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Journal of Refugee Studies Advance Access originally published online on March 31, 2006
Journal of Refugee Studies 2006 19(2):158-186; doi:10.1093/jrs/fej019
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Journal of Refugee Studies Vol. 19, No. 2 © The Author [2006]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Articles

Protracted Refugee Situations: Parallel Health Systems and Planning for the Integration of Services

Elizabeth A. Rowley1, Gilbert M. Burnham1 and Rabbin M. Drabe2

1 Center for Refugee and Disaster Response, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore MD 21205, USA erowley{at}jhsph.edu
2 District Director of Health Services, Adjumani District, Uganda

The international community typically responds to refugee situations by establishing ‘care and maintenance’ programmes specifically for refugees. Limited resources may also be directed to hosting communities, but donors often channel the bulk of funding through UNHCR and its implementing partner NGOs, who in turn create service delivery structures that are operated in parallel to local structures. Although there may be cause for this approach in a short-term emergency phase, particularly if the host country systems are very weak, this eventually becomes financially problematic if refugees continue to live in exile for years at a time. In the short term, it can also engender an inequitable and inefficient use of scarce resources. This paper traces the evolution and impact of implementing refugee health services in parallel to local systems using observations from Uganda, and offers Quality Design as a model for planning the local integration of services.

Key Words: protracted refugee situations • integration of services • health service delivery • northern Uganda • southern Sudan


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