Description of the Intervention

Project rationale

The project was conceived in response to persistent and interrelated gaps in access to healthcare, protection services, and community-level support systems among refugee populations in Uganda. Despite the country’s progressive refugee policy framework, significant challenges remained in ensuring equitable, quality, and comprehensive service delivery, particularly in the areas of sexual and reproductive health (SRHR), mental health and psychosocial support (MHPSS), and gender-based violence (GBV) response.

At the time of project design, refugee populations in Kampala, Kyaka II, and Adjumani faced multiple barriers to accessing essential services. Health systems, especially in high-refugee-hosting areas, were under considerable strain due to increased demand, limited infrastructure, shortages of medical supplies, and insufficient human resources. These systemic constraints were further exacerbated by the protracted nature of displacement, which increased long-term reliance on public health services without corresponding expansion in capacity.

Within this context, access to SRHR services remained inconsistent and often inadequate, particularly for women and adolescent girls. Barriers such as stigma, limited awareness, cultural norms, and weak service delivery systems reduced the utilization of available services. Similarly, mental health and psychosocial support services were largely underdeveloped, despite a high burden of psychological distress associated with conflict, displacement, and socio-economic hardship.

Gender-based violence represented a critical and cross-cutting concern across all intervention areas. GBV was both widespread and underreported, with women and girls disproportionately affected. Survivors faced significant challenges in accessing care, including stigma, fear of retaliation, limited knowledge of available services, and weak or fragmented referral systems. In many cases, the response to GBV lacked integration across health, legal, and psychosocial services, resulting in gaps in survivor-centred care.

In addition to service delivery gaps, the project design recognized important limitations at the community level. Awareness of rights, available services, and referral pathways remained low among refugee populations, while harmful social norms and practices continued to perpetuate inequality and violence. Community structures, including Village Health Teams (VHTs) and other grassroots actors, were often overstretched and insufficiently equipped to address complex issues such as GBV prevention, mental health, and sexual and reproductive health. Institutional and coordination challenges also contributed to the identified gaps. While multiple actors were engaged in the humanitarian response, coordination across sectors and stakeholders was not always optimal, leading to duplication in some areas and gaps in others. Furthermore, the integration of gender and human rights perspectives into service delivery and institutional practices remained limited, affecting both the quality and inclusiveness of interventions.

The project was therefore designed to address these interconnected challenges through an integrated and multisectoral approach. It sought to strengthen the capacity of health systems to deliver quality SRHR, MHPSS, and GBV services; enhance community-level awareness and engagement; improve referral and coordination mechanisms; and promote accountability and participation among rights-holders. A key aspect of the project rationale was the recognition of GBV as both a human rights violation and a public health issue. This dual framing informed the design of the intervention, ensuring that GBV was addressed not only through protection mechanisms but also through strengthened health system responses, including clinical management, psychosocial support, and referral pathways.

The inclusion of both settlement (Kyaka II and Adjumani) and urban (Kampala) contexts further reflected the need for differentiated approaches tailored to specific operational realities. While settlement areas required strengthening of infrastructure and service delivery capacity, the urban context demanded strategies to address issues of access, affordability, and identification of vulnerable populations within dispersed communities.

Specific Objective (SO)

The Specific Objective (SO) of the project was to improve the health and sexual and reproductive health (SRHR) of Congolese, South Sudanese, and Somali refugees in Uganda by addressing sexual and gender-based violence (SGBV) as both a human rights violation and a major public health concern across the intervention areas of Kampala, Kyaka II, and Adjumani. This objective was pursued through an integrated approach that combined the strengthening of healthcare service delivery, particularly in SRHR and mental health and psychosocial support (MHPSS), with enhanced prevention and response mechanisms for SGBV. The intervention also aimed to promote access to quality, safe, and survivor-centred services, while addressing structural and socio-cultural barriers that limit the ability of refugees, especially women and girls, to seek and receive care.

In addition, the Specific Objective reflected a broader commitment to a rights-based approach, emphasizing the protection of dignity, the promotion of gender equality, and the empowerment of affected populations to claim their rights and actively participate in decisions affecting their health and well-being.

Results (R1–R4)

The project was structured around four interrelated results (R1–R4), which together contributed to the achievement of the Specific Objective. These results addressed both service delivery and systemic gaps, combining health, protection, community engagement, and accountability components.

Key components (SRHR, MHPSS, GBV, community systems, AAP)

The project was implemented through a set of integrated thematic components that addressed the multidimensional health and protection needs of refugee populations. These components were closely aligned with the project results (R1–R4) and together formed the operational backbone of the intervention.

Sexual and Reproductive Health (SRHR): The SRHR component focused on improving access to comprehensive and quality sexual and reproductive health services for refugee populations, particularly women and adolescent girls. This included the provision of family planning services, antenatal and postnatal care, and the clinical management of sexual violence. Efforts under this component aimed to strengthen health facility capacity, enhance service availability, and promote the utilization of SRHR services. It also addressed socio-cultural barriers that limit access to care, including stigma, gender norms, and lack of awareness. By integrating SRHR into primary healthcare services and outreach activities, the project sought to ensure that services were accessible, acceptable, and responsive to the needs of vulnerable populations.

Mental Health and Psychosocial Support (MHPSS): The MHPSS component addressed the high burden of psychological distress among refugee populations, resulting from experiences of conflict, displacement, and socio-economic hardship. The project supported the integration of mental health services into primary healthcare systems, enabling early identification and management of mental health conditions. This component included both facility-based and community-based interventions, such as counselling, psychosocial support sessions, and referrals for specialized care. It also aimed to reduce stigma associated with mental health and improve community awareness of available services. By strengthening both service delivery and community support systems, the project contributed to improved mental well-being and resilience among affected populations.

Gender-Based Violence (GBV) Prevention and Response: The GBV component was central to the project and addressed both prevention and response aspects of gender-based violence. It focused on strengthening survivor-centred services, including clinical care, psychosocial support, and referral pathways, while also addressing underlying drivers of violence at the community level. The project supported the capacity building of health workers and other service providers to ensure appropriate and sensitive handling of GBV cases. At the same time, community-based activities were implemented to raise awareness, challenge harmful norms, and promote gender equality. The integration of GBV services within health systems ensured that survivors could access comprehensive care in a timely and coordinated manner.

Community Systems Strengthening: Community systems strengthening was a cross-cutting component that aimed to enhance the role of community structures in health promotion, prevention, and service linkage. This included working with Village Health Teams (VHTs), community leaders, and other grassroots actors to improve outreach, awareness, and referral mechanisms. The project supported training and capacity development of community actors to enable them to address key issues such as SRHR, MHPSS, and GBV. It also emphasized community engagement as a means of promoting behavioural change, improving service uptake, and ensuring that interventions were responsive to local needs and realities.

Accountability to Affected Populations (AAP): The AAP component focused on strengthening mechanisms that promote transparency, participation, and responsiveness in the delivery of services. It ensured that refugees and host communities had opportunities to provide feedback, express concerns, and influence decision-making processes related to the project. This included the establishment and reinforcement of feedback channels, community dialogues, and participatory platforms. The project aimed to institutionalize accountability practices within both community and service delivery structures, thereby enhancing trust, improving service quality, and fostering a sense of ownership among beneficiaries.

Integration of Components: These components were not implemented in isolation but were designed to be mutually reinforcing. For example, GBV response was integrated within SRHR and MHPSS services, while community systems strengthening supported all thematic areas through improved outreach and engagement. Similarly, AAP mechanisms cut across all components, ensuring that interventions remained responsive and aligned with the needs and priorities of affected populations.

Theory of change

The theory of change followed a logical pathway: strengthening health systems and service delivery, empowering communities, improving coordination and referrals, and enhancing accountability mechanisms would collectively lead to improved access to quality care, increased awareness and prevention of violence, and ultimately improved health, dignity, and protection of refugee populations in Kampala, Kyaka II, and Adjumani.

The theory of change for the project was based on the premise that improving access to quality, integrated health and protection services, while simultaneously strengthening community systems and accountability mechanisms, would lead to improved health outcomes and enhanced protection for refugee populations, particularly in relation to sexual and gender-based violence (SGBV). The project assumed that if health facilities were strengthened to provide comprehensive and quality services, including sexual and reproductive health (SRHR), mental health and psychosocial support (MHPSS), and clinical management of gender-based violence, then access to and utilization of these services by refugee populations would increase. This, in turn, would contribute to improved health status, timely care for survivors of violence, and overall well-being.

At the same time, the project recognized that service availability alone was insufficient to achieve meaningful change. It therefore posited that if communities were empowered through awareness-raising, capacity building, and engagement of community structures such as Village Health Teams (VHTs), then knowledge of rights, available services, and prevention strategies would improve. This would lead to increased demand for services, reduced stigma, and positive shifts in social norms, particularly around gender equality and violence prevention.

The theory of change also emphasized the importance of integrated and functional referral systems. It assumed that if coordination between different levels of care, community, primary healthcare, and specialized services, was strengthened, then individuals requiring advanced medical or psychosocial support would be able to access appropriate services in a timely and efficient manner. This was particularly critical for survivors of SGBV, who require comprehensive and multisectoral care.

Furthermore, the project was grounded in the belief that strengthening accountability to affected populations (AAP) would enhance the relevance, quality, and responsiveness of interventions. By establishing mechanisms for feedback, dialogue, and participation, the project aimed to ensure that services were aligned with the needs and priorities of refugees and host communities. Increased participation was expected to foster ownership, trust, and sustainability of outcomes.

Underlying these assumptions was a broader recognition of SGBV as both a public health issue and a human rights violation. The project therefore integrated protection and health approaches, aiming to address both the immediate consequences of violence and its root causes.