Executive Summary

This report presents the findings of the final external evaluation of the project “Protecting the Dignity of Refugees in Uganda: Responding to Sexual and Gender-Based Violence as a Human Rights Violation and Public Health Issue,” implemented by Farmamundi in partnership with Africa Humanitarian Action (AHA) and Emesco Development Foundation with funding from the Basque Government. The project was implemented in three distinct refugee contexts in Uganda, Kampala (urban refugees), Kyaka II Refugee Settlement, and Adjumani Refugee Settlements, with the overall objective of improving the health and sexual and reproductive health of refugee populations by addressing sexual and gender-based violence (SGBV) through an integrated, rights-based and survivor-centred approach.

The evaluation adopted a mixed-methods methodology combining document review, comparative analysis of baseline and endline datasets, Key Informant Interviews (KIIs), Focus Group Discussions (FGDs), and routine project monitoring data. The assessment was guided by the OECD-DAC evaluation criteria of relevance, coherence, effectiveness, efficiency, impact, sustainability, and coverage, while also examining humanitarian principles including participation, accountability, gender equality, localisation, human rights, conflict sensitivity, and Do No Harm.

Overall, the evaluation concludes that the project was highly relevant, largely effective, efficiently implemented, and generated significant positive outcomes for refugee populations and the institutions serving them. The intervention responded directly to critical health and protection needs within Uganda’s refugee response by integrating primary healthcare, sexual and reproductive health (SRH), mental health and psychosocial support (MHPSS), gender-based violence prevention and response, community engagement, and accountability mechanisms into a coherent programme model. Its design reflected the different realities of urban refugees in Kampala and settlement-based populations in Kyaka II and Adjumani, allowing activities to remain responsive to the specific challenges of each operational context.

The project substantially achieved its Specific Objective. Access to essential healthcare services improved through the provision of medicines, strengthened health facilities, mobile outreach services, and referral support for specialized care. More than twice the planned number of refugees received medical care and essential medicines, while referrals for advanced diagnostic and specialist services exceeded project targets. The intervention also strengthened clinical management of SGBV survivors, expanded access to mental health and psychosocial support services, and reinforced referral pathways linking community, primary healthcare and tertiary care facilities. Baseline and endline findings further demonstrate improvements in healthcare utilisation, reductions in financial barriers to care within settlement settings, increased use of community-based service providers, and improved access to treatment at supported facilities.

Beyond service delivery, the project successfully strengthened community systems and institutional capacity. Village Health Teams, community leaders, healthcare workers and local institutions received technical training that improved their capacity to prevent, identify, refer and respond to SGBV and related health concerns. Community awareness activities significantly increased knowledge of health rights, available services, referral pathways and gender equality while contributing to reductions in stigma surrounding mental health and gender-based violence. Refugee participation was strengthened through community committees, dialogue platforms, accountability mechanisms and feedback systems that promoted transparency, responsiveness and greater ownership of interventions.

One of the project’s greatest strengths was its integrated implementation model, which recognised that refugee health outcomes are inseparable from protection, psychosocial wellbeing, gender equality and community empowerment. Rather than treating SGBV solely as a protection issue, the project addressed it simultaneously as a public health concern requiring coordinated clinical, psychosocial, legal and community-based responses. This holistic model created multiple entry points for vulnerable refugees to access care while strengthening collaboration among government institutions, humanitarian partners and refugee-led structures.

The evaluation found that the project demonstrated strong efficiency by maximising available resources through partnerships with public health facilities, local governments, refugee structures and humanitarian coordination mechanisms. Existing systems were strengthened rather than duplicated, allowing the intervention to deliver results well beyond several planned targets while reinforcing institutional ownership. Collaboration with the Ministry of Health, Office of the Prime Minister, Kampala Capital City Authority, district local governments and other stakeholders enhanced implementation quality and contributed to improved coordination across the health and protection sectors.

Evidence also indicates that the project generated important longer-term impacts extending beyond immediate service delivery. The intervention strengthened institutional capacities, improved coordination between health and protection actors, enhanced community resilience, expanded accountability to affected populations, and established stronger referral and survivor support systems. Many of the skills, structures and partnerships developed during implementation are expected to continue benefiting refugee populations beyond the project period.

Nevertheless, the evaluation identifies several structural constraints that continue to affect refugee health and protection outcomes. Persistent shortages of medicines within the wider health system, increasing demand for specialised care, transportation barriers, financial constraints among urban refugees, chronic disease management needs, mental health stigma, and dependence on external humanitarian financing remain significant challenges. While the project mitigated many of these constraints, they require continued investment and stronger government and partner engagement to sustain and expand achievements.

Overall, the evaluation found that the project successfully demonstrated the value of delivering health and protection interventions as an integrated package rather than as separate programme components. By bringing together primary healthcare, sexual and reproductive health, mental health and psychosocial support, gender-based violence prevention and response, community engagement, and accountability mechanisms, the intervention addressed the multiple and interconnected challenges faced by refugee populations in Kampala, Kyaka II, and Adjumani. Although important system-level constraints remain, the project strengthened existing health and community structures, improved access to services, and reinforced collaboration between government institutions, humanitarian partners, and refugee communities. The experience and lessons generated through implementation offer practical guidance for the design of future programmes seeking to improve health and protection outcomes for refugees in Uganda.