For numerous public health employees in Uganda, reacting to disease break outs of epidemic capacity in not brand-new. This is due to the fact that the country has remained in readiness and action modes for rather a long time and its illness outbreak system has routinely been tested for many years.
Uganda has actually had four Ebola Virus Illness (EVD) outbreaks in 2,000, 2014, 2017 and2018 The biggest and most lethal was in 2000 that signed up 425 cases and 224 deaths. In between, the country has likewise had outbreaks of Marburg, Crimean Congo Hemorrhagic fever, Yellow Fever, Rift Valley Fever, Avian Influenza and measles among others.
These break outs have not just evaluated and reinforced the country’s readiness and response system but likewise provided health workers huge experience and steeled their nerves to handle fatal break outs. They have battled these break outs close to two decades and managed to stop them.
” Uganda has had the distinct chance to deal with numerous disease outbreaks, enabling the nation to determine specific factors that contribute to effective management of public health emergency situations,” states Dr Jane Ruth Aceng, Uganda’s Health Minister.
By the time the World Health Company (WHO) declared COVID-19 a global pandemic on 11 th March 2020, Uganda had actually just included Ebola in Kasese district on the border with the Democratic Republic of Congo. The country was still on red alert in anticipation of spillovers from DRC where EVD was still raving.
” Our health workers right from the Town Health Teams throughout the nation to the top management of the Ministry of Health have actually taken part in illness break outs and acquired a lot of experience at the same time. While COVID-19 has its unique obstacles such as quick spread, other aspects of dealing with it are pretty much what we have done over the years,” states Dr Henry Mwebesa, the Director-General of Health Services.
Therefore, while COVID-19 is brand-new, in Uganda it found an all set and well-prepared preparedness and reaction system that simply kicked into action when hired. Years of investment in human resources, equipment and modest infrastructure came in handy when COVID-19 struck giving the nation a fairly decent action to the break out.
Multi-sectoral management and Response
To start with, the nation has a multi-sectoral and multi-disciplinary National Task Force (NTF) that is chaired by His Excellency the President of the Country. This gives Uganda, disease break out action the political clout that is vital.
Political leadership and dedication have actually played an enormous role in Uganda’s response to COVID-19 and in earlier illness break outs” says Dr Mwebesa. “The chair of the National Taskforce, the President of Uganda, H E Yoweri Kaguta Museveni has demonstrated sound leadership and dedication communicating on science and suggestions from a clinical advisory committee made up of renowned Ugandan scientists, while emphasizing a multisectoral method in the fight versus the extremely infectious COVID-19” he includes.
” Government of Uganda is using a holistic technique in reacting to the active COVID-19 break out. “One of the lessons we learnt from EVD is the value of cross-border cooperation, a key step we are following even in the COVID-19 action” she adds.
At the Ministry of Health, the Event Management System with its action pillars is housed in the Public Health Emergency Operational Center and supervise nationwide application of all directives and guidance of the NTF.
Previously in April 2019, the Ministry of Health and partners brought a major simulation exercise that made it possible for the nation to identify strengths and gaps in its readiness and reaction system. By the time COVID-19 struck, numerous gaps had actually been fixed and the new reaction required just altering of top priorities to focus on the brand-new issue but keep the old and tested strategies and tactics.
The simulation entailed screening functionality of each pillar right from the importation of a case at the country’s Entebbe International airport, through the processes of safe transportation, laboratory screening, contacting tracing, case management, neighborhood engagement to safe and dignified burial in case a patient died. Each of these pillars was checked in real-time providing health employees and other frontline workers a genuine feel of the operations which showed to be a success when the very first index COVID 19 case was spotted at Entebbe International Airport.
A Robust Security System spots diseases without delay
Prior to the simulation exercise, surveillance for disease outbreak which has actually now handled COVID-19 befitted from a robust Integrated Disease Surveillance and Reaction (IDSR) system that has actually been undertaking active disease monitoring in neighborhoods by Village Health Teams( VHTs), at health centers by health workers and at border Points of Entry (PoEs) by trained immigration and port health staff.
IDSR as a technique has actually boosted the public health surveillance and reaction to COVID-19, by assisting in early detection of suspects, obtaining laboratory confirmation of the illness, and starting action at all levels.
” The IDSR system which likewise consists of community disease monitoring has actually been used and tested throughout the years. Even in the current COVID-19 response, the system is assisting us discover cases in real-time and is among our most relied on public health tools”, Says Dr Mwebesa. Undoubtedly, the Ministry of Health, WHO and other partners have actually overtime reinforced the Integrated Disease Surveillance and Response (IDSR) allowing it to discover and respond to any disease outbreak throughout the country within 48 hours of notice.
The ISDR system is supported by online application such as GoData, Open Data Toolkit (ODK), mTrack, U-reports and a control panel which are all suggested to make it effective. These tools facilitate case investigation, contact follow up, visualization of chains on transmission, data exchange along with guidance, assessment and reporting. There are some challenges with IDSR which as Dr Mwebesa says are being attended to with assistance from partners. “We hope it will be enhanced and refined however for now, IDSR is serving us well in the COVID-19 response, he states.
Client Management and Health Employees’ Defense
Case management for COVID-19 likewise found many health workers already experienced and practising infections avoidance and control for EVD and other illness. They are proficient at donning and doffing of individual protective devices and inpatient care abilities. “The case management group are managing all verified cases and from the discharges taped, they are doing a great job,” says Dr Mwebesa while describing the work of the case management group.
Health employees protection is of utmost concern in illness outbreaks and is often a sign of the readiness of the system. It is notable that as of 22 August 2020, seventy-eight (78) health workers had actually been contaminated with COVID-19 and in the exact same time, health workers have identified, treated and released 1,396 confirmed COVID-19 clients with only one (1) health employee death up until now.
Uganda also has a network of local recommendation hospitals which are the designated treatment centers for COVID-19 patients.
These health centers have the human and logistical capacity to deal with break outs and have prepositioned stocks of materials such as PPEs that have come in handy in the COVID-19 response.
The decentralized management of COVID-19 cases to a couple of designated centers at the National and Regional Recommendation Hospitals has actually assisted keep important health services particularly maternal and youth conditions at district medical facilities and lower health centers. The classification of a couple of picked centers for COVID-19 case management has made sure expense efficient use of Individual Protective Equipment (PPE) and other products a lesson that was well learnt from the management of EVD.
The Lab: Probably one of a kind in the Sub-region
There is also the Uganda Infection Research Study Institute (UVRI), a P4 laboratory that functions as the national influenza center, a WHO influenza teaming up lab as well as the national diagnostic laboratory for highly transmittable viral infections among other capabilities and responsibilities. According to Teacher Pontiano Kaleebu, the Director of UVRI, current COVID-19 laboratory operate in Uganda is predicated on the massive work done on influenza research that started in 2006 with assistance from Center for Disease Control, WHO and other partners. Presently, UVRI is mandated to confirm COVID-19 diagnosis in the country and has the capacity to check about 3000 samples per day.
The commendable work by UVRI is supplemented by the decentralized testing conducted at Makerere University College of Health Sciences Lab, Central Public Health Laboratories, and Mutukula, Elugu and Tororo field laboratories which has reduced the turn round time for samples testing. This decentralized laboratory systems and sample transportation that is supported by WHO also used vital lesson from the EVD outbreak that required delivery of samples to UVRI within 24 hours of collection in order to attend to problems of neighborhood transmission.
Danger Interaction and Community Engagement
COVID-19 Threat communication and neighborhood engagement found a team of public health experts well versed in the fast development of messages and dissemination through already established channels and networks. The country was currently circulated with COVID-19 messages and information by the time the index case was identified.
” Our field response activities are supported and managed by District Task Forces which are functional in all our districts. Our neighborhood mobilisers are all over the nation doing what they have constantly done” states Dr Mwebese in action to the work going on the communities. “We already had a Danger Communication and Community Engagement Plan for one health, and another one for Ebola Infection Illness, so it was simple to establish one for COVID-19, he adds.
For a huge bulk of Ugandans, regular hand washing, social distancing and early seeking of care and adhering to them are not totally brand-new. These steps which are central to the avoidance, control and treatment COVID-19, had been drummed down their ears throughout the years in response to the many outbreaks especially EVD.
At district and sub-county levels, mobilization efforts whether public health, political or social are typically led by the Homeowner District Commissioners (RDCs) who represent the President in every district.
Luckily for Uganda, there is the highly valued grassroots structure– the Town Health Teams (VHTs) made up of mainly young people selected by their communities to promote health at the neighborhood, home, and specific levels.
Logistics and Product
During the EVD preparedness and outbreak action, the logistics pillar was responsible for ensuring materials are provided anywhere needed. While the Government was accountable for the overall functional processes, donor partners such as DFID, IrishAID, USAID, dealing with WHO also helped with procurement which allow the nation develop sustainable procurement experience and capacity. UN personnel from UNICEF, WFP, IOM and WHO set up a delivery system that ensured fast shipment of supplies to end line users in real-time which has actually been a beneficial experience for COVID-19
Experienced and helpful journalists
Journalists and other communication specialists also had prior preparation and orientation on reporting about disease outbreaks from various training session organized by MoH and WHO. Many have experience on real-time reporting of EVD and public health problems such that with COVID-19 they just needed information on the illness to right away kick into action.
” The reporter profession depends on trust. “Rumours damage credibility and produce panic, both in your area and globally making it challenging for us to respond effectively to the break outs,” he stated.
The ever-dependable donors and partners
In Uganda, as undoubtedly in numerous African countries, no illness outbreak is ever total without the vital contribution of donors and development partners. “We have strong coordination with our advancement partners who have continued to support us in danger communication, surveillance, case management among response pillar,” says Dr Jane Ruth Aceng, the health minister.
For the COVID-19 response, important contributions directed through WHO have been from IrishAid EUR 1,830,000; DFID GBP 1,172,778; DANISH DKK 16,565,000; Azerbaijan USD 100,000; GAVI USD 1 million; and JUPSA USD 158,216
” We value and heartily thank these donors for the vital assistance that has had a tremendous impact not only in the prevention, control and treatment COVID-19 however likewise on other illness outbreaks in Uganda over the years.
Earlier in May 2019, the government of Uganda and partners reported an investment of over 18 million dollars in EVD readiness and preparedness. Under this financial investment, over 10,000 health workers were trained in Infection Avoidance and Control (IPC), psychosocial assistance, security, safe and dignified burial and other elements of the disease outbreak action.
These experienced health employees have dependably and with confidence cascaded the COVID-19 IPC determines throughout the nation.
In addition, with donor support, several Ebola Treatment Units (ETUs) were built across the country and these have actually in turn been utilized in the COVID-19 reaction. These centers have not been used to accommodate validated COVID-19 patients, they have actually however been used as quarantine centers for individuals under observations.
Financial investment in facilities saw the procurement and deployment of ambulances, pickup trucks, bikes that have been utilized to evacuate or move COVID-19 clients, for surveillance, and for community engagement activities. In addition, some of the IPC products for EVD prepositioned at local referral health centers, have can be found in helpful for COVID-19 work.
Border entry points and Entebbe International Airport staff were trained in EVD detection and geared up with infrared thermometers and thermo-scanners for the task. In reality, the COVID-19 index case for Uganda was identified by a skilled health worker manning the thermal scanner at Entebbe airport.
Of course, there are obstacles as Uganda relentlessly fights COVID-19 with the number of contaminated individuals increasing every day.
” There are a number of challenges in dealing with this new infection. Given that the onset of the break out, we have actually been able to carry out over 250,000 tests.
” Uganda has permeable borders with all her neighbours. This makes complex screening activities which are primarily setup at the official gazetted points of entry” she adds. To reduce this difficulty, the Ministry of Health is supporting districts to execute community-based monitoring; and is supporting a regional approach to action application with cross border surveillance.
Certainly, Uganda has a lot of work to do. Already, 22 COVID-19 deaths have actually been signed up and given the easing of restrictions and social interactions of Ugandans, this hints risk ahead.
” A lot has been done in Uganda, however we need to support the government to even do more within the existing health system. We have to construct a sustainable system not only for EVD and COVID-19 but also for other health problems.
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