A Health System That Kept a Girl in School
In Luwero District, about 70 kilometres north of Kampala, a 17-year-old girl became pregnant and quietly assumed her education was over. She did not tell her teachers. She did not visit a health facility. She simply stopped going to school.
It was a community health worker trained by Samasha Medical Foundation who found her. Through a routine household visit, the health worker identified the girl, connected her to antenatal care, and worked with her family and school to ensure she could return to classes after delivery. Today, she is in Senior 4, continuing her education.
Samasha Medical Foundation was established in 2017 to address the chronic gaps in sexual and reproductive health services in Eastern Uganda. The region has some of the highest rates of teenage pregnancy, maternal mortality, and unmet need for family planning in the country, yet it remains underserved by both government health systems and international NGOs.
Samasha's model is built on community health workers, locally recruited individuals who are trained to provide basic health education, referrals, and follow-up care within their own communities. These workers are not medical professionals. They are neighbours, parents, and community members who understand the social dynamics that shape health-seeking behaviour in their areas.
"The health system doesn't reach everyone. But our community health workers do. They know every household, every family, every girl who has stopped going to school."
What makes Samasha's approach effective is not just the technical training its health workers receive, but the trust they hold within their communities. In areas where formal health services are associated with cost, distance, and stigma, community health workers offer an alternative entry point, one that is free, local, and familiar.
Samasha has trained over 150 community health workers across Luwero, Nakaseke, and Kayunga districts. These workers conduct household visits, facilitate community dialogues on SRHR, and provide referrals to health facilities for services including family planning, antenatal care, and post-rape care. They also play a critical role in identifying and supporting adolescents who have dropped out of school due to pregnancy or early marriage.
Samasha's growth was supported by a multi-year partnership with an international reproductive health organisation that provided funding, training, and mentorship. That partnership allowed Samasha to develop its community health worker curriculum, establish referral pathways with district health facilities, and build a monitoring system to track outcomes.
The results were significant. In the districts where Samasha operates, the number of adolescents accessing antenatal care increased, school re-entry rates for pregnant girls improved, and community awareness of SRHR rights grew measurably. Samasha became a trusted partner of district health teams and was increasingly invited to contribute to local health planning processes.
In 2025, the international partner that had supported Samasha's work restructured its global operations and withdrew from Uganda. The transition was not planned in advance. There was no formal exit strategy, no bridge funding, and no structured process for transferring the technical support that had been embedded in the partnership.
Samasha's leadership was left to manage the transition alone. Community health workers who had been receiving small stipends were told there was no budget to continue payments. Training programmes were paused. The monitoring system, which had been maintained with support from the international partner, became difficult to sustain.
The organisation has not closed. Its founder continues to lead the work, and many community health workers continue to operate on a voluntary basis. But the infrastructure that was built, the training systems, the referral pathways, the data collection, is at risk of eroding without sustained support.
Samasha's story is a reminder that the most effective health systems in underserved areas are often the ones that are least visible to international funders. They are built on relationships, not technology. They are sustained by trust, not contracts. And they are led by people who will continue to show up, even when the funding stops, because the communities they serve are their own.
But showing up is not enough. Organisations like Samasha need the kind of sustained, flexible support that helps them build the internal systems, governance, and fundraising capacity to survive and grow on their own terms. That is the work Third Sector Builders was created to do.