From hardship to hope: Cash plus skilling programme supports young refugees

 

Ida Merusa (not her real name) is a 16-year-old adolescent mother who suffered double jeopardy when she was defiled after fleeing armed conflict in her home country of South Sudan. She now lives as a refugee at Imvepi Refugee Settlement in Uganda’s West Nile district of Terego.

“When I became pregnant after being defiled at the age of 15, I dropped out of  school. Life has been difficult for me, given that as an adolescent mother and a refugee, I am often denied rights such as access to education, job opportunities and basic needs for survival. It is a cycle of physical, psychological and emotional hardship, and you have to quickly adapt to the new environment you  find yourself in,” Merusa says while breastfeeding her one-year-and-one- month-old baby.Merusa is not alone.

Her newly found friend, Sarah Fatuma, a 19-year-old mother and a refugee from the Democratic Republic of Congo, also dropped out of school while in the latter stages of secondary school at Imvepi Senior Secondary School.

“Life in a refugee settlement is quite challenging, especially for young girls,  because we can fall into the wrong peer groups. I used to loiter around markets and did not take my studies seriously, doing odd jobs to meet living costs and to support my family with essential supplies. That’s how I ended up pregnant and leaving school,” Fatuma recalls.

Merusa and Fatuma are among many adolescent mothers and child-led  households who fled armed conflict in their countries of origin and are rebuilding their lives at Imvepi Refugee Settlement.

Given their vulnerable situations, both young mothers faced harmful coping strategies for self-reliance and sustainable livelihoods. They engaged in income-generating activities and undertook domestic duties at a tender age to support their households. They had no choice but to leave school.

For these young mothers, after attending the mentorship and life skilling training, life has never been the same again. Fatuma already enrolled back to school and Merusa says she will join her friend to continue with her education next year at Impevi SS.

The cash and skilling training under the PROSPECTS Programme

The mentorship and life skilling training programme, implemented by UNICEF- Uganda is a multi-year strategic initiative funded by the Kingdom of the Netherlands to empower young refugees and host community members in  eight countries that include Uganda, Egypt, Iraq, Kenya, Lebanon, Jordan and  Ethiopia.

The programme focuses on skills development, including foundational learning and digital training, to help youth transition from education to employment. It provides access to life skills, financial literacy and pathways to education and livelihoods that enhance resilience and self-reliance.

 As part of the broader PROSPECTS initiative, UNICEF Uganda is supporting an unconditional cash transfer programme to support out-of-school adolescents and young people, with a specific focus on forcibly displaced persons and host communities in four refugee-hosting districts. The districts include Terego, Madi-Okollo, Isingiro, and Kampala for urban refugees.

This is because many forcibly displaced adolescents and young people like Maseru and Fatuma face heightened vulnerability due to displacement including disruption of education, family separation, exposure to violence and limited access to services. These challenges are further compounded for those with disabilities or from extremely poor households.

As a result, many forcibly displaced adolescents and young people are deprived of opportunities for education, skills development, mentorship, and protection. Participation in such programmes often carries a high opportunity cost, as adolescents and young people are expected to engage in income-generating activities or domestic responsibilities to support their households.

To address these barriers, Stella Ogalo, a Social Policy Specialist at UNICEF Uganda, explained that the social protection component of the PROSPECT programme provides direct financial support to adolescents and young people to offset the opportunity costs foregone, thereby enabling them to participate in life-skills training, mentorship and digital skilling offered, without sacrificing their immediate livelihoods.

 The project focuses on providing cash support to out-of-school adolescents and young people for six months. Each member of the cohort receives UGX 45,000 (US$12) per month, with the disabled beneficiaries receiving an additional 50 per cent top-up of UGX 22,500 (US$6) per month. The cash assistance is intended to bridge the burden of accessing skilling programmes provided by UNICEF and partners within the PROSPECTS framework funded by the Kingdom of the Netherlands. Other skilling programs include digital skilling, vocation  skilling. i-UPSHIFT and entrepreneurship skilling.

“These adolescents have faced challenges such as transport, childcare (for those with children) and other household demands that affect their ability to participate in the skilling programme. Therefore, the cash provided is not meant to cover skilling costs but to enable these adolescents and young people  to access mentorship and other related opportunities,” Ogalo emphasized.

Stella Ogalo further stated that the programme also strengthens linkages to  other essential services such as child protection, education, psychosocial support and healthcare provided by the Ugandan Government through established local structures. Beneficiaries will be provided with information on  social protection systems in countries of return, helping to prepare adolescents and young people who may eventually choose to repatriate.

 “By promoting financial inclusion, enhancing self-reliance and preventing harmful coping mechanisms such as child labour and early marriages, the programme aims to improve the well-being of displaced and host communities and lay the groundwork for long-term resilience and sustainable livelihoods,”  she added.

 In line with the Refugee and Host Population Empowerment (ReHoPE) strategic framework (2017), Ogalo said the programme endeavours to  support both the refugee and host community. Although Merusa’s abuser fled back to South Sudan and escaped justice, she has regained her self-esteem and is determined to follow in Fatuma’s footsteps and return to school next year.

 “The cash and skilling training programme has given me the confidence to  go back to school. I want to study and join Muni University to pursue nursing. I have used the money provided by UNICEF Uganda to invest in a joint-venture business with my elder sister and have also joined the Goodwill Village Saving Group  (VSG),” she added.

Another South Sudanese refugee, Noah Baker (21), a cash plus skilling beneficiary who had dropped out in primary seven, has also gone back to school. “I’m now in senior two at Imvepi Secondary School, and I thank UNICEF for the financial support, which has helped increase income in my small baking business,” he said.

 During one of the training sessions, Merusa and Fatuma’s cohort were visited by Hamida Kabarwan -a cadre health worker at Odupi Health Center III in Odupi subcounty, Terego district. Kabarwan provided vital information to the beneficiaries about child protection services and Government of Uganda programmes tailored at stopping child labour and early marriages.

The trainees were also informed about the Sauti -Uganda Child Helpline (UCHL) through which adolescents and young people can report cases of abuse and gender-based violence (GBV). The call centre operates 24 hours a day across  Uganda under the Ministry of Gender, Labour and Social Development (MGLSD).

Sustainability and scaling up

Ogalo said the programme prioritizes government leadership and ownership by  working closely with national and local authorities to advocate for inclusive  financing and the integration of adolescent-focused social protection into national planning and budgeting processes. It will also strengthen community  engagement and enhance capacity-building of local leaders, service providers  and community structures to ensure long-term continuity of services. 

 

Sweden’s support enhances survival rates for preterm babies at Kawempe and other regional hospitals

Inside Uganda’s busiest hospital maternity wards, teenage mothers and their premature babies benefit from upgraded facilities and ongoing international collaboration

By Moses Sserwanga

Ruth Nabwire (not her real name), aged 17, is one of many young mothers whose preterm baby was admitted to the remodeled Neonatal Intensive Care Unit (NICU) at Kawempe Government Referral Hospital in Uganda’s capital, Kampala as of 4th November 2025.

Every four hours, she joins other mothers in the congested NICU to breastfeed and care for their preterm babies under close supervision by hospital staff. The young mother was particularly glad about the NICU’s modern equipment; without it her preterm baby, delivered three weeks ago and weighing slightly more than 1.2kg, would likely have died.

“I'm happy to be here because the caring medical staff have assured me that my baby girl will survive, and I will be discharged in two weeks. I was admitted with infections to the High Dependency Unit (HDU), and the doctors and nurses determined that I needed surgery and that my preterm baby had to be moved to the NICU, where she is now under specialized care and observation. The doctors allow us in to breastfeed and care for our babies,” Nabwire explained, smiling.

According to the hospital’s Executive Director, Dr Emmanuel Byaruhanga Kayongoza, Kawempe Government Referral Hospital (KGRH) is a 200-bed facility and one of the busiest maternity units in Africa. This translates to an immense workload for the hospital staff and associated resources. The hospital handles thousands of deliveries – at least 21,000 – and other emergency obstetric cases annually. On average, the hospital receives 80 expectant mothers, and 100 babies are delivered each day.

This reflects the significantly disproportionate burden of maternal and newborn mortality, with Kawempe National Referral Hospital contributing about 60 per cent of institutional maternal and perinatal mortality in the Kampala Metropolitan Area (Kampala, Wakiso, Mukono and Mpigi districts). Kampala currently records an institutional mortality rate of 222.8 per 100,000, the highest in Uganda compared with other regions. The national average stands at 38.8 deaths per 1,000 births, which is double the national average of earlier years which stood at 18.5 per 1,000 births.

For Dr Loy B. Nabirye, a neonatologist and pediatrician at Kawempe National Referral Hospital, says it is a busy routine managing a high rate of teenage pregnancies and related complications. On average, the hospital receives about 150 teenage pregnancies per week. This reflects the teenage pregnancy rate, which stood at 28 per cent for 2024–2025.

“The numbers can be overwhelming given the limited facilities and resources available. We are very grateful to the Government of Sweden, which, through the United Nations Children’s Fund (UNICEF Uganda), generously funded the remodeling and reorganization of service Neonatologist Dr Loy B. Nabirye briefs Swedish Members of Parliament on neonatal care during their visit to the UNICEF-supported Neonatal Intensive Care Unit at Kawempe National Referral Hospital, KampalaNeonatologist Dr Loy B. Nabirye briefs Swedish Members of Parliament on neonatal care during their visit to the UNICEF-supported Neonatal Intensive Care Unit at Kawempe National Referral Hospital, KampalaNeonatologist Dr Loy B. Nabirye briefs Swedish Members of Parliament on neonatal care during their visit to the UNICEF-supported Neonatal Intensive Care Unit at Kawempe National Referral Hospital, Kampaladelivery at the HDU and NICU to manage severe obstetric cases,” Nabirye stated.

Nabirye revealed that since 2019, the strong partnership with the SwNeonatologist Dr Loy B. Nabirye briefs Swedish Members of Parliament on neonatal care during their visit to the UNICEF-supported Neonatal Intensive Care Unit at Kawempe National Referral Hospital, Kampalaedish Government through UNICEF has significantly contributed to improvements in the quality-of-service delivery, ensuring better health outcomes for both mothers and their babies- All pictures By Zahara Abdul/UNICEF

“UNICEF has supported us to provide essential newborn equipment including mechanical ventilators, patient monitors, CPAP machines, radiant warmers, transcutaneous bilirubinometers, 10 baby incubators, infusion pumps and wall oxygen extension and baby cots, among others,” Nabirye said.

Some of this equipment has also been provided at Bwera General and Fort Portal Referral hospitals with the same support from Sweden through UNICEF.

To follow up on this important Official Development Assistance (ODA) from the Swedish Government, in fulfilment of the rights of the most vulnerable in the least developed countries, including children, a delegation of eight Swedish Members of Parliament and staff from UNICEF Sweden undertook a field visit to Uganda.

The MPs represented eight political parties in Sweden and included Katrina Tolgfors, Martina Johansson, Magnus Berntsson, Yasmine Eriksson, Joar Forsell, Janine Alm Ericson, Markus Kauppinen and Andreas Lennkvist Manriquez. They were accompanied by two staff members from UNICEF Sweden, Karin Strömstedt and Erik Windmar.

They were joined in Kampala by the UNICEF Representative to Uganda, Dr Robin Nandy; Dr Yaron Wolman, Chief of Child Survival and Development at UNICEF Uganda; and Adam Kahsai Rudebeck, the Counsellor, Deputy Head of Mission and Head of Cooperation at the Embassy of Sweden. During the visit, the Swedish MPs were warmly welcomed at UNICEF-supported facilities including Kawempe National Referral Hospital in Kampala, Bwera General Hospital in Kasese, Kamwenge (refugee-hosting) District, and Fort Portal Regional Referral Hospital in Kabarole District.

At Kawempe National Referral Hospital, Dr Nabirye told the visiting MPs that the facility turnover is around 650 neonates per month, meaning the hospital manages between 80 to 130 neonates daily, of which about 60 per cent are premature with low birth weight (LBW) between 0.5kg and 2.49kg. Following UNICEF support, the hospital has established a high care unit (HCU) to manage preterm babies, a high care term unit, an intermediate care unit, and a Kangaroo Mother Care Unit (KMC), achieving a survival rate of 83 per cent for preterm babies.

In Kasese, the Chief Administrative Officer, Mr Paul Walakila, told the Swedish MPs that the district is a hotspot for epidemic-prone diseases and meteorological disasters influenced by geography, climate and mobility across its porous border with the Democratic Republic of Congo (DRC). Outbreaks of Ebola, cholera and measles have occurred, while malaria and HIV remain major endemic health burdens.

Walakila noted that despite these challenges, with Sweden’s support through UNICEF, the district has procured a specialized NICU and basic maternal and newborn resuscitation equipment at Bwera Hospital. “We have also trained Village Health Teams (VHTs) and implemented robust integrated community outreach to address teenage pregnancies and gender-based violence,” he said, citing a 24-year-old grandmother whose 12-year-old daughter gave birth in Mukunyu Sub-County. He thanked the Swedish Government for enabling health reporting systems and interventions to raise community awareness about child pregnancies, gender-based violence, child abandonment and child labour, among other issues.

With support from UNICEF, the district has trained over 1,000 model parents and 5,930 adolescents in child protection, sexual and reproductive health, and life skills. Due to limited access to immunization services and harder-to-reach populations, Kasese District organizes four outreach sessions per month to provide immunization, antenatal care, nutrition education and growth monitoring for children under five. Outreach sessions are conducted jointly by health workers and VHTs, with support from the Ugandan government and development partners, including UNICEF.

The Swedish MPs visited households in Mpondwe Town Council and interacted with model parents and VHTs to understand community mobilization and the para-social services they offer in their areas of operation. In Nyabugando Ward, Ms Monica Masika, a para-social worker, was seen conducting one of the weekly VHT community health outreaches where mothers gather and are trained on preparing nutritious meals for their children, ensuring immunization and reporting cases of child abuse, neglect and gender-based violence.

The nursing officer in charge of the neonatal ward at Bwera General Hospital, Ms Doreen Mbabazi, guided the MPs on a tour of the newly constructed NICU, which has improved the treatment of children. The MPs spoke with two mothers who gave birth to preterm babies weighing 0.4 kg and 0.6 kg. Thanks to the modern equipment installed at the facility, the babies were well managed, gained weight and were discharged.

At Fort Portal Regional Referral Hospital, the MPs visited the In-Patient Therapeutic Centre (ITC), where severely malnourished children are treated and parents trained on balanced diets. Wilson Bwambale, a father of twin boys, was at the ITC receiving care for his two-year-old malnourished sons. He expressed gratitude to the MPs for the visit and for Sweden’s support in strengthening Uganda’s health systems. On-the-job mentorship and coaching for facility staff in maternal, infant, young child and adolescent nutrition (MIYCAN), Integrated Management of Acute Malnutrition (IMAM) and Baby-Friendly Health Facility Initiatives (BFHI) are provided at the hospital.

Dr Archbald Newton Bahizi Sebahire, Senior Executive Consultant at Fort Portal Regional Referral Hospital, noted that the regional infant mortality rate is 46 deaths per 1,000 live births, higher than the national average of 34 deaths. He also noted that adolescent childbearing (ages 10–19) stands at 7.2 per cent, higher than the national average of 6.5 per cent.

Dr Bahizi said the hospital plans to construct and equip a maternal-children ward complex to address infrastructure limitations and deliver patient-centred care, improving health outcomes for mothers and children. Dr Daniel Murokora, a Reproductive Health Advisor at the Ugandan Ministry of Health, told the Swedish delegation that UNICEF has also provided critical support to the Ugandan government during epidemic outbreaks such as Ebola, mpox, and Covid-19.

“We have deployed these resources in a transparent manner by establishing Water, Sanitation and Hygiene (WASH) infrastructure interventions. These interventions have helped to stem the spread of deadly diseases in Uganda and beyond,” he stated.

Scaling up and sustainability

Uganda’s Director General of Health Services, Dr Charles Olaro, thanked the Swedish Government for the continued support through UNICEF, which has helped to bridge gaps in emergency preparedness and set the stage for scaling up and ensuring sustainability in the long term.

“The UNICEF support has catalyzed reforms in surveillance, digital health and regulatory systems, and we are truly grateful. There has also been increased capacity building. We have trained managers in leadership skills and healthcare professionals in neonatal care. This has strengthened hospitals’ ability to provide sustainable, high-quality care,” Olaro told the Swedish delegation.

Dr Olaro said that for all the hospitals where UNICEF has offered support, the Government of Uganda will establish expanded, dedicated facilities for antenatal and neonatal care. Already, Kawempe National Referral Hospital has established a separate centre for pregnant teenagers to shield them from victimization and stigma.

The UNICEF Country Representative, Dr Robin Nandy, urged health providers to take advantage of the support offered by the Swedish Government to scale up services and to put plans in place to ensure sustainability in the long term.

Swedish Members of Parliament speak out

The Swedish MPs expressed satisfaction with the services being delivered as a direct result of Official Development Assistance extended to Uganda by the Government of Sweden.

“We are delighted to learn and see that with support from Sweden, the Government of Uganda is able to offer these critical health services to the citizens of Uganda, especially mothers and children. We will encourage ongoing dialogue between our two governments to ensure that support continues and is directed to the identified priority areas,” Katarina Tolgfors stated.

Janine Alm Ericson and Martina Johansson called for the scaling-up of interventions to cover as many Ugandans as possible. Magnus Berntsson and Joar Forsell expressed appreciation for the specialized care extended to child mothers to deal with post-birth stress, and the training extended to them to look after their newborn babies.

The writer is an Advocate of the High Court of Uganda , Stakeholder Engagements ,Media and Communications Consultant

Email:msserwanga@gmail.com

UNICEF-Uganda , sanitation in Rwamwanja Refugee Settlement in Kamwenge Uganda

 

How a market-based approach is delivering durable toilets, safe water and healthier futures in Uganda’s refugee-hosting district

By Moses Sserwanga

In Uganda’s refugee-hosting district of Kamwenge, Byabasambu is a selected model village where a comprehensive programme to enhance sanitation and hygiene, and promote infection prevention and control (IPC) at community level, is being implemented with the support of UNICEF Uganda.

For the last five years, communities have been mobilized in cluster model villages and sensitized to abandon the long-standing practice of open defecation. Households are encouraged to construct modern, sustainable toilet facilities under the Water, Sanitation and Hygiene (WASH) programme, which has registered tremendous success in reducing the disease burden in this remote district.

Kamwenge, which has a large refugee population accounting for about half of the 552,000 residents, has hitherto faced many challenges, and access to social services such as safe water, health care and education remains limited in many hard-to-reach areas. In response to these challenges, the Government of Uganda through district leadership championed by the Local Council V Chairman, Joseph Kalungi, is implementing the Community-Led Total Sanitation (CLTS) outreach programme, which is now transitioning to a Market-Based Sanitation Improvement Approach (MBSIA) to address slippage and foster the construction of more durable and climate-resilient sanitation structures.

Getrude Kengonzi, an environmental health officer, explained that the new MBSIA is a facilitated approach of community collective action that encourages household investment in basic improved sanitation products such as toilets, delivered through a network model characterized by sales agents (sanitation promoters), linked with well-trained and capable masons.

At his home in Kamwenge District, Godfrey Mony demonstrates how he uses a tippy-tap made from locally available materials, part of community hygiene practices promoted through WASH interventions. All pictures by Zahara Abdul/UNICEF

Grace Bonabana and Godfrey Moni are among the hundreds of community members who have embraced the MBSIA programme in the remote village of Byabasambu, Lukunyu Town Council, Kyakanyemera Sub-County, Kamwenge District. Their clean, well-maintained homesteads were among those visited by a delegation of eight Swedish MPs who have been in Uganda on a fact-finding mission to assess firsthand the impact of Official Development Assistance (ODA) extended to Uganda by the Swedish Government.

The MPs, representing eight political parties in Sweden, included Katrina Tolgfors, Martina Johansson, Magnus Berntsson, Yasmine Eriksson, Joar Forsell, Janine Alm Ericson, Markus Kauppinen and Andreas Lennkvist Manriquez. They were accompanied by two staff members from UNICEF Sweden, Karin Strömstedt and Erik Windmar. In Kamwenge, they were joined by the UNICEF Representative to Uganda, Dr Robin Nandy; Chief of Child Survival and Development, UNICEF Uganda, Dr Yaron Wolman; and the Counsellor, Deputy Head of Mission and Head of Cooperation, Embassy of Sweden, Adam Kahsai Rudebeck.

Bonabana and Moni gave moving testimonies to the visiting Swedish MPs about how their lives have been transformed by the CLTS and MBSIA UNICEF-supported interventions.

“Very few homes had sanitation facilities in this village. People used to go to the bush to ease themselves. It was open defecation for many homesteads and families. Poor sanitation led to the spread of diseases like cholera and dysentery, a gastrointestinal infection that causes severe diarrhea with fever, abdominal pain and vomiting,” Bonabana told the Swedish visitors.

Moni said the situation has since improved. “We are much better now. Most households have climate-resilient and sustainable toilets, and the disease burden is reducing. Community members can now save money to take their children to school and improve their families’ welfare,” he said.

Both Bonabana and Moni showed the visitors their newly constructed smart toilets, raised drying racks for house utensils, handwashing facilities, home-based income-generating activities such as chicken and goat rearing, and well-maintained gardens where households plant nutritious foods for their families to improve their nutrition.

For Kengonzi, the CLTS and MBSIA initiatives have been a blessing for the people of Kamwenge. “A comprehensive capacity-building programme was conducted for extension workers and community leaders to enhance local sanitation management skills. 78 masons were trained and empowered to construct sustainable and climate-resilient sanitation facilities, thereby contributing to local economic development. The programme has also improved basic sanitation services for 27,600 households through the distribution of 1,000 sato pans and community education initiatives,” she revealed.

According to Dr William Mucunguzi, Kamwenge District Health Officer and UNICEF focal person, WASH infrastructure development has led to the construction of latrine facilities in three primary schools, including provisions for menstrual hygiene management. “Latrine facilities have been constructed in two healthcare facilities, and handwashing stations installed across all stations. Chlorine generators have been installed in three healthcare facilities to ensure a safe water supply, and 29 health workers and political leaders across 30 schools have been trained to foster a culture of hygiene and infection prevention,” he said.

Impact, scaling up and sustainability

Dr Mucunguzi noted that the interventions have yielded significant positive impacts on the community, schools and healthcare facilities. He observed that with CLTS and now MBSIA, the district has progressed from 86 per cent latrine coverage in 2019 to 95.3 per cent currently.

“Through the implementation of the MBSIA approach adopted in the past two years, six sub-counties have been supported reaching 121 villages, and 27,600 households now have access to basic sanitation services. This has led to improved health outcomes and reduced incidences of sanitation-related diseases,” he added.

Kalungi thanked the Swedish Government for its continued support to Uganda, noting that it has transformed the lives of many Ugandans including vulnerable communities such as refugees. “Uganda has an open-door policy when it comes to refugees. When services like education, health, sanitation and nutrition are offered to communities, we do not discriminate between nationals and refugees. These services are accessed by everyone in the community, including refugees," he said.

“WASH interventions have reduced sanitation- and hygiene-related illnesses, including diarrheal diseases and intestinal worms. This has had a ripple effect on child development with fewer sick days, reduced malnutrition and improved cognitive performance, especially in early childhood,” he added.

The creation and training of village sanitation promoters, sanitation entrepreneurs and VHTs has established a grassroots mechanism for ongoing hygiene promotion. The training of local masons and the active engagement of the community have fostered a sustainable approach to sanitation.

“The construction of latrine facilities and healthcare facilities in schools has elevated hygiene standards, promoting the health and well-being of students and patients. We have formed and trained water boards, and Kamwenge is now a district water authority. To ensure continuity and scaling up of services, district officials are also training mechanics in the operation and maintenance of water systems; training school health clubs in menstrual health and liquid soap making; and strengthening school management structures on WASH. We are encouraging the formation, training and transformation of masons’ associations into economic enterprises to ensure sustainability,” Kalungi said.

UNICEF-supported sanitation, therefore, have significantly improved the health, safety and dignity of children and communities in Kamwenge District. However, for the district to consolidate these gains and achieve universal access to basic sanitation, further investment and partnership will be essential. UNICEF’s catalytic role has demonstrated scalable impact and laid a strong foundation for sustainable WASH systems.

The writer is a Media and Communications Consultant/ Advocate of the High Court of Uganda

Editor;msserwanga@gmail.com