Adolescents’ Comprehensive Sexual Reproductive Health and rights response in Refugee resettlement center Uganda.
CARA aims to implement integrated sports health camps to address SRH needs for adolescents in Nakivale Refugee camp in Isingiro Uganda
The youth participating in sports in Nakivale Refugee Camp in Isingiro district as a psycho social tool. The project will capitalize on this to make an impact on the health and rights of the targeted beneficiaries.
What specific problem(s) are you trying to address?
Young people (especially young women) who live under marginalized circumstances in refugee camps, urban slums, or as child soldiers are highly vulnerable to sexual coercion, exploitation, and violence and may have no choice but to engage in high risk or transactional sex for survival. Until relatively recently, reproductive health care has been a neglected element of emergency health care services in refugee camps, despite the fact that poor reproductive health is a major cause of morbidity and mortality once emergency health needs have
been met. In 2014, UNHCR reported 125 sexual based violence 54% of these were rage and 24% of the rape cases were children in Nakivale Settlement camp.
The picture above shows some of the children that do not have access to SRH information and services at Nakivale Refugee camp sorounding communities. These will be some of the youngest targets for information on sexual reproductive services. It has been noted that in Uganda, the sexual debut is as early as 9 years so the information given to these children will empower these young stars to make good decisions as teenagers.
The picture above shows young mother that have been targeted to be reached by CARA with family planning services. Some of the mothers that come pregnant escaping violence in their countries have given birth to their babies. Some were raped along the way to Uganda and others are continuing to experience sexual violence in the camps still.
What are some of your unanswered questions about the problem(s) you are working to address?
Currently CARA is working on the promotion of rights and empowerment of the adolescents with information in the access to sexual reproductive health. However, the uptake is still low. Nakivale refugee camp has also exhibited mobility of the settlers as majority of the young are always in the move so sustaining outreaches has proved a challenge. The available mobilized youth have also shied away from receiving SRH services that are provided in the camps.
Explain Your Idea
The goal of the project is to ensure availability, accessibility and full utilization of SRH services by the youth 10-19 years in Nakivale Refugee settlement area by December 2018. To achieve this, CARA proposes to establish integrated SRH outreaches for the youth 10-19 years using sports as a stabilization tool to provide an integrated service.
The project will also support integration of family planning services, HIV prevention, counseling, SRH information in one outreach. This will be done to promote comprehensive services among the targeted beneficiaries. Focusing on key populations, children and youth. The core packages of prevention services for key population will be provided and this will include community based peer education and outreach, condom promotion, HCT, Family Planning and sexual reproductive health, Safe Male Circumcision, Family and community cantered approach, meaningful involvement of PHAs, referrals and linkages. The prevention services offered by this project will be taken nearer to the hot spots of the key populations.
The project will establish resettlement age appropriate peer groups that will meet on a bi-monthly basis to discuss issues that affect their health.
The project will target 380 children and youth between the age of 10-19. Most of these will be primary refugees but also the youth in Nakivale area will receive the services. The idea will use sports as a tool for mobilization, counseling and psycho social support for the refugees.
Condom education sessions being conducted for the couples to reduce on sexually transmitted infections and family planning. The youth above the age of 18 will have the condom education session during the project implementation, CARA will avail condom dummies for this purpose to ensure that the youth are equipped with skills on proper condom use
The project will mobilize the the adolescent for games and thereafter the SRH camps will be held for the mobilized youth.
Name the three most important ways that your idea will address your identified problem(s).
Many girls and boys lack the information, knowledge, confidence, and agency to assert their preferences and needs; if and when they do, they face stigma when they try to access services. Therefore the idea will;
1. Through the integrated camps, CARA will increase availability of age specific services for the youth and children in the settlement camps
2. Create demand for the services that are to be brought to the beneficiaries in the camps. CARA will work with SRH health service providers to reach to the adolescents in the camps
3. Create an enabling environment for the adolescents to access the quality and timely SRH services. This idea will target the youth that have shunned SRH services as a result of stigma and misinformation.
How is your idea unique?
The adolescent boys and girls, married and unmarried, abused and at the risk of being abused among others were involved in the development of the idea and through quarterly case conferences for the youth to provide feedback on emerging issues. Age appropriateness of the services to be provided (information and actual services). The project will tackle stigmatization of beneficiaries by offering child and youth friendly packages at the time and place of their convenience. Through the peer groups approach, beneficiaries will also be encouraged a peer to peer approach for the rape victims, young mothers and gender based violence victims to create demand for the services. This will also encourage age appropriate peer counseling desks and motivational speeches will be made on a monthly basis to the groups to sensitize the children and youth. The idea will create an impact of children and youth free from STI infections and all the available services on SRH are fully utilized.
What are some outstanding concerns or questions that you have regarding your idea?
CARA is still in the process of understanding
Who are your end users?
One of the tools used to mobize the youth 10-19 years will be games and football is the most cherished sport in these refugees camps where it is watched and played by many of the refugees.
Adolescents in one of the organized peer to peer SRH education sessions. CARA will conduct youth sexual reproductive health education sessions to equip the youth with skills and knowledge. This will create a sense of awareness on the existing services in the refugee camp and beyond.
Youth taking part in sports as a means to keep fit and a mobilization strategy for CARA
Where will your idea be implemented?
What is the primary type of emergency setting where your innovation would operate?
Tell us more about the emergency setting that you intend to implement in
Nakivale refugee settlement was established in 1958 and officially recognized as a refugee settlement in 1960 through the Uganda Gazette General Notice No. 19. Currently the center hosts Congolese, Rwandans, Burundians, South Sudanese among others. The settlement is divided into 79 villages with an average of 800 to 1,000 people per
village. Internally Displaced Persons. The settlement camp has 60,992 settlers (UNHCR 2015) of these 94.8% are refugees while 5.2% are asylum seekers
What is your organization's name?
Community Awareness and Response on AIDS (CARA)
Tell us more about you.
Community Awareness and Response on AIDS (CARA) is a Registered Non-governmental, non political and not for profit organization established in 1995 by a group of people affected and concerned about HIV and AIDS, Human Rights Violations, Poverty, Food security and nutrition. CARA was also established to promote access to safe water, hygiene and sanitation at community and household level, promote family planning and sexual reproductive health and building the capacity of both CARA and communities to handle challenges affect ting them. The organization is currently operating in the regions of Central, East, and Western Uganda.
What is the current scale of your proposed innovation?
Community - 1+ communities within 1 country
Experience in Implementation Country(ies)
Expertise in Sector
Yes, for more than a year.
The CARA is currently operating in the districts of Kayunga, Mukono, Mayuge and Buhweju in Uganda. CARA has established head offices in Kayunga Town Council, Kayunga District and regional offices too
What is your organizational status?
Registered non-profit, charity, NGO, or community-based organization.
What is the maturity of your innovation?
Existing Prototype or Pilot: Tested a part of my solution with users and am iterating.
How has your idea changed based on feedback?
CARA conducted a prototype of the idea with the beneficiaries that it intends to work with. During this activity, CARA selected children and categorized them in age groups in these categories 10-13 years, 14 - 16 years and 17-19 years. The team from CARA shared the idea and the adolescents were encouraged to provide feedback to the already existing idea. CARA noted the following;
- All the children were very exited about the idea and mentioned that they will encourage their peers to join
- The adolescents consulted noted that they will prefer the outreaches to take place in the evening and weekends when they are not in school or in technical institutions
- There is need to separate the children below 13 from those 14 and above. They all have different peculiar issues. Condom use is illegal for children below the age of 18 in Uganda, therefore the services will be provided in accordance with the legal and policy frameworks of the country. Contraceptive will be for those above 18
Who will implement this idea?
CARA through its Western region will commit 5 full time staff and 10 volunteers staff to work in partnership with the USAID/RHITES south west to implement the idea. All of these will be based at the camp. Majorly, they will be mobilizing the youth and creating an enabling environment for them to play and access the health services. Health facilities in Isingiro district will be part of the health services service provision team. This will be in HIV counseling and Testing and family planning. The Nakivale Refugee settlement administration will provide the space for these activities. The schools will also be part of the implementation as they will support CARA in the mobilization and coordination of peer groups for the youth. The local leadership will also be part and parcel of the idea.
Using a human-centered design approach, you may uncover insights that lead to small or foundational changes to your organization’s existing strategy or processes in order to unlock the potential of your idea. How would your organization go about making such changes?
CARA advisory board advises on matters of policy, financial, human resources, technical and gives strategic thinking and direction to the organization. The secretariat is headed by Executive Director who is the chief accounting officer, responsible for the day to day running of the organization. There are other key staffs responsible for technical implementation of activities and 5 staff staff implementing the idea are part of them. The key implementation decisions will be decided by the (ED) and executed by the technical staff. The team of volunteers provide a supportive role in the implementation. Most importantly the partnerships, collaboration and networking support the arm of referrals and linkages to ensure that services CARA cannot provide and accessed through these partnerships.
What challenges do your end-users face? (1) What is the biggest challenge that your end-users face on a day-to-day, individual level? (2) What is the biggest systems-level challenge that affects your end-users?
The end users face the challenge of harsh community attitudes especially those that have become parents at a very young age. This has affected their ability to access services for fear of being discriminated and stigmatized. CARA intends to provide refugee friendly services by ensuring that the services are brought closer to the end users in a more youth friendly approach ensuring that their dignity is preserved.
At system level, most of the national strategic plans have not included the refugees as part of the end users for most of the health care services. There are limited health centers close to the camp which affects uptake
Low demand for services in SRH at the facility will be addressed through using sports and games as a mobilization tool following the feedback provided.
Tell us about your vision for this project: (1) share one sentence about the impact you would like to see from this project in five years and (2) what is the biggest question you need to answer to get there?
By 2022 CARA aims to ensure that 579 youth in Nakivale refugee camp Uganda practice safe sex behaviors by 2022 and there are low HIV incidences at the camp.
Some of the short term impacts will be tremendous reduction of early pregnancies among the teenagers and delayed sex debut, access and utilization of existing SRH services through creating increased demand for these services in the refugee camps. This will be strengthened by creating an enabling environment through youth friendly services
What is it that most attracted you to Amplify instead of a more traditional funding model?
The creativity the amplified brings in the provision of services to the young people. There is limited prescription on what should be done and more focus is given to innovation with meaningful feedback to ensure that the end users are part and parcel of the intervention that are developed.
One of the primary targets beneficiaries for CARA is young people and SRH in refugee camps is one of the key areas of intervention. Therefore it was an honor for CARA to make a contribution to this cause
Do you intend to implement your Amplify idea in refugee camps / temporary settlements?
We aim to implement our Amplify idea in a refugee camp / temporary settlement.
How long have you and your colleagues been working on this idea together?
How many of your organizations’s paid, full-time staff are currently based in the location where the beneficiaries of your proposed idea live?
Between 5-10 paid, full-time staff
Is your organization registered in the country you intend to implement your idea in?
We are registered in all countries where we plan to implement.
My organization's operational budget for 2016 was:
Between $100,000 and $500,000 USD
What do you need the most support with for your innovation?
Understanding User and/or Community