What Uganda’s wrong – and right – in its fight to contain COVID-19

Ugandan President Yoweri Museveni last month tightened restrictions in the country following a worrying increase in infections and deaths linked to COVID-19. The tough new measures included a 42-day lockdown and restrictions on the movement of people. Public health specialist Gloria Seruwagi reveals some of the critical success factors and issues the government is lacking in its response strategy.

How is Uganda doing?

Not good, I’m afraid. Our healthcare system is quite fragile and was never designed for large-scale or prolonged intensive care. There have been pockets of success in building the resilience of the health system, but efforts are generally fragmented and rarely consolidated.

The country’s health system has therefore been strained and is unable to cope with the increasing number of cases. He does not have enough supplies, especially oxygen and beds for critically ill patients. The COVID-19 response is also not as decentralized as it should be.

The private sector stepped in to provide support. But it’s expensive and many families can’t afford it. Development partners and civil society are also trying to provide support, but the reach is limited.

Without safe or effective treatment options, people self-medicate and use herbal remedies or home concoctions. There are also a lot of unreported cases.

Most Ugandans feel trapped. The second lockdown essentially means that people cannot rely on other support systems and social networks that would have helped them cope in the absence of accessible, responsive and affordable health care.

What is your biggest concern?

The unmet need for mental health and psychosocial support.

Second, a relatively unhealthy obsession with biomedical science in fighting the pandemic at the expense of other disciplines. Here I am thinking above all of the community-oriented disciplines.

For example, social workers have expertise in counseling, deep roots in communities and a network across the country. But they remain largely locked in and fail to cut as “essential workers” authorized to provide services. We don’t see many psychologists or psychotherapists in the traditional response space.

Music, dance and drama are inexpensive and can be used to educate, model behavior, entertain and also calm a population in great distress. And we still haven’t taken advantage of information and communication technologies to change behavior, which is a missed opportunity, especially with high cell phone ownership and use of social media.

Health teams in villages have community access but generally lack essential skills in mental health counseling or services. It would be a good time to equip them.

These are low-cost, sometimes free, interventions that you don’t hear policymakers consider because the focus is on purchasing vaccines, oxygen, and all health care supplies.

These are important and rank high for obvious reasons. But Uganda needs to balance the clinical side with other contributors to the well-being of the population, especially when it cannot afford to provide essential health care to all and immunization coverage is at its highest. low.

The largely top-down approach to the national response did not effectively utilize structures at the local level that would assist the government in dealing with critical and clinical cases. I know the national response has a “community engagement” pillar. But we don’t know exactly how this happens; it sounds more like rhetoric than action.

Finally, I am concerned about the effect on the continuity of services, in particular health services related to maternal and child health, sexual and reproductive health, HIV and non-communicable diseases. A laser focus on COVID-19 negatively affects the delivery of care for other conditions and addresses other pressing issues. And, of course, the occupational risks for health workers.

What is not working?

Our containment strategy was not that tight. Schools were reopened and then closed with an accumulation of cases. By the time of the lockdown, many community mixtures, infections and transmissions had occurred and continued to spread with the movement. We failed here and were not prepared to face the consequences.

The enforcement approach, in some cases, is far from ideal and even counterproductive. The anger of the community erupted, widening the wedge between the people and their government. We have allowed a breakdown in social capital and public trust, leading to very negative perceptions of public policy.

In addition, due to the lack of clear guidelines and information, stigma has increased, sometimes to extreme levels. Examples include a body thrown to the side of the road or the isolation of family members. People are in survival mode and are acting desperately.

COVID-related research was commissioned during the first wave and some of it was funded by the government, which is great. We have had rapid dissemination but adoption remains low, so the long-standing battle between evidence and policy remains. The researcher-public engagement was not optimal either.

What works?

Public perception of risk is high and compliance with guidelines has increased significantly. We needed it from the start, but back then people didn’t believe COVID-19 was real, and our recently concluded political season didn’t help much. The in-depth profiling of COVID-19 cases has helped a lot and many families have now been directly affected.

Despite limited bed capacity and other shortages, such as oxygen, the few patients who receive care receive quality services and survival rates are high. The skill and ability to deal with these cases is excellent. But that’s only for a few. So if this is a success factor, it is also a problem. Uganda’s higher level health facilities have high capacity, but can only handle limited critical cases. Lower level facilities have not decongested hospitals and cannot handle critical cases. They are lacking on many fronts, including human resources, skills and supplies.

What should be done?

Along with other very important and urgent issues on the political radar, we need to activate the multi-level COVID-19 community engagement strategy and task forces and decentralize some aspects of the response. Make the community partners. Strengthen surveillance and case management capacities at all levels.

I think that home care must now be widely promoted, with clear and sufficient directions. This was integral to Uganda’s success in HIV, as was political and other leadership (religious, cultural).

Policymakers need to use research recommendations and listen to frontline practitioners. In addition, they must fight the infodemic and give people factual and empowering information.

It is vital that the government provide civilians with continuous updates. The president’s leadership in the first wave was great, updating, explaining and giving people advice on what might come next. Many people listened and felt the leadership was responsible. This central platform could continue, other actors (technical, civil society, socio-cultural) being exchanged to discuss the issues.

Finally, we must focus on national cohesion. Public support must be mobilized as Uganda deals with issues beyond its control – like vaccine makers forcing Uganda, among other countries, to wait in a long queue. We need to have honest conversations about national health inequalities and disadvantages and how we achieve health care for all. We need to learn lessons on how to balance an effective national response to a pandemic with preparing our various systems to better absorb unprecedented shocks.

Gloria Seruwagi previously received COVID research funding from the Ugandan government through the Makerere University Research and Innovation Fund (MakRIF) and Elrha / R2HC (Research for Health in Humanitarian Crises).

By Gloria Seruwagi, teacher and researcher, Makerere University