UNHCR, through its healthcare partners, provides free primary health care services to refugees and host communities in Nyarugusu camp. There are seven health facilities: one 1,128 bed capacity hospital, two health centres that operate for 24 hours a day (80 and 48 bed capacity), and four health posts. Health services include: care for outpatients and inpatients, medical referrals and reproductive healthcare including HIV/AIDS, antenatal care, post-natal care, family planning, surgical management of obstetric cases and minor surgeries, emergency obstetric and neonatal care (EmoC), medical care for survivors of rape and other SGBV-related trauma, mental health, immunization, health education, and preparedness to respond to disease outbreaks.
Major gaps exist in the health sector as highlighted in participatory assessments, and many health indicators remain below SPHERE standards. The number of health facilities in the camps is insufficient to cater for the increased population and to achieve the recommended 1 health facility for 10,000 refugees, which would avoid the current situation where refugees walk long distances to access overcrowded health services. Facilities also lack equipment necessary to diagnose illnesses, such as x-rays and laboratory equipment, resulting in poor quality of care and reliance on expensive medical referrals to tertiary level hospitals. Budgetary constraints have led to uncompetitive staff salaries that are lower than those given by the Ministry of Health. This hampers recruitment of qualified health staff and leads to overreliance on refugee incentive staff. The increased population has increased the workload for clinicians serving an average of 80 refugees per day, further compromising the quality of health care.
There is a need to construct additional health facilities to increase access to health facilities, alleviate overcrowding and delayed service provision at health sites. The existing health facilities are in dire need of renovation. Medical supplies, including the available stock of drugs, and diagnostic equipment are inadequate. A combination of good health workforce and improved diagnostic capability will increase the quality of health care provided to refugees, thus reducing morbidity and mortality.
In 2017, UNHCR plans to scale up the level of mental health services provided in the camp given the increased demand among Congolese refugees brought about by numerous reasons, including long-stay in the camp and SGBV-related issues. There is a need to increase the quality of community-level preventive services by recruiting additional Health Information Technicians (HIT) members to increase the ratio of HIT/refugee population from the current 1:1,000 to the standard of 1:500. Nyarugusu camp is located in a malaria endemic area and malaria is the leading cause of morbidity and mortality. Preventive activities, such as procurement of long-lasting mosquito bed nets and sufficient quantities of antimalarial drugs, need to be ensured.
Given the current state of health care in the camps, also the number of medical referral slots to tertiary facilities for cases that cannot be managed in the camp needs to be increased. UNHCR will also procure additional ambulances to assist with transporting patients to hospitals in Mwanza and Dar es Salaam. Ambulances break down frequently and in the absence of alternative transport, this can result in halt of medical referrals which can be dire in emergency cases. A more cost-effective strategy is to support visits by medical specialists, such as surgeons and cardiologists, to the camp so that their skills can serve a larger number of refugees. In 2017, there is a need to support specialists’ visits to the camps thus improving the quality of care in camps.
2017