NEEDS ASSESMENT REPORT FOR RWAMWANJA PHASE 2 1.0.
Project justification
The project team in liaison with the local community leadership at Rwamwanja settlement performed a multi sector needs assessment to ascertain the most pertinent needs of Rwamwanja refugee settlement. The rationale of the needs’ assessment was to align the Project activities with the community needs subsequently optimizing the impact of the project. Below were the findings categorized in sectors: 1.1.General health sector: The health sector of the Rwamwanja refugee settlement leaves a lot to be desired despite the many interventions by a number of implementing partners. The community is mostly affected by malaria, respiratory tract infections, malnutrition especially in children, watery diarrhea and other hygiene related diseases. There are also currently high instances of anemia within the settlement, with 48.8% of women found to be anemic. Despite this, there is one health center III at Rwamwanja refugee camp as well as a newly constructed health center II in Kyempango manned by a 49 technical health staff on the ground translating in to 1:100 clinician to patient ratio every day. The settlement health facilities are overly under stocked with drugs and other medical supplies relevant to sustain a functional health system. In this scenario, the settlers are left with the option of procuring the required drugs yet many find the cost of these drugs high and can hardly afford them. As a matter of fact, a study conducted by UNCHR in August 2018 at Rwamwanja settlement ascertained that more than 51% of the households at the settlement reported cost of medicine as a hindrance to accessing quality medical services. Also, the available health facilities do not receive adequate supply of specialized drugs for treating medical conditions like diabetes, neuropathy, diabetes melittus, hypertension, Chronic Obstructive Pulmonary Disease (COPD), eye sight, stroke and angina, depression, Arthritis commonly found in the elderly people. This means that such cases are categorized as specialized emergencies and have to be transferred to Fort Portal hospital that is located 90km away, often realizing fatalities while still in transit. Additionally, the hygiene situation at the Rwamwanja settlement is in a dire state, with a huge deficit of toilets forcing many dwellers to defecate in polythene bags which are later dumped around the community posing imminent health risks. The
community also lacks sufficient garbage sites that can facilitate a safe disposal of harmful waste and this is one of the justifications for the prevalent hygiene related diseases and the gastro intestinal infections. 1.2.Wash - Menstrual Hygiene Management: Globally, refugee girls and young women often lack the ability to manage their menstruation safely and with dignity due to a lack of adequate facilities, products and knowledge. This is not any different at Rwamwanja settlement where menstruation is a taboo characterized with stigma and cannot be discussed publicly. Results from the baseline study indicated that school girls and young women at Rwamwanja refugee settlement lacked access to the menstrual hygiene knowledge and products required for them to manage their menstruation in a healthy and dignified manner. Although UNHCR mandates that all women and girls of reproductive age are to receive distributions of disposable sanitary pads, soap and underwear, 71% of the girls reported not having enough menstrual products, 65% reported not having enough soap and 59% reported not having enough underwear. 44% percent also reported that they did not have enough information about menstrual hygiene. Many of the girls and young women, rely on donations from partner organisations which donations are often insufficient and not time bound. As a matter of fact, 20% of the girls admitted to reusing the disposable sanitary pads because they were not able to receive a donation in time, posing imminent health issues resulting from improper hygiene. Additionally, access to water in Rwamwanja community that currently stands at 15 litres per person is still below the UN standard of 20 litres per person. Due to the very few water points, many girls and women have to walk long distances and make long queues to collect water for household use making the all process tedious. As a strategy to save the available water, many girls opt for using less water for bathing and washing which poses additional challenges ultimately affecting the hygiene of the young women and school girls especially while in their menstruation periods. 1.3.Community Economic Empowerment: The needs assessment report ascertained that over 78% of the dwellers in Rwamwanja settlement rely on Agriculture for food and daily livelihood. However, 57% of the households that access agricultural land reported that the food produced was not sufficient for their families and thus relied on food donations as a supplement.
Rwamwanja settlement has a handful of livelihood groups that provide access to high yielding varieties of common food crops, support crop post-harvest handling and informal vocational skills development including tailoring, hairdressing, baking, craft making and soap making for group-based income generation. Community savings & credit structures (Village Savings and Loan Associations) are also promoted to increase refugees’ access to cheap credit. However, the impact of these skilling groups and credit facilities is almost non-existent given the high influx of refugees in Rwamwanja settlement that lack skill to engage themselves in the money economy. Additionally, many of the refugees have not been equipped with basic financial literacy skills to appropriately manage the credit facilities extended to them and many end up wasting the credit resources thus creating a vicious cycle of poverty. The community still owns a mono directional thought that men are the only ones mandated to fend for their families and the women to perform the house chores. This explains the low household incomes and has persistently kept the Rwamwanja community in poverty. 1.4.Child and Maternal Health Due to over reliance on one health facility, the resources for maternal health are overly strained and the patient to health provider ratio is way too high. The maternity wing at the Rwamwanja Health centre has limited space with only 12 beds for postdelivery care. Subsequently, the patients have to share beds with at least two people and their new born babies.
The health centers offer integrated maternal health
services in one place that is, pre-natal care, antenatal and post-natal care which also encompasses provision of family planning methods. This has deterred many young women from accessing reproductive health services simply because they lack privacy to personally interact with the health service provider to elucidate the pros and cons associated with the different family planning methods. That notwithstanding, the health facility has done a lot of awareness on the benefits of family planning which has generated a lot of demand. The downside however is that there is inconsistent supply of family planning commodities which has led to missed opportunities to prevent unintended pregnancies and unsafe abortions. The increasing number of child mothers and teenage pregnancies has also posed an additional challenge that the health facility is struggling with given the associated health complications. The maternity ward caters for not only deliveries but also offers post abortion care to the unsafe abortion patients who are mostly teenagers.
1.5.Gender Based Violence Due to the lack of economic opportunities, many women and men are engaging in polygamy, land conflict, alcoholism and drug abuse which often results in to genderbased and domestic violence. Many girls are forced to fetch water and firewood from distant places in the wee hours of the day, prompting sexual abuse in form of defilement and sexual assault. To make matters worse, the victims of defilement are often forced by their families to marry the perpetrators resulting in to multiple sexual offences while in marriage and trauma often leading to depression and suicide. Domestic violence is seen as a norm in the community mostly affecting women and girls. Some of the cases are reported to the authorities but the main challenge is that women often retract their statements forcing the police to release some perpetrators with the police constantly dealing with repeat offenders. The release is usually demanded during the period cash transfer or food distribution by donor organisations so that the men who are registered can access them on behalf of their families. 1.6.Environmental conservation There has been reported increase of cover loss in Rwamwanja settlement and this has been justified by the influx of refugees in the settlement. The influx has exerted pressure on the forest cover leading to deforestation to gain access to cultivatable land and to construct households. Also, since 90% of the Rwamwanja population depends on firewood and charcoal as the main sources of energy for cooking, cutting down trees is a common practice within the settlement and this is cited as the biggest reason behind the escalating deforestation in the settlement. Since the settlement borders a game reserve, reports of poaching of wildlife and birds for food especially by the Congolese refugees were made and this poses a threat to the environment and also injures the tourism sector. The dire hygiene sanitation around the settlement characterized by human and animal waste, which eventually are carried in to Katonga river and drained in to Lake Victoria posing an imminent health disaster to the community that survives on water body.