Challenges and advances in delivering healthcare to the Batwa: hearing from the Bwindi Community Hospital

In 2006, the Ugandan Coalition of Civil Society Organizations made a grave warning about the Batwa, a 60,000-year-old indigenous people: they were in danger of extinction.

Dispossession of their ancestral forest home has had a disastrous impact on their lifestyle, and their spiritual ties with the forest have been damaged. They have endured many other human rights violations, and their politically neglected status dramatically adds to their marginalization. They number only about 6,700 (IWGIA, Indigenous World 2020: Uganda), and their access to services such as education and health is fragile.
The Bwindi Community Hospital is a non-profit hospital that offers preventative and curative services to over 100,000 people. It operates under highly challenging conditions, but they're always looking to do more and better for the community. They have been providing healthcare to the Batwa, and our partnership with them has helped bring about very positive changes for this unique community. Read what the hospital had to say about the outcomes of the project.

What concrete short-term, medium-term and long-term results do you hope to achieve with this healthcare action for the Batwa community?

Concrete short-term results:
- Building a well-facilitated team of community health volunteers within the Batwa population to help monitor health indicators among this population. Over 95% of community health volunteers now have basic equipment and materials to monitor health indicators (mainly malnutrition) and help with effective health promotion.
- Direct Batwa involvement in improving their own health, i.e., at least 80% of the Batwa community health volunteers are now engaged in health promotion in their local communities and will have refresher training each year.
- Delivering regular Batwa-integrated health outreaches to over 95% of the Batwa settlements.
- Monitoring health indicators among the Batwa, such as immunization status of children under five, prenatal care, healthcare facility delivery, nutrition status for children under five and sanitation.
- Specific attention to psychosocial issues among the Batwa with active mental health issues and improved access to mental health care.
- Ongoing hand-washing coverage at over 95%.
- Ongoing collaboration with other Batwa stakeholders.

Concrete medium-term results:
- Increase health care unit deliveries from 95% to 99%.
- Increase immunization completion rate from 93% to 95%.
- Reduce malnutrition cases from 4% to less than 1% among Batwa children under five.
- Develop Batwa involvement in managing their health.
- Have a healthy Batwa population that is mindful of their health and free from preventable diseases.
- Have 80% of Batwa people with psychosocial issues attended to by mental health care infrastructure.

Concrete long-term results:
- Increase latrine coverage from 78% to 90%.
- Improve health among the Batwa.

Does the Batwa community have specific needs different from the rest of the population of this area? What are they? Why is that?

The Batwa community does have specific needs different from the rest of the population.

Housing
Most still live in semi-permanent houses, which increases the risk of skin infections. This happens because of their low economic status and a cultural habit of moving from one place to another. As a result, some even end up abandoning well-structured housing and moving to other settlements.

Poverty
Most of them are below the poverty line as compared to the rest of the population. This impacts other indicators negatively, like education and nutrition. The reason for this has to do with a culture of not getting involved in business or income-generating activities, i.e., they believe in living in the present and don't save for the future.

Education
Most Batwa drop out at a low education level. This makes it much harder for them to secure employment anywhere in Uganda. Cultural issues that include early marriages and lack of support for education also have a significant impact.

Health seeking behavior
They only come to the hospital when they are already severely ill. This is due to the cultural behavior of first seeking local remedies and the fact that sometimes they don't have the money to purchase the necessary items, such as soap.

What are the greatest challenges BCH now faces?

The biggest challenges have to do with funding and staff turnover.

Learn more about our partnership with the Bwindi Community Hospital to provide healthcare to the Batwa.