Komakech Henry, Atuyambe Lynn, El-Jardali Fadi, Orach Christopher Garimoi
Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, P.O. Box 7072, Kampala, Uganda.
American University Beirut, Beirut, Lebanon.
Confl Health. 2025 Jun 2;19(1):32. doi: 10.1186/s13031-025-00672-2.
Low- and middle-income countries face several challenges in providing health services, particularly to displaced populations, during all phases of emergencies. However, little is known about how health services are organized to displaced populations following repatriation. This study examined the organization of health services following the repatriation of South Sudanese refugees from the three West Nile districts of Arua, Adjumani, and Moyo in Uganda.
We conducted a qualitative case study in three West Nile refugee hosting districts, 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, including health service providers, district civil leaders, local government staff, and non-government organization staff. The data were analyzed using content analysis.
Following repatriation, the district health teams in the three districts assumed overall responsibility for planning, managing, and providing health services. Health services followed an integrated model within a decentralized framework in all three districts. Health services were available in most areas except for former refugee settlements where facilities were either closed or relocated. After repatriation, funding for health services was provided through the government's primary health care grant with minimal support from aid agencies. Districts, however, face several challenges, including shortages of medicines and essential supplies, inadequate health workers, and poor infrastructure.
Refugee repatriation disrupted health service delivery in the refugee hosting districts, leading to a reduction in funding; inadequate skilled health workers and equipment; and the closure of some facilities. To ensure the continuity of health services, government and aid agencies should plan for repatriation and establish strategies to sustain health services in refugee-hosting areas.
低收入和中等收入国家在紧急情况的各个阶段提供卫生服务，尤其是为流离失所人群提供服务时面临若干挑战。然而，对于遣返后如何为流离失所人群组织卫生服务，人们知之甚少。本研究调查了乌干达阿鲁阿、阿朱马尼和莫约这三个西尼罗河地区的南苏丹难民遣返后的卫生服务组织情况。
我们在阿鲁阿、莫约和阿朱马尼这三个西尼罗河难民收容区进行了一项定性案例研究。我们采用了世界卫生组织的卫生系统框架，重点关注四个板块：卫生服务、筹资、药品和供应品以及人力资源。我们对32名经过有目的挑选的受访者进行了深入访谈，包括卫生服务提供者、地区民政领导人、地方政府工作人员和非政府组织工作人员。数据采用内容分析法进行分析。
遣返后，这三个地区的地区卫生团队承担了规划、管理和提供卫生服务的总体责任。在所有三个地区，卫生服务在分权框架内采用综合模式。除了设施已关闭或搬迁的前难民营外，大多数地区都有卫生服务。遣返后，卫生服务资金通过政府的初级卫生保健补助金提供，援助机构的支持很少。然而，各地区面临若干挑战，包括药品和基本供应品短缺、卫生工作者不足以及基础设施差。
难民遣返扰乱了难民收容区的卫生服务提供，导致资金减少；熟练卫生工作者和设备不足；一些设施关闭。为确保卫生服务的连续性，政府和援助机构应规划遣返事宜，并制定在难民收容地区维持卫生服务的战略。
