PAGE 1: COVER & INTRODUCTION
INCLUSIVE RCCE: ENSURING NO ONE IS LEFT BEHIND
A Practical Framework for KCCA Health Security
KCCA RCCE Learning Platform | Module 3
Introduction:
Inclusive RCCE is not a separate activity. It’s the foundation of ALL effective RCCE. When we intentionally design for inclusion—considering literacy levels, disabilities, languages, digital access, gender dynamics, cultural beliefs—our messages reach more people, behavior change improves, and health outcomes are better.
This reading covers:
- The 5 Principles of Inclusive RCCE
- Kampala’s 10 Vulnerable/Marginalized Populations
- Accessibility Dimensions (Physical, Linguistic, Sensory, Digital, Cognitive)
- Designing for Inclusion: Practical Steps
- Case Studies: What Works in Kampala
PAGE 2: THE 5 PRINCIPLES OF INCLUSIVE RCCE
PRINCIPLE 1: INTENTIONALITY
Inclusion doesn’t happen by accident. You must PLAN for it.
In Practice:
- When designing RCCE, ask: “Who might we miss? Who faces barriers?”
- Conduct accessibility audit: “Can persons with disabilities access our materials?”
- Budget for inclusion: translation costs, sign language interpretation, accessible venues
Example:
❌ NOT Intentional:
“We’ll do a radio campaign in English and Luganda—that reaches most people.”
✓ Intentional:
“We’ll do radio in English and Luganda (reaches 80%), PLUS:
- Somali radio spots (for refugees)
- Sign language videos (for Deaf community)
- Simple visual posters with symbols (for low-literacy)
- Community meetings with interpretation (for languages not on radio)
- SMS in multiple languages (for those without radio access)”
PRINCIPLE 2: PARTICIPATION
Communities aren’t just recipients of information—they’re partners.
In Practice:
- Consult affected populations: “How do YOU want information?”
- Co-create messages: “Does this message make sense to YOU?”
- Engage community leaders from marginalized groups
Example:
❌ NOT Participatory:
Health officials design Mpox messages, print posters, distribute to refugee settlement.
✓ Participatory:
Health officials meet with refugee community leaders, ask: “What concerns do you have about Mpox? How should we communicate?” Together they:
- Co-create messages in Somali
- Train refugee peer educators
- Deliver information through trusted imams
PRINCIPLE 3: ACCESSIBILITY
Information and services must be physically, linguistically, and cognitively accessible.
PHYSICAL ACCESSIBILITY:
- Venues have ramps, wide doors, accessible toilets
- Distribution points within walking distance
- Meetings held at times people can attend
LINGUISTIC ACCESSIBILITY:
- Materials in multiple languages (English, Luganda, Swahili, Somali, French, Arabic)
- Plain language—avoid jargon, use short sentences
- Visual communication (pictures, symbols) for non-literate
SENSORY ACCESSIBILITY:
- Audio for blind persons; visual for Deaf persons
- Sign language interpretation at events
- Large print for low vision; Braille for blind persons
DIGITAL ACCESSIBILITY:
- SMS for those without smartphones
- USSD codes (work on basic phones)
- Offline materials (not everyone has internet)
- Mobile-friendly formatting
COGNITIVE ACCESSIBILITY:
- Simple, clear messages (not complex medical terminology)
- Repeated messaging (reinforcement)
- Multiple channels (so people encounter message several times)
PRINCIPLE 4: NON-DISCRIMINATION
Everyone receives respectful, dignified treatment.
In Practice:
- Challenge stigma in messaging
- Train health workers on respectful communication (no judgment toward sex workers, LGBTQ, refugees)
- Ensure equal access (refugees receive same services as citizens)
Example:
❌ Discriminatory:
HIV prevention showing only heterosexual couples (excludes LGBTQ)
✓ Non-Discriminatory:
HIV prevention says “everyone at risk” and shows diverse couples/individuals
PRINCIPLE 5: CONTINUOUS LEARNING
Inclusion is ongoing, not a checklist.
In Practice:
- Collect feedback: “Did our messages reach you?”
- Monitor exclusion: “Who didn’t show up? Why?”
- Adapt based on learning
Example:
After distributing cholera materials:
- Blind community didn’t receive (materials only printed)
- Refugee women didn’t attend meetings (needed childcare)
- Youth ignored posters (prefer TikTok)
Response (Continuous Learning):
- Create audio versions
- Provide childcare at meetings
- Develop TikTok content
PAGE 3: KAMPALA’S 10 VULNERABLE/MARGINALIZED POPULATIONS
| Population | Size/% | Key Barriers | RCCE Implications |
| Persons with disabilities | 15% (280,000+) | Physical barriers, sensory barriers, stigma | Accessible venues, sign language, alternative formats (audio, large print, symbols) |
| Refugees/asylum seekers | 50,000 | Language barriers, legal insecurity, distrust of authorities | Multilingual materials, partner with refugee leaders, culturally-appropriate messengers |
| Street-connected children/homeless | 10,000+ | No fixed address, no phone access, fear of authorities | Reach at hangout spots, peer educators, trusted community organizations |
| Elderly persons | Growing % | Mobility challenges, limited phone/internet access, isolated | Community meetings, radio (trusted source), door-to-door through VHTs |
| Sex workers | 5,000-10,000 | Stigma, fear of law enforcement, marginalization | Peer educators, non-judgmental messaging, confidential channels |
| LGBTQ persons | Unknown (hidden) | Criminalized, stigmatized, fear of exposure | Peer networks, discreet channels, affirming language |
| Informal settlement residents | 60% (1.1M) | Limited WASH, health access, low literacy, informal leadership | VHTs as trusted messengers, visual materials, community-led solutions |
| Women & girls | 50% (940,000) | GBV, limited decision-making power, reproductive health needs | Gender-specific messaging, women’s groups, address power dynamics |
| Religious/ethnic minorities | Varies | Discrimination, cultural distinctiveness | Engage religious leaders, respect cultural practices, avoid stereotyping |
| Low-literacy/non-literate | 40% adults | Can’t read written materials | Oral communication, visual materials, trained community messengers |
PAGE 4-5: ACCESSIBILITY DIMENSIONS IN DEPTH
1. PHYSICAL ACCESSIBILITY
Barriers:
- No wheelchair ramps
- Distribution points too far
- Meetings during work hours
Solutions:
- Audit venues for accessibility
- Locate services within communities
- Offer multiple meeting times
2. LINGUISTIC ACCESSIBILITY
Barriers:
- English/Luganda only
- Complex medical terminology
- Assumed literacy
Solutions:
- Translate to Somali, Swahili, Arabic, French
- Use plain language (6th-grade reading level)
- Use visuals/symbols
- Oral communication options
3. SENSORY ACCESSIBILITY
Barriers:
- Radio-only information (excludes Deaf)
- Posters only (excludes blind)
- No captioning on videos
Solutions:
- Sign language interpretation at meetings
- Audio descriptions for materials
- Large print/Braille
- Video captions
- Multiple format options (print, audio, video, visual)
4. DIGITAL ACCESSIBILITY
Barriers:
- 50% without smartphones
- 30% lack reliable electricity
- Limited internet connectivity
Solutions:
- SMS AND WhatsApp (not just digital)
- USSD codes (work on basic phones)
- Offline downloadable materials
- Print materials at key locations
- Radio remains critical
5. COGNITIVE ACCESSIBILITY
Barriers:
- Complex messages
- Too much information at once
- Assumed prior knowledge
Solutions:
- Simple, clear messages
- One idea per sentence
- Repeat key messages
- Multiple exposures through different channels
PAGE 6: DESIGNING FOR GENDER INCLUSION
Why Gender Matters in RCCE:
Women face specific barriers to health information and services:
- Limited mobility due to household responsibilities
- Controlled access to money/phones
- Less formal education
- Reproductive health needs
- Gender-based violence
Inclusive RCCE for Women:
- Include women in decision-making (not just messaging TO women)
- Address women’s actual barriers (childcare, time, money)
- Engage women’s groups (savings groups, mothers’ associations)
- Use female messengers
- Address power dynamics (husbands, in-laws controlling decision-making)
- Messages focused on women’s agency (“You can protect your children”)
Example:
❌ Not Gender-Inclusive:
“All adults should get vaccinated”
✓ Gender-Inclusive:
“Mothers: Getting vaccinated protects you and your children. Talk to your husband/partner. Bring your children for vaccination on Saturdays 8am-2pm at Kawempe Health Center. Free service.”
(Addresses: agency, power dynamics, concrete time/location, framing for women’s priorities)
PAGE 7: DESIGNING FOR DISABILITY INCLUSION
Types of Disabilities:
- Physical: Mobility, paralysis, amputations, chronic illness
- Sensory: Blindness, low vision, Deafness, hard of hearing
- Intellectual: Cognitive disabilities, developmental delays
- Psychosocial: Mental health conditions
- Hidden: Chronic disease, mental health conditions that may not be visible
Barriers to Information:
- Physical barriers (inaccessible venues, no transportation)
- Sensory barriers (no sign language, no audio descriptions)
- Communication barriers (complex language)
- Stigma (assumptions about capability)
- Exclusion from planning (not asked what they need)
Inclusive RCCE for Persons with Disabilities:
✓ Physical Disabilities:
- Accessible venues (ramps, wide doors, accessible toilets)
- Flexible timing
- Transportation support if needed
✓ Blind/Low Vision:
- Audio versions of materials
- Large print
- Screen reader-compatible digital materials
✓ Deaf/Hard of Hearing:
- Sign language interpretation (certified interpreters)
- Captions on videos
- Visual demonstrations
- Written information
✓ Intellectual Disabilities:
- Very simple language
- Visual supports (pictures, symbols)
- Repetition
- Small group communication
✓ Psychosocial Disabilities:
- Quiet, low-stress environment
- Flexible timing
- Trauma-informed communication
- Peer support
Key Principle: Ask persons with disabilities what they need—don’t assume.
PAGE 8: DESIGNING FOR REFUGEE/MIGRANT INCLUSION
Barriers:
- Language: Multiple languages in refugee population (Somali, Arabic, Kirundi, Kinyarwanda, DRC languages)
- Legal insecurity: Fear of authorities if undocumented
- Distrust: Previous government persecution
- Cultural differences: Different health beliefs, practices
- Limited access: Excluded from some services
- Trauma: Conflict-related trauma may affect health-seeking
Inclusive RCCE for Refugees:
✓ Language:
- Identify most common languages in your area
- Partner with interpreters from refugee community
- Use multilingual materials (at least 5 languages in Kampala: English, Luganda, Swahili, Somali, Arabic)
✓ Trust-Building:
- Partner with refugee community leaders (not just government)
- Use refugee peer educators
- Ensure non-enforcement presence (health, not police)
- Respect cultural practices
- Formal agreements with refugee leaders
✓ Access:
- Services available to ALL (documented and undocumented)
- Clear communication about documentation requirements (if any)
- No deportation threats
✓ Cultural Appropriateness:
- Understand health beliefs (may differ from Western medicine)
- Involve traditional healers/religious leaders
- Respect family decision-making structures
- Gender-appropriate communication (some cultures require same-gender messengers)
PAGE 9: KAMPALA CASE STUDY – WHAT WORKS
Example 1: Cholera Prevention in Bwaise (Informal Settlement)
The Challenge:
- 40% adult illiteracy
- 15+ languages spoken
- High population density
- Limited WASH infrastructure
- Distrust of government
Inclusive RCCE Response:
- Used VHTs as messengers (community members, trusted)
- Simple visual posters (no reading required—cholera symptoms shown in images)
- Community meetings (not just radio)
- Somali-speaking VHT for Somali-speaking families
- Demonstrations (showing handwashing, water treatment) instead of lectures
- Free handwashing stations in market (addressed barrier)
- Free water treatment tablets (addressed barrier)
Result:
- Message comprehension >80% (vs. 40% for radio-only approach)
- Behavior change achieved
- Zero cholera outbreak (prevention worked)
Example 2: Ebola Preparedness with Refugees (Makindye Settlement)
The Challenge:
- Refugees fearful of authorities (deportation concerns)
- Multiple languages (Somali, Arabic, Kirundi, French)
- Limited trust in government
- Economic pressure (need to keep working/trading)
Inclusive RCCE Response:
- Partnership with refugee community leaders (not just KCCA)
- Refugee peer educators (same language, trusted)
- Adapted messaging: “You can work safely AND protect yourself” (addressed economic barrier)
- Practical advice specific to refugee occupations (market vendors, transporters, etc.)
- Religious leaders engaged (respected influencers)
- Visual materials (symbols, no text)
- Pre-agreed decision-making process (community leaders involved)
Result:
- High engagement and trust
- Behavior change adoption
- No Ebola cases; readiness maintained
PAGE 10: DESIGNING YOUR INCLUSIVE RCCE – STEP BY STEP
Step 1: Identify Vulnerable Populations in YOUR Setting
- Which of the 10 populations exist in your division/area?
- What specific barriers do they face?
- Who are the trusted messengers/leaders?
Step 2: Conduct Accessibility Audit
- Physical: Can people with mobility challenges access venues?
- Linguistic: What languages are spoken?
- Sensory: Can Deaf/blind people access information?
- Digital: What’s realistic (phone access, electricity)?
- Cognitive: How complex is the language?
Step 3: Adapt RCCE for Each Population
- Message content (what do THEY need to know?)
- Messenger (who do THEY trust?)
- Channel (how do THEY access information?)
- Format (what format works for THEM?)
- Participation (how can THEY provide input?)
Step 4: Engage, Don’t Assume
- Ask communities: “What works for you?”
- Test materials with actual audience
- Iterate based on feedback
- Celebrate what works
Step 5: Monitor & Evaluate
What would improve it?
Did the message reach vulnerable populations?
Did they understand it?
Did behavior change?