When much of the world was waking up to the enormous implications of a global pandemic, Uganda was already a step ahead thanks to Ebola.

While COVID-19 has its unique challenges, such as quick spread, dealing with it requires the type of response Uganda has been practising over the years with the Ebola threat,

“Uganda has had the ‘unique’ opportunity to deal with several disease outbreaks, enabling the country to identify specific factors that contribute to the successful management of public health emergencies,” says Hon Dr Jane Ruth Aceng, the country’s Health Minister.

“Investment in response to these outbreaks has enabled us to build strong systems that can prevent, detect and respond to outbreaks. In line with this, we have invested in infrastructure, capacities, institutional relationships, and networks,” she adds.

So far, Uganda has managed to contain the number of COVID-19 cases and deaths to a low level, at 3,776, with 44 deaths as of 6th September 2020. This is due in large part to its experience with Ebola.

“COVID-19 found a ready and well-prepared preparedness and response system,” says World Health Organization (WHO) Representative to Uganda, Dr Yonas Tegegn Woldemariam. “The outbreaks also had given health workers experience to steel their nerves when dealing with deadly diseases, and that confidence kicked into action when called upon.”

Multisectoral leadership and response

To begin with, the country has a multisectoral and multidisciplinary National Task Force, chaired by Uganda’s president, that relies on science and advice from a scientific advisory committee constituted of renowned local scientists.

The country’s surveillance system, grown robustly through the many different outbreak experiences, is designed to detect diseases promptly, from the community level through Village Health Team monitoring to health facilities and border entry points. The system is supported by several online applications: GoData, Open Data Toolkit, mTrack, U-reports and a dashboard that facilitates case investigation, contact follow-up, visualization of transmission chains, data exchange as well as supervision, assessment, and reporting.

Long before coronavirus emerged, the Government and partners invested more than $18 million in preparedness and readiness for another Ebola outbreak. This included, in early 2019, training more than 10 000 health workers on infection prevention and control, psychosocial support, surveillance, safe and dignified burials, and other aspects of disease outbreak response. This training made the cascading of the COVID-19 prevention and control measures quick throughout the country.

The Ebola detection training also extended to immigration and port health staff at border entry points and the international airport who were equipped with infrared thermometers and thermo-scanners. It was one of those trained health workers who detected the country’s first COVID-19 case at the airport in the early hours of 21 March, three days after public gatherings were suspended.

The five Ebola Treatment Units that were constructed in 2018 quickly shifted to quarantine centres for people under observation for COVID-19. Patients testing positive were transferred to the designated management centres at the national and to the 15 regional referral hospitals with human and logistical capacity to handle outbreaks.

Investments in infrastructure, such as ambulances, pick-up trucks and motorcycles, made for the adequate evacuation or transfer of COVID-19 patients as well as for health workers’ surveillance and community engagement activities.

Risk communication and community engagement

For the majority of Ugandans, the threat of Ebola, which first appeared in 2000, repeatedly impressed on them the necessity of regular hand washing, social distancing and seeking treatment early. These measures became central to the prevention, control and treatment of COVID-19.

The Village Health Teams, composed of nearly 100 000 mostly young people who are chosen by their communities, typically are the first point of contact for households. They deliver health care messages; counsel affected communities, families, and individuals; promote behaviour changes; and assist with community engagement. In April this year, they began reaching out to households with messaging on coronavirus and what individuals must do for protection.

With a team of public health experts well versed in the rapid development of messages through already-established channels and networks, COVID-19 prevention information had circulated before the first case was detected.

Laboratory capacity

The Uganda Virus Research Institute, established in 1936, functions as the national influenza centre, a diagnostic laboratory for highly infectious viral infections and a WHO collaborating laboratory for influenza. Now it validates COVID-19 diagnosis, with capacity to test around 3000 samples per day. Learning through the Ebola experiences on the need for quick diagnosis, the institute requires that samples of possible viral infection be delivered to it or one of five field laboratories for testing confirmation within 24 hours of collection. WHO currently supports these decentralized laboratory units and the transporting of samples. Since the onset of the outbreak, Uganda has conducted more than 250,000 tests.

Supplies and logistics

Donor partners, such as the United Kingdom’s Department for International Development, IrishAID and the United States Agency for International Development, working with WHO, assisted with procurement of the protective equipment and testing items. Along with WHO, the United Nations Children’s Fund, the World Food Programme and the International Organization for Migration set up a system that ensured the quick delivery of the supplies to the front-line health workers and Village Health Teams.

The testing of the Ebola response procedures in real-life and in simulation that Uganda has endured over the past two decades paid off in how the country has tackled the new novel coronavirus. Now, says its top health officials, it is learning from the COVID-19 experience and building even stronger.

“We have to build a sustainable system not only for Ebola virus disease and COVID-19 but also for other health problems. The more we do on this, the better we shall get at it,” says Dr Jane Ruth Aceng, the Minister of Health.

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