Health Perspectives WITH James William Mugeni
USA—29, June 2020: Editor, ‘’we will need 2 billion shillings to distribute masks,’’ says the Ministry of Health is rather an unfortunate situation that was easy to avoid. And I will not mince words as we are getting into self-created tight situations.
The principals, Dr. Diana Atwine and Dr. Ruth Aceng know the kind of situation patients run into in Mulago if the patient is admitted through the private wing then finally ending up in the general hospital.
Once from the private wing health workers tend to ignore the patient and reserve them for specialist attention. Covid-19 took that path so many healthcare systems were ignored and yet we need them now.
We have a pandemic whose approach was messed up from start. It took the path of an income generating activity for a secluded few. Resources allocated and misappropriated now we are moving to a situation where everybody matters. You can’t say we are in this thing together when you dictate and you don’t listen to our side of the story.
Uganda has not even appealed to the private practitioners, let alone used all its traditional healthcare structures. I have been writing and even calling the heads of the national task force and nobody ever picked my phone despite recommendations from people who mattered in Covid-19. You had the will of the people from the immense contributions of food and other resources; financial and physical. You can’t now tell us we don’t have money to distribute masks. You are making masks an issue and still using a top-to-bottom approach.
If people are empowered, people can even use homemade masks. So pathetic seeing ministers taking the lead in masks distribution, the permanent secretary ministry of health almost needing to be inducted on her roles.
So, why do we need 2 billion shillings for distribution of masks when all districts received new vehicles and all RDCs funded with fuel? Why would a district take an example, Tororo with a population of 400,000 people cannot pick masks from a central distribution point using district and hospital government vehicles?
What about me who runs a private clinic and I see patients on a daily basis; and i pick drugs and sundries using my own means, what is my role? How do I support my catchment area as their community own resource person?
National medical stores (NMS) have traditional drug distribution routes, all districts have a standard ministry of health procurement guidelines. You have district administration health teams that end up with village health teams (VHTs), antimalarial drug distribution teams, let alone Local Council (LC) systems. Why are ministers all over the place?
Below is the latest picture as presented by CDC Africa and Ministry of Health. Let me emphasize that Covid-19 is basically a primary health intervention disease. And the pillars are (a) Community participation and involvement this was killed and can still be stimulated with goodwill, (b) Appropriate technology-masks can still be homemade. Muslims using hijabs as an example, distributed cheaply using boda-boda, use of ordinary soap and water to wash hands all the time, (c) Intersectoral collaborations; all sectors go Covid-19 and help Ministry of Health. This again is not happening. (d) Political will is not political partisanship (We need to value problem solving over partisanship) faced with Covid-19 as elaborated below let us have a genuine country call, what is a government of Uganda embossed mask imply?
CDC Africa and the MOH provided a behind other scenes look at the Covid-19 situation in Uganda. Summary of what was presented.
- Uganda has entered phase 3 of the pandemic which is local transmission. It was stated repeatedly in the presentation that we are just now at the start of the outbreak in Uganda. Uganda is no longer trying to stop the outbreak – because of the crisis in border countries; this is impossible. The strategy now is to focus on case management, along with control and containment of the virus in order to slow the spread.
We will start to see rapid growth in covid-19 cases in the coming weeks. While almost all countries have had parabolic curves, Uganda has a chance to maintain a flatter growth trajectory if masks and social distancing measures are observed.
- However, the messaging for prevention has been challenging. Because the crisis here has been mild thus far, there is a growing perception that Covid-19 really isn’t that bad, or that somehow Uganda is immune. Uganda is not immune – onset of the pandemic was significantly delayed because of how aggressive and early the government was in managing containment.
The public needs to start taking responsibility for wearing masks correctly and observing social distancing or the spread will become rapidly exponential. However, the government and health sectors have not found a good way to inform and motivate the public. The government is encouraging organizations to make and distribute masks and engage in community education around prevention as well as role -model the practices themselves.
- Mask campaigns have kicked off, focusing on border countries. The weight of evidence shows proper wearing of masks by the population will significantly slow the spread, especially when combined with social distancing.
- In preparation for a growth in cases, the Ministry of Health is working on how to isolate mild cases outside of hospitals so that hospitals can handle the more severe cases. Uganda is not ready for home-based care strategies, but this may come depending on the severity of the outbreak. The MOH may set up pop-up hospitals near regional referral centers to handle moderate cases.
- Testing has been excellent in Uganda by global standards. A better test indicator than “tests per capita” is “tests per cases detected”. WHO standard his 30 tests administered per case detected. Uganda is at 100 tests administered per case detected. America is around 40. Our East Africa neighbours are 40 and below.
- It has been a constant struggle to get the test kits in the country. However, we are far better off than most developing countries. This is due to the government aggressively calling manufacturers and suppliers early on in the crisis to establish supply chains. The eventual goal is to have open testing so anyone can walk in and be tested, but there aren’t enough tests to do this. The current focus is border testing, high risk testing, and random sampling. MOH did one round of random sampling last month. They are now starting a second random sampling now throughout the country.
- Future lockdowns will probably not be a full national lockdown – there are strategies in place to implement regional lockdowns based on localized hotspots of infection.
- International flights and border crossing will not happen for the foreseeable future; it’s not even on the table for discussion. Uganda feels under siege from its neighbours because apart from Rwanda, our neighbours are doing very little to control the spread; and internationally the virus is still running at the peak of its arc. Right now Uganda’s focus is on bringing back Uganda citizens and refugees seeking asylum.
Returning citizens have been received from Sudan and will soon arrive from Amsterdam. The goal is 300 people every two weeks. The MOH has reserved 24 hotels of various price points for self-isolation. They have also set up several schools to house people who can’t afford to pay for hotels.
- Finally, the MOH is working with partner organizations on better information sharing systems. No doubt you’ve seen recent changes to the UG Covid dashboard. There are significant enhancements coming with access to large data sets for statistical and regional analysis which will be available to the general public and will aid in strategic decision making.
The presentation was optimistic, while also asserting the gravity of the situation related to hospital capacity, availability of PPE, and the very high risk of an exponential outbreak if there isn’t public cooperation.
Let me emphasize it here. It is not the public cooperation, but it is the government to create trust. Government has lost it out on the population as it loads it on the population. The curfew is misconstrued, the armed forces are acting on the contrary you can’t say they are killing to save and promote health.
The author is a Medical clinical officer/Certified public Manager based in the United States of America