Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework
Abstract Background Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies...
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| Format: | Article |
| Language: | English |
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BMC
2025-01-01
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| Series: | Conflict and Health |
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| Online Access: | https://doi.org/10.1186/s13031-024-00640-2 |
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| author | Henry Komakech Shatha Elnakib Lama Bou Karroum Evelyn Nyachwo Winnie Adoch Sarah Sali Godfrey Goddie Okeny Christopher Garimoi Orach |
| author_facet | Henry Komakech Shatha Elnakib Lama Bou Karroum Evelyn Nyachwo Winnie Adoch Sarah Sali Godfrey Goddie Okeny Christopher Garimoi Orach |
| author_sort | Henry Komakech |
| collection | DOAJ |
| description | Abstract Background Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression. Methods We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson’s Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated. Results Uganda’s experience with the integration of refugee’s dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda. Conclusion Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels. |
| format | Article |
| id | doaj-art-3093c8c6fcbd4a86a77411165dc36d91 |
| institution | Kabale University |
| issn | 1752-1505 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Conflict and Health |
| spelling | doaj-art-3093c8c6fcbd4a86a77411165dc36d912025-01-26T12:36:26ZengBMCConflict and Health1752-15052025-01-0118S111710.1186/s13031-024-00640-2Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle frameworkHenry Komakech0Shatha Elnakib1Lama Bou Karroum2Evelyn Nyachwo3Winnie Adoch4Sarah Sali5Godfrey Goddie Okeny6Christopher Garimoi Orach7Department of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere UniversityInternational Health Department, Johns Hopkins Bloomberg School of Public HealthCenter for Systematic Reviews on Health Policy and Systems Research (SPARK), American University of BeirutDepartment of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere UniversityDepartment of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere UniversitySchool of Women and Gender Studies, College of Humanities and Social Sciences, Makerere UniversityDepartment of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere UniversityDepartment of Community Health and Behavioural Science, School of Public Health, College of Health Sciences, Makerere UniversityAbstract Background Uganda has been confronted with a sustained influx of refugees for decades. This prompted the government to explore opportunities to integrate refugees into local service structures including its national health system. This paper chronicles the history of policies and strategies that have influenced the integration of refugees into the national health system in Uganda and investigates factors that impacted policy evolution and progression. Methods We used a case study approach that drew on a document review and key informant interviews with 28 respondents at national and subnational levels. Interviews were analyzed using thematic qualitative analysis and findings were organized using Walt and Gilson’s Policy Triangle Framework. Data from the literature review, media review, and key informant interviews were triangulated. Results Uganda’s experience with the integration of refugee’s dates to 1999 when the country first implemented the Self-reliance strategy. Since then, policy learning and evolution have taken place, with policies around integration evolving and improving over time, moving the country towards more effective implementation of integrated health services. A conducive policy environment was key as a set of legislations at national and district-levels and sector-specific plans and budgets that included refugees have provided the foundation for implementation. The integration received support and buy-in from the highest levels of government including the President and the Office of The Prime Minister. This was coupled with deliberate efforts by the government to mainstream refugee response in local plans and budgets, allowing implementation at district and sub-district levels. These factors were pivotal to the implementation of the integration agenda. Conclusion Our study highlights the complex, dynamic, evolving, and multifaceted nature of the multisectoral health policy process in the integration of health services in refugee settings. The findings shed light on the importance of collaboration between stakeholders, mobilization of legal and political frameworks to shape the integration of refugee health services into the national health system, and the importance of ensuring that high-level commitments translate to action and development plans at local levels.https://doi.org/10.1186/s13031-024-00640-2IntegrationRefugeesHealth policyPolicy triangleNational health systemUganda |
| spellingShingle | Henry Komakech Shatha Elnakib Lama Bou Karroum Evelyn Nyachwo Winnie Adoch Sarah Sali Godfrey Goddie Okeny Christopher Garimoi Orach Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework Conflict and Health Integration Refugees Health policy Policy triangle National health system Uganda |
| title | Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework |
| title_full | Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework |
| title_fullStr | Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework |
| title_full_unstemmed | Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework |
| title_short | Examining the integration of refugees into the national health system in Uganda: an analysis using the policy triangle framework |
| title_sort | examining the integration of refugees into the national health system in uganda an analysis using the policy triangle framework |
| topic | Integration Refugees Health policy Policy triangle National health system Uganda |
| url | https://doi.org/10.1186/s13031-024-00640-2 |
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