Football as a gateway to student mental health in Uganda

According to the World Health Organization and UNICEF, one in seven people aged 10 to 19 have a mental health disorder, and half of all disorders that develop during a lifetime occur before the age of 18. In low- and middle-income countries, the number of childhood mental health professionals remains well below one per 100,000 children, making care based solely on specialist consultations difficult to scale-up (WHO and UNICEF, Mental health of children and young people: service guidance, 2024).

School is one of the few places where public systems meet almost all adolescent girls on a regular basis. The WHO and UNESCO have made this a focus of their prevention strategy, inviting States to integrate health promotion into schools' day-to-day operation (WHO and UNESCO, Making every school a health-promoting school: implementation guidance, 2021).

In Uganda, the Ministry of Health adopted guidelines on mental health for children and adolescent girls in 2017, which set out prevention measures in schools (Uganda Ministry of Health, 2017). However, implementing them remains limited in schools with the most vulnerable populations. A survey of 889 high school students in Kampala describes low to medium knowledge of mental health and significant stigma faced by those concerned, two factors that hinder asking for help (Nantumbwe Z, Kasujja R, Schomerus G. (2026)). Another study conducted in the capital measured a notable prevalence of symptoms of depression and anxiety among adolescents (Mbithi G, Sarki A, Mabrouk A, Odhiambo R, Namuguzi M, Atukwatse J, Kabue M, Mulupi S and Abubakar A (2025)). In dense neighborhoods, this results in dropouts, conflicts, risky consumption or simply silent withdrawal, with girls more exposed to silence and boys under pressure to show nothing.

Over four years in the field, Watoto Wasoka has developed a method called BUREF ( Building Resilience through Football), which uses football as an entry point to speaking up. The approach is organized around three pillars: play, a non-stigmatizing approach to sensitive subjects; peers, the first ones able to spot a fellow classmate in difficulty; and referral pathways to suitable services. Each session alternates between structured play time and a guided discussion on a specific topic: emotions, stress, inclusion, mutual support, in an identically repeated sequence (Play, Reflect, Learn, Act) which means it can be transmitted to non-specialists. It was first tested outside school, with more than 5,000 young people aged 8 to 17 in Kampala and Wakiso, and then in four schools with nearly 800 students.

The FID-supported project is rolling out this approach to ten schools, where a mental health club meets twice a week for one hour during the time already scheduled for extracurricular activities. It is led by six trained students, three girls and three boys, chosen by their fellow students for their trustworthiness, and supervised by two teachers appointed by management, who ensure supervision and continuity between two sessions.

The project team provides manuals, initial training, a refresher halfway through and monthly supervision visits, as well as written child protection procedures and referral pathways to health facilities. The initiative uses the rooms, grounds and staff already in place, without a parallel infrastructure, which determines its cost-effectiveness and whether educational authorities would potentially take charge of it.

• Operationally, 3,000 students aged 12 to 18 will participate in the clubs at ten public schools in Kampala, with twenty designated teachers and sixty trained and supervised facilitator students, and operational child protection procedures in each school.
• In terms of data, the project will measure the quality of the implementation, how student well-being has changed, how well schools have integrated it, and the actual cost of the model, in order to potentially build an intervention impact assessment protocol.
• At institutional level, the lessons will be presented to the Ministry of Education and Sports, the Ministry of Health and the educational services of Kampala, in the form of a revised manual and scale-up roadmap. The program's main goal is that students participating in clubs are better able to understand their emotions, cope with stress, and ask for help. At school level, this should result in better ability to identify students in difficulty, to provide initial support for them and guide them towards the appropriate services, with schools gradually taking over operating the clubs themselves.

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