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Uganda: IRC supports COVID-19 response

Published on: 04/06/2020

In Kabarole District IRC's support is driven by strengthening WASH in healthcare facilities.

Provision of personal protective equipment

On 21 March 2020, Uganda had its first confirmed case of COVID-19. This was followed two days later by eight more. Prior to that, on 18 March, the President addressed the nation on COVID-19 and outlined the guidelines on preventative measures. 

The Government of Uganda has established a number of structures to coordinate various COVID-19 response activities. These include:

  1. A multi-sectoral and inter-ministerial National COVID-19 Response Team headed by the Prime Minister. The Response Team has various subcommittees including the WASH subcommittee.
  2. At district level, all districts have established District and Sub County COVID-19 Task Teams with different response subcommittees.
  3. Inter-Agency Joint Task Force established by Uganda’s National Security Council to support the Ministry of Health. It is led by the Uganda Peoples’ Defence Forces and comprised of the Uganda Police Force, Uganda Prison Services, National Joint Intelligence Committee, Immigration and Customs, National Water and Sewerage Corporation, UMEME (Electricity utility) and Kampala City Council Authority. 
Guidelines, operating procedures, information materials 

The Ministry of Health has published and disseminated key COVID-19 information materials including a fact sheet, a poster and guidelines for prevention of COVID-19 in public places (banks, offices, shopping malls, restaurants, markets). Other ministries including the Ministry of Water and Environment have also issued their guidelines. The Government established a call centre and a COVID-19 Information Portal with a real-time database.

A summary of the national and Kabarole District COVID-19 situation as of 31 May 2020:

Uganda

  • Confirmed cases - 457
  • Active cases - 283
  • Samples tested - 84,576
  • Recoveries - 72
  • High risk travellers - 1,550

 Kabarole

  • Alerts- 177
  • Suspected cases- 61
  • Total community and suspected case samples taken- 1,629
  • Confirmed case-01
  • Institutional quarantine-26
District/regional government priorities, needs and response

Following the confirmation of the first COVID-19 case in Uganda, Kabarole District Health Office constituted a District COVID-19 Response Task Team concerned with surveillance, response and mitigation against the spread of the disease. This is headed by the District Health Office and is part of the overall District COVID-19 task force. The task force developed a detailed Preparedness and Response Plan and Budget which was widely shared with all stakeholders in the district, including IRC. This was used to raise financial and material support in the district in addition to funding provided by the Ministry of Health. 

Kabarole’s focus is towards risk communication, surveillance, infection prevention and control, transport for frontline health workers, information education communication (IEC) materials and personal protection equipment (PPE). IRC agreed to contribute towards the key areas and participate as a member in the COVID-19 infection prevention and control (IPC) team albeit virtually and on the phone. 

IRC contributions in Kabarole District

IRC Uganda has supported Kabarole District’s efforts in the prevention and mitigation of the virus in the following ways:

  • Contribution to conducting IPC drills in healthcare facilities (HCFs) for healthcare workers and cleaning staff. The interventions are based on training of trainers (ToT) conducted last year for District IPC team. IRC Uganda has used the experience gained by being part of the IPC team for Ebola preparedness in 2019. Each HCF has an IPC focal person in an IPC committee that was trained to conduct COVID-19 IPC drills in 54 healthcare facilities. IPC and WASH in healthcare facilities often overlap, for instance on hand hygiene, medical PPE, environmental cleanliness, and healthcare waste management.
  • Eight radio programmes on Jubilee FM and Voice of Tooro (VOT) for risk management communication. The major focus was on providing facts about COVID-19 and dispelling the myths that were undermining government sensitisation of communities about the disease. The radio programmes were facilitated by the District Health Team and members of the Kabarole District WASH Task Team who emphasised the WASH component in mitigating the spread of COVID-19.
  • Personal protective equipment including disposable gloves, aprons and face masks. The major objective was to keep the health workers motivated to continue working, knowing they are safe from contracting the disease. And at the same time, reducing the chances of healthcare workers transmitting COVID-19 and other nosocomial diseases. PPEs were also important for practical IPC drills.
  • Renovation of eight latrines in health centres was another contribution IRC made towards the district response to COVID-19. Assessments had been done on 21 latrines in government HCFs that needed renovation to ensure the latrines are usable and reduce the current latrine deficit. Eight were prioritised and have since been renovated. The renovation involved pit emptying, fixing doors and handwashing facilities, making floors and adding sato pans. The District Water Officer, as senior district engineer, and the District Health Inspector have been focal persons in ensuring latrine standards are met.
  • IRC is committed to building WASH systems resilient enough to address even these global health challenges. It builds on earlier interventions to improve WASH in healthcare facilities in Kabarole by addressing the numerous gaps identified.
Renovation of sanitation facilities in health centres in Kabarole

Part of the low cost but high impact interventions that will be carried out by IRC to improve WASH in HCFs are based on the 2018 WASH in Healthcare Facilities Assessment Report. Latrines were not only inadequate in HCFs, but existing structures fell below standards of safety, privacy and convenience to the user. They were not washable, had cracked floors and most were nearly full. IRC contracted KAHASA (Kabarole Hand Pump Mechanics Association) to do renovations with a double benefit of improving WASH in HCFs and also further building capacity of the Hand Pump Mechanics Association to provide operation and maintenance of water and sanitation services.

KAHASA working on curtain wall of latrines at a health centre (IRC Uganda)

What has been achieved in Kabarole

These rather low-cost interventions have had a great impact on Kabarole District’s response to and mitigation of the spread of COVID-19. By 31 May 2020:

  • 126 radio talks shows have been held on local FM stations for risk communication management involving healthcare workers and influencers. These have been supported by the office of the Resident District Commissioner, UNICEF, IRC and Amref. 24 TV talk shows on NBS and King TV and 10 spot messages on prevention were offered by KRC radio. In addition, 43 Mobile van and megaphone risk communication days have been conducted mainly targeting market centres. The funding for these activities coming from IRC, Marie Stopes and HEWASA.
  • Of the five infection prevention and control steps issued by the Ministry of Health, four are related to WASH. So far 156 sessions of IPC drills have been conducted in 54 HCFs by the District Health Team supported by IRC.
  • Other outputs include: 57 routine sensitisations targeting trading centres, markets and hotels; 31 Sub County Task Forces created, oriented and trained. Follow up with volunteers and supporting their efforts in community mobilisation and sensitisation headed by the District Chairperson and with support from organisations like HEWASA, DHT, JESE, Amref, IRC and Baylor and 1512 IEC materials distributed such as information charts on COVID-19, handwashing and hand rub guides have been distributed to the communities.
  • The District COVID-19 Task Force has been active in ensuring health services are delivered. During the lockdown, 570 health emergencies (deliveries mainly) were responded to.
Investing in WASH in healthcare facilities is essential

These interventions have so far provided significant outcomes for Kabarole, marking a progressive response and mitigation against the spread of the virus. All healthcare facilities and healthcare workers in Kabarole have remained active and motivated. All Kabarole markets were able to maintain the standard operating procedures and none were closed by authorities during the lockdown compared to other parts of the country. There has been increased interest of the district in addressing WASH in HCFs. Extension of piped water in Kasenda and Kabende has targeted the HCFs. District decision makers take more note from the Health Team. There is also increased adoption of handwashing practice and gradually entrenching behaviour.

Moving forward, IRC would like to see strengthening of WASH in HCFs in Kabarole District. Therefore, immediate attention will be on advocacy and lobbying for increased interest and investment for WASH in HCFs; capacity development of the District Health Officer and ensuring adequate linkages with other key sectors like the water department.

Organising the availability of IPC materials (chlorine  dispenser, sanitisers, handwashing with soap, alcohol-based hand sanitiser) and access to safe clean water with the district water department, utility companies  and WASH partner organisations like Amref, PATH, HEWASA and the Infectious Diseases Institute among others. IRC will continue building a more sustainable medical waste management system in Kabarole (contributing to one or two centrally located incinerators and collection systems in the district).

In conclusion, significant lessons can be learned here. Having a strong WASH system prepares organisations, districts and nations to address even these global health challenges. Interventions in WASH in HCFs are ‘no regret’ investments as their impact is far reaching especially as it results in improved healthcare outcomes. And lastly, WASH is pivotal in IPC and primary health care. It is important that we demonstrate this to countries and donors.

 

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