Pastoralist communities in Uganda face some of the worst health indicators, with HIV, malnutrition, maternal health challenges, and mental health disorders being major public health concerns. The HIV prevalence rate in pastoralist districts of Uganda is estimated at 8%, nearly doubling the national average of 5.1%, driven by mobility, low healthcare access, and cultural practices that increase vulnerability. Limited awareness and stigma prevent many pastoralists from seeking HIV testing, treatment, and prevention services. Additionally, Malnutrition rates among pastoralist children (0-5 years) remain high, with over 35% experiencing stunted growth due to food insecurity, prolonged droughts, and poor dietary diversity. Seasonal food shortages further expose pastoralist households to acute hunger, disproportionately affecting pregnant women, children, and the elderly.
Maternal health services remain a critical challenge for pastoralist mothers, facing some of the highest maternal and infant mortality rates in Uganda. The lack of skilled birth attendants in these communities, emergency obstetric care, and antenatal services forces many women to give birth at home under unsafe conditions. Long distances to health facilities and harmful traditional practices further increase the risks, leading to avoidable maternal deaths and complications.
Mental health remains an overlooked crisis, with pastoralist youth and women facing high levels of psychological distress due to economic hardship, displacement, and gender-based violence. Despite the growing burden. With only 1 psychiatrist per 1 million people in Uganda, mental healthcare remains out of reach for those in remote cattle-keeping communities.
Access to general healthcare is further worsened by poor infrastructure and mobility challenges, leaving many pastoralist families with limited or no access to essential health services, including vaccinations, malaria prevention and treatment, and emergency care.
The health program at RIWE_AFRICA seeks to improve access to affordable and quality healthcare services for pastoralist communities in Uganda. This includes health promotion, disease prevention, and addressing the unique healthcare needs of pastoralists. RIWE_AFRICA partners with healthcare providers, community health workers, and the District Local Governments to ensure that healthcare services reach the most vulnerable pastoralists in need.
Working with the pastoral communities, we advocate for equitable healthcare policies and focus on community-based healthcare models that integrate innovative preventive and treatment health and culturally relevant healthcare solutions. Our efforts aim to build the capacity of local health systems, enhance community health education, and ensure that marginalized groups, especially women and children, receive the healthcare they deserve both at the health facilities and the community level.
We primarily target pregnant women pastoralists, pastoralists living with HIV, both children and adults, adolescent youths, children (0–5 years), persons with disabilities, and survivors of sexual violence. These face the greatest barriers to accessing quality healthcare services and are prone to suffering from the mentioned diseases.
Project Title: SAFE GIRLS Project
Implementation period: Nov 2024 – Sep 2027.
Funder: Dovetail Impact Foundation unrestricted Grant (15% of the grant allocated to the project)
Other Partners:
Health facilities
Geographic Coverage:
Ntoroko District Pastoralist communities
Target Population:
Adolescent girls and boys aged 10–24, with a primary focus
Project Goal
To empower pastoralist adolescents, especially girls, through safe, community-based learning spaces that strengthen SRHR knowledge, decision-making skills, confidence, and supportive environments for healthy transitions into adulthood.
Project Objectives
To provide safe, structured learning spaces where adolescents receive accurate, age-appropriate SRHR information.
To strengthen adolescents’ SRHR knowledge, confidence, and decision-making, particularly for girls at risk of early marriage, school dropout, and teenage pregnancy.
To reduce stigma and harmful cultural norms surrounding menstruation, puberty, sexuality, and open SRHR conversations.
To improve school attendance and retention among girls by promoting menstrual health management and positive peer support.
The SAFE GIRLS Project is a community-led initiative designed to empower adolescents, particularly girls, in pastoralist communities, thereby strengthening access to Sexual and Reproductive Health and Rights (SRHR). The project uses Community Health Clubs (CHCs) as the primary platform where adolescents regularly meet, learn, and build confidence in a safe, supportive environment.
The Community Health Clubs function as safe spaces where adolescents aged 10–24 meet for structured weekend sessions facilitated by trained SRHR Facilitators. Through these clubs, girls and boys receive age-appropriate Comprehensive Sexuality Education (CSE) that covers menstrual health, bodily autonomy, consent, healthy relationships, personal safety, and decision-making skills. The CHCs encourage open dialogue, allowing adolescents to ask questions that are often difficult to raise at home or school due to stigma, fear, or cultural restrictions. The learning approach is interactive, culturally respectful, and tailored to the real-life challenges faced by pastoralist adolescents.
To ensure accuracy and linkage to services, the project integrates health workers who provide youth-friendly SRHR guidance and referrals. Parents, cultural leaders, and community influencers are engaged through targeted dialogue sessions, helping dismantle taboos and strengthen community support for adolescent health education.
Through the SAFE GIRLS Project, RIWE_AFRICA has to date established 12 active Community Health Clubs in Rwebisengo and Bweramule Sub-counties, reaching over 280 adolescents. Each club operates on a 3-month cycle, meeting for 1–2 hours on weekends to avoid interfering with school activities.
The CHCs have become vital learning centers where adolescents gain knowledge, build self-esteem, resist harmful practices such as early marriage, and develop the confidence needed to stay in school and pursue opportunities with dignity.
Project Title: Briding the Birth Gap in Uganda’s Karamoja region.
Implementation Status: Ongoing
Funder: Laerdal Foundation
Partners:
Moroto and Nakak Districts.
Health Facilities
Geographic Coverage: Moroto and Napak
Target Population: Pregnant mothers, newborns, and frontline community health workers (VHT-Mentor Mothers, Midwives, and TBAs
To reduce preventable maternal and newborn deaths among pastoralists through strengthening community-led emergency care systems and improving timely access to skilled health services during pregnancy, childbirth, and the postnatal period.
Strengthen the capacity of frontline health providers (VHTs, TBAs, and midwives) through simulation-based training in maternal and newborn emergency care.
Increase community knowledge, preparedness, and demand for safe maternal and newborn practices through inclusive health education, women’s group engagement, and male involvement.
Assess the effectiveness and implementation of an integrated community–facility maternal and newborn health model, and to inform district-level learning, decision-making, and potential scale-up.
In pastoralist communities of Uganda’s Karamoja region, the journey to motherhood is often marked by significant risks. Long distances to health facilities, limited transport options, recurrent climate and livelihood shocks, and continued reliance on home deliveries often supported by Traditional Birth Attendants, expose mothers and newborns to preventable complications and deaths. Many women give birth without timely access to skilled care.
The Bridging the Birth Gap project responds to these challenges through an integrated, community-centred maternal and newborn health model that strengthens both community and facility-level systems, improves coordination, preparedness, and emergency response during childbirth.
The project equips midwives, Transitional Birth Attendants (TBAs), village Health Teams (VHTs), and Midwives with internationally recognized simulation-based training packages:
Helping Mothers Survive (HMS) – managing postpartum hemorrhage, complications in labor, preeclampsia, and obstetric emergencies
Helping Babies Breathe (HBB) – resuscitation and stabilization of newborns
These trainings improve the ability of the service providers to identify danger signs, manage complications, and initiate appropriate emergency care.
To address delays in referrals, which is one of the biggest contributors to maternal deaths, RIWE_AFRICA designed the Facility–Community Encounter (FACE) Tracker, a digital system linking VHTs and TBA (in the community) directly to midwives ( at the health facility).
Using smartphones:
VHTs identify maternal-related emergencies or cases and refer them to health facilities through the FACE tracker app tool.
Midwives receive instant alerts about the referral and make instant follow-ups
Health facilities prepare before the mother arrives
The mindwive records the feedback in the system and any support provided to the mother.
This innovation has improved rapid response and reduced delays. It has also improved coordination between community and facility-level care.
Even when emergencies are identified early, distance and transport costs often prevent mothers from reaching a health facility. To overcome this, the project provides emergency transport vouchers to vulnerable mothers. These vouchers ensure that no mother is denied care simply because she cannot afford transport. This promotes equity for those in remote pastoralist communities.
Community engagement is a cornerstone of the project. Through the Participatory Community women’s group, RIWE_AFRICA reaches mothers with vital information on antenatal care, safe childbirth, newborn care, and emergency preparedness. This engagement helps shift harmful norms, strengthens community responsibility, and increases demand for skilled birth attendants
