Understanding the organisation and delivery of health service following the repatriation of South Sudanese refugees from the West Nile districts in Uganda

Abstract

Abstract Low-and-middle-income countries (LMICs) face overwhelming challenges providing health services to their populations, and even more for provision of health services to displaced populations. Little is known about how health services are organized and delivered to displaced populations in these countries especially following repatriation. Objective To examine the organization and delivery of health services following the repatriation of South Sudanese refugees in Uganda from three west Nile districts of Arua, Adjumani, and Moyo. Methods We conducted a qualitative case study in three West Nile refugee hosting districts of Arua, Moyo, and Adjumani. We used the World health Organization Health System Framework focusing on four blocks: health services, financing, medicines, and supplies and human resources. We conducted in-depth interviews with 32 purposefully selected respondents representing health service managers, district civil leaders, staff from local government and international aid agencies, and health service providers across primary, secondary, and tertiary levels of care. Content analysis was conducted. Results Following repatriation, the District Health Teams in the three districts assumed overall responsibility for planning, management, and provision of health services. Health service delivery was based on an integrated model. Health facilities provided comprehensive health services based on a decentralized framework in all the three districts. In addition, health services were available in most areas except for former refugee settlements where facilities were either closed or relocated. Post repatriation, the main source for health financing was government funding through the Primary Health Care grant with limited support from aid agencies. Districts, however, faced several challenges in health service delivery including shortage of medicines and essential supplies, inadequate health workers, and poor infrastructure. Conclusion The repatriation of refugees affected health services delivery in the refugee affected districts notably reduction in financial resources, availability of skilled human resources, equipment and as well as closure of some health facilities. Key stakeholders should plan and prepare for refugee repatriation and put in place mechanisms to support the continuity of health services delivery in refugee affected settings. Further research to examine health systems adaptability and resilience following repatriation is recommended.