The Center for Reproductive Rights and CARE International in Uganda today released their report on the pilot program they launched in 2019 to improve the delivery of sexual and reproductive health and rights (SRHR) services at one of Uganda’s largest refugee settlements.

This innovative program at the Pagirinya settlement in Adjumani combined a human rights-based approach with community-led mechanisms to establish an accountability system for SRHR violations. The district serves over 245,000 refugees from South Sudan and the Democratic Republic of Congo and a host population of 237,400.

According to the report, Implementing Rights-based Accountability for Sexual and Reproductive Health and Rights in Humanitarian Settings: Good Practice Case Study from Adjumani District, Northern Uganda, the approach succeeded in bringing refugee and host women and girls closer to decisions that impact their lives and provided a pathway to solutions for complex SRHR issues in humanitarian settings.

“Implementation of international human rights law and principles through rights-based accountability mechanisms is a key element to improving sexual and reproductive health outcomes and preventing maternal morbidity and mortality in humanitarian contexts,” said Grady Arnott, Manager of Legal Research at the Center.

Evidence from the pilot program demonstrates that:

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• Intersectional discrimination undermines access to sexual and reproductive health (SRH) services and disproportionally impacts those most marginalized.
• Access to quality SRH services and information is crucial to the realization of human rights.
• At all stages of policy and planning, full and meaningful participation by refugee and host women and girls is critical for accountability.
• Institutionalizing accountability mechanisms at the level of response enhances the delivery of health services and strengthens humanitarian and health systems.

“Through the accountability mechanism, people knew their rights so they could demand services at the health facility and for the services to be of quality… and when problems were being addressed the clients were able to increase in number in accessing the SRH services.”

Pagirinya refugee settlement duty-bearer

Recommendations for States and Stakeholders

The report outlines recommendations for states and humanitarian stakeholders to follow to advance accountability for SRHR:

• Respect, protect and fulfill the human rights, including SRHR of women and girls in humanitarian settings.
• Recognize accountability as a human rights obligation, core human rights principle, and essential element of ensuring access to available, accessible, acceptable, quality, and non-discriminatory SRH services and information in humanitarian settings.
• Eliminate barriers and increase the participation of women and girls at all levels of decision-making within humanitarian response.
• Institutionalize and strengthen participatory, community-led and rights-based accountability mechanisms within humanitarian and host health systems delivering SRH services; and advance the evidence for those mechanisms to inform best practices for which strategies, policies, and actions.
• Invest dedicated and sustained resources through official development assistance and cooperation for establishing and maintaining these accountability mechanisms to meet demands for essential SRH services

Read the full report here:

• Implementing Rights-based Accountability for Sexual and Reproductive Health and Rights in Humanitarian Settings: Good Practice Case Study from Adjumani District, Northern Uganda

“Our role in the community is to make sure we give awareness of sexual and reproductive health and that women are aware of their rights… (we) are now empowered in leadership. When we collect the complaints from the community, now they go to the ombudsperson. As a result, our complaints are always collected and feedback given.”

Women’s representative on Council for SRHR

Read more:

• Accountability for Sexual and Reproductive Health and Rights in Humanitarian Settings: Examining the Role and Relationship of Diverse Branches of International Law. This technical paper examines obligations under international law and commitments made by states at the UN regarding access to sexual and reproductive health information and services for civilians in humanitarian settings, including in armed conflict.
• Human rights-based accountability for sexual and reproductive health and rights in humanitarian settings: Findings from a pilot study in northern Uganda. This peer-reviewed article, published in “PLOS Global Public Health Journal” examines the pilot program’s methodology and was co-authored by Grady Arnott and Beatrice Odallo from the Center and Charles Otema, Godfrey Obalim, Teddy Nakubulwa, and Sam B. T. Okello of CARE International.