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6. Conclusions
The conclusions are organized by evaluation criterion and express the evaluation team’s overall judgement. They are intended to add interpretive value rather than to restate findings.
Relevance. The intervention was highly relevant. Its integrated health–protection–MHPSS model was well matched to a refugee needs profile in which health and protection vulnerabilities are deeply interlinked, aligned with Uganda’s refugee inclusion and health policies, and kept relevant through context-sensitive adaptation across urban and settlement settings. The single notable relevance gap was the underfit of the essential medicines model to urban chronic-care needs in Kampala.
Effectiveness. The intervention was highly effective. The large majority of targets were met or substantially exceeded — frequently by two to three times — and the specific objective was largely achieved. Effectiveness was strongest in service delivery, outreach, MHPSS, survivor support and accountability, and more qualified in the durability of capacity gains and in converting service contacts and awareness into sustained outcomes, particularly in the urban context.
Efficiency. The intervention was efficient. It delivered well above appraisal expectations through cost-conscious procurement and, above all, by leveraging existing public and community systems, generating economies of scope through integrated delivery and efficient task-shifting to VHTs. Mobile outreach and urban specialised care were the most resource-intensive elements.
Impact. The intervention made a credible and substantial contribution to improved health access, strengthened SGBV response, increased awareness, and enhanced institutional capacity, with the strongest evidence of impact at the access and utilisation level. Impact was clearest in the settlement contexts; in Kampala it concentrated in MHPSS while chronic-care financing remained a structural constraint. Adopting a contribution logic, the evaluation plausibly and substantially attributes these changes to the intervention.
Sustainability. Sustainability is the intervention’s principal area of exposure. Gains embedded within institutions, communities and existing systems have good prospects for continuity, but financing-dependent components — outreach, referral coordination, the medical hostel and specialised survivor support — are at risk without transition planning or follow-on financing.
Connectivity / Coherence. The intervention was coherent and well-connected, deliberately pairing humanitarian relief with system strengthening and aligning with relevant policies, actors and standards. Post-project continuity is partial, contingent on consolidating the integrated elements and transitioning the relief-oriented ones.
Coordination. Coordination was a clear strength, both within the Farmamundi–AHA–EMESCO consortium and with government and humanitarian actors, evidenced by complementary partner roles and a dense functional coordination fabric. The main weakness was the funding-dependent and occasionally disrupted referral-coordination loop at receiving hospitals.
Coverage. Coverage was broad and equitable, exceeding plan and extending beyond the target areas, with strong prioritisation of women, children and survivors. Residual gaps concern urban chronic-care patients, the most remote settlement populations, men and adolescent boys in protection/MHPSS, and persons with disabilities.
Ownership and Participation. Ownership and participation were distinctive strengths. Communities were engaged as rights-holders with genuine influence over implementation and review, AAP mechanisms were functional, and local institutions were embedded in delivery and coordination.
Cross-cutting issues. Gender, HRBA, conflict sensitivity, and the inclusion of vulnerable groups were generally well integrated, with a strong gender and rights orientation. The weakest areas were the engagement of men and boys, the targeting of persons with disabilities and older persons, and the systematic treatment of environmental considerations.
Comparison with the December 2025 Endline Survey. The final evaluation largely confirms the findings of the December 2025 endline survey, with most indicators showing strong convergence in both magnitude and direction of change. Improvements in access to health services, reductions in barriers to reporting SGBV, strengthened accountability mechanisms, and increased community engagement were consistently reflected across both data sources. This alignment provides confidence that the results presented in this evaluation are firmly grounded in the quantitative evidence generated by the endline survey.
Where differences emerge, they arise primarily from the evaluation’s use of additional sources of evidence, including key informant interviews, focus group discussions, project monitoring records and document review. These sources enabled the evaluation to explain and contextualise trends that could not be fully understood through survey data alone, including the influence of population mobility, staff and volunteer turnover, urban cost pressures and institutional factors affecting sustainability. As a result, the final evaluation not only validates the endline findings but also provides a deeper understanding of the drivers of change, the factors constraining progress, and the implications for future programming.
Overall judgement. The intervention was a relevant, effective, efficient and well-coordinated humanitarian health-and-protection programme that delivered substantially beyond its targets, advanced the rights and dignity of refugees across three demanding contexts, and embedded valuable community and institutional capacity. Its central unfinished agenda is sustainability — securing the continuity of its financing-dependent gains — together with closing specific coverage and design gaps, particularly urban chronic care, inclusion of under-reached groups, and environmental integration.