Utilization of Comprehensive Health Promotion Packages Targeted for Refugees in Northern Uganda: A Policy Brief

Summary

In July 2016, there was a large influx of refugees from South Sudan to Northern Uganda through Elegu border in Adjumani district. The Ministry of Health conducted a Rapid Health Assessment in the district and the results revealed that the refugees had poor hygiene practices and a negative attitude towards health services. Recommendations were; the development of comprehensive health promotion packages specifically targeting refugees in Northern Uganda and translation of the health promotion messages into refugee local languages. The Ministry of Health conducted a Rapid Health Assessment in the district. Results revealed that the refugees had poor hygiene practices and a negative attitude towards health services. Recommendations were; the development of comprehensive health promotion packages specifically targeting refugees in Northern Uganda and translation of the health promotion messages into refugee local languages.

Introduction

From 8^th to 12^th August, 2016, the Ministry of Health conducted a Rapid Health Assessment of among Refugees in Adjumani district, Northern Uganda. This was a public health response following the huge influx of over 40,000 refugees to Uganda from Southern Sudan in July 2016 through Elegu border in Adjumani district. Re- sources such as shelter, water and human waste facilities were overstretched thus there was potential for outbreaks of communicable diseases. The assessment aimed: to assess the general health status of the refugees, identify service delivery gaps and potential public health threats posed by the arriving refugees and recommend public health actions for rapid response.

Approaches and results

The assessment focused on refugees who arrived in Uganda from June to August 2016 at the refugee reception centers namely – Elegu border post, Pagirinya 1, Pagirinya 2 and Nyumanzi. Information was collected using the WHO Standardized Health Assessment Checklist, individual level questionnaire, observations and interviews with key service providers. Existing reports were re- viewed to corroborate information. Poor hygiene practices were observed amongst the refugees. Open defecation was rampant at the reception centers and near the river.

There was use of unsafe water from the river at Pagirinya 1. By 11^th August 2016, there was a cholera outbreak in Adjumani district with 16 suspected cases. 131 (66.5%) of 197 refugees interviewed had health problems, 62.6% had accessed general health care. Medical workers reported negative attitude by refugees towards health services, mainly, HIV prevention and care. Refugees detested condom use, rejected HIV test results and those who sought HIV care were highly stigmatized.

Mothers avoided Elimination of Mother-To-child Transmission of HIV (eMTCT) services and only returned to health facilities when very ill. Expectant mothers who needed emergency caesarian sections delayed to consent for the operations unless their husbands also consented. Mothers who gave birth opted for self-disposal of the placentas for cultural reasons. The observed health promotion messages were in English. Efforts were made by community workers and interpreters, to convey health promotion messages to the refugees using local languages.

Conclusion

There were poor hygiene practices and negative attitudes towards HIV/AIDS and Maternal Child Health services among the refugees. Much as health services were available, some of the refugees who reported health problems did not seek them. The health mes- sages available were in English and less useful to majority who could not read English.

Recommendations

Refugees have health challenges specific to them as a community. Although there are health promotion messages in place, there is need for the development and utilization of comprehensive health promotion packages targeted for refugees in Northern Uganda. The health messages should be translated to the refugee languages for comprehension.