response in vulnerable and refugee-hosting settings. In order to do so, UNFPA works in collaboration with Government and other relevant stakeholders to enhance the use of bottom-up user-centered design, indigenous innovation, and participatory methods to build on the capacities of affected populations. The 2014 OCHA report on Humanitarian Innovation: The State of the Art provides the guiding basis for UNFPA Uganda’s innovation in the areas of SRHR and gender equality, by putting affected communities and local systems at the heart of the innovation process.

 

Result 7: Enhance the identification of root-causes and implementation of long-lasting solutions through engagement of young people

UNFPA Uganda is committed to building peaceful, cohesive and resilient refugees and host communities across Uganda through the full and meaningful participation of young people in peacebuilding, as guided by the UN Security Council Resolution 2250 on Youth, Peace and Security. In order to do so, UNFPA works with government and other relevant stakeholders to enhance refugee and host community youth’s contribution to participation, partnerships, prevention and conflict resolution through capacity building and creation of opportunities that will enable young people to realize their full potential in life are a prerequisite for their engagement in civic affairs.