How COVID-19 has put Ugandas healthcare system to the test – PML Daily

Health workers at Mulago Specialised National Hospital undergo disinfection upon leaving the COVID-19 isolation and treatment unit (PHOTO/PML Daily).KAMPALA – Although it was initially believed that COVID-19 would last a short while, this does not seem to be the case anymore. The disease has penetrated communities and fatalities continue to rise. As of December 3, 2020, Uganda reported 21,409 COVID-19 cases and 206 deaths. The countrys tightly-controlled response to the pandemic such as lockdown, travel restrictions and curfew seem to have registered lots of positive outcomes, including a low death rate.
According to a Lancet Commission report presented at the 75th United Nations General Assembly in September 2020, Uganda was ranked among the 10 countries that had achieved suppression of the pandemic in August 2020.
Nevertheless, the healthcare sector is at the epicentre of this unprecedented global challenge and several healthcare services have been negatively impacted by COVID-19.
Sexual and reproductive health services (SRHR)
The onset of COVID-19 brought about a reversal in priorities of the healthcare system.
Availability, accessibility and cost of services like SRH were severely affected. An online cross-sectional study conducted between April and May 2020 among youths aged 18 to 30 reported that out of 724 participants, 203(28.0%) reported not having information or education concerning sexual and reproductive health. Some reported not having testing and treatment services of sexually transmitted infections available during the lockdown and 159 participants (22%) said HIV testing and counselling services were not available. Moreover, 44 females were pregnant or had delivered at the time of the study and eight of these reported difficulty in accessing pre or post-natal health care during the lockdown.
“Having no transport (68.7%) was the commonest limiting factors for access to SRH services and information during the lockdown followed by long distances (55.2%), unaffordability of the services (42.2%) and curfew (39.1%),” the report states.
Sexually transmitted diseases were the commonest (40.4%) challenge relating to SRH during the lockdown followed by unwanted pregnancy (32.4%) and sexual abuses (32.4%). The analysis shows that these challenges were more prevalent among co-habiting and unemployed youths.
“There is a need for Uganda government together with other stakeholders to incorporate SRH into responses from the outset. This will support the youths to access information and services related to SRH,” the researchers advice.
Challenges to the HIV care continuumA research paper dubbed: COVID-19 and the HIV care continuum in Uganda: minimising collateral damage published in the African Academy of Science journal indicates that COVID-19s associated strict lockdown measures such as a ban on public and private transport presented barriers to HIV testing. Moreover, for those with a new diagnosis of HIV, closures of clinics and the restrictions on leaving the house during lockdown prohibited essential linkage to care.
FigurePredicted relative change in HIV mortality (A) and incidence (B) in 1 year from April 1, 2020, from a 6-month disruption of specific HIV services in sub-Saharan Africa, for 50% of the populationThis disruption in antiretroviral therapy (ART) access has consequences on ART adherence. Significant lapses in HIV virological suppression may result in increased community transmission of HIV in Uganda, the paper partly reads.
According to UNAIDS data, an estimated 1.4 million people were living with HIV in Uganda in 2018 and about 23,000 of these succumbed to the disease and its related illnesses.
Uganda’s scenario is similar to what could happen in other sub-Saharan countries if COVID-19 persists.
A research paper, Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19, published by the Lancet journal in August 2020 states that a six-month disruption of ART across 50% of the population of people living with HIV who are on treatment could lead to more than 500,000 extra deaths from AIDS-related illnesses including. In addition, interruption of ART would increase mother-to-child transmission of HIV by approximately 1·6 times.
The research highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic.
It will be important for countries to prioritize scale up of supply chains and ensure that people already on HIV care are able to stay on treatment, including by adopting policies such as multi-month dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems, the researchers recommend.
Missed opportunities in Primary Health Care
At the heart of primary health care (PHC) is affordable and accessible of healthcare services to the population. Uganda has endeavoured to achieve this goal by decentralising the health system through creating different levels of health centres and linking them with communities through village health teams (VHTs) and community health workers (CHWs).
Although PHC is critical in epidemic response owing to its multi-level engagement among communities, healthcare providers and government, these elements were largely ignored in the early days of the pandemic, according to one study.
The study, Coronavirus disease-2019 epidemic response in Uganda: The need to strengthen and engage primary healthcare, published by the African Journal of Primary Health Care and Family Medicine records that community participation was limited as most of the measures were dictated and enforced by security and military personnel.
“This scared away the potential patients who would have come for testing and created resentment of the prevention measures,” the researchers write.
Additionally, the roles of VHTs and CHWs, who would have been instrumental in household-level health education was largely neglected. Also, there was poor inter-sectoral collaboration between the relevant ministries, for example, the Ministry of Works and Transport could not avail permits for movement early enough during the lockdown. As a result, maintaining essential health services became challenging as health workers could not easily move.
The researches call on government to prioritize PHC in order to management of mild and moderate cases in the community, as well as active case and contact follow-up.
“This will protect the scarce hospital-based resources for managing severe and critical cases and promote a people-centred response to the epidemic. Effective use of resources during the response is key to sustain an effective health system post-pandemic,” they advise.
This article was made possible with support from the THRiVE Consortium & Africa Centre for Systematic Reviews & Knowledge Translation through CoVPRES project funded by MakRIF.
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