Description
Objectives: Social health protection is a central component for achieving universal health coverage (UHC), which is driven by civil society movements and demands a bottom-up approach. Therefore, civil society organizations (CSOs) are perceived as powerful intermediaries between orchestrator (IGOs) and targets (refugees). Refugees are in a more protracted situation in the past two decades, integrating refugees into national health system is the most sustainable way in long-term to provide adequate health access. This paper aims to explore the existing mechanisms and challenges for CSOs participating in social health protection for refugees, with a country focus on Uganda.
Methodology: This study utilizes the qualitative approaches. Existing literature and data on CSOs’ participation in social health protection will be reviewed. The author will utilize process tracing and single case study to analyze the approaches for CSOs participating in social health protection for refugees. Besides, semi-structured interviews will be conducted, and interviewees are chosen based on the actors involved. The reasons for choosing Uganda are two: Uganda takes the most progressive refugee hosting policy, and it has not yet defined a social protection floor.
Results and discussions: This study is managed into four steps: 1) clarify the elements of social health protection (covering the cost of effective access to health care and income security to compensate for the earning loss), and linkage between social health protection and protracted refugee situations; 2) define CSOs and its specific role in ensuring the access to affordable health services based on the UHC2030 and Civil Society Engagement mechanism; 3) elaborate the achievements of major CSOs active in Uganda (such as social networks and refugee-led organizations) contributing to the social health protection for refugees; 4) analyze the barriers when CSOs participating in the design and implementation of social health protection schemes for refugees and come up with relevant suggestions. This paper’s innovation is about utilization of orchestration theory in public health sector, exploring the relationship among various actors in the sector.
Conclusions: There are mainly three approaches for CSOs participating in social health protection: 1) providing parallel health services to refugees in camps with free of charge; 2)training volunteers for strengthening the capacity of national health workforce considering the cultural sensitivity; 3)advocacy for inclusive health policies and equitable access to health services for refugees, and information dissemination and skills training for certain vulnerable groups mainly in urban areas.
Despite Uganda takes the most progressive refugee policies, there are major barriers faced by CSOs. 1) Most public health expenditure is covered by out-of-pocket payments, and the service quality is unstable as the funding mainly comes from IGOs and may stop when the latter’s budget is limited; 2) CSOs are usually not formally included in social health protection assessments, which hampers the feasibility of health protection schemes. This study demonstrates that CSOs may be entitled with stronger operational capabilities through seeking for financial support from IGOs’ joint programmes with governmental ministries; and strive for a seat in social protection assessment initiatives and participating in knowledge production of refugee health needs.
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