Uganda

Introduction

In Uganda, out of 6,937 existing facilities, 2,976 (40.3%) are private health facilities and 1,008 (14.5%) are private not for profit (PNFP). During the onset of the COVID-19 pandemic, the Ministry of Health initially outlined the role of the private sector, as that of screening and surveillance for COVID-19 clients and referring to the nearest government treatment center. As the pandemic evolved to community transmission and the number of cases escalated beyond the government facilities’ capacity to absorb patients for isolation and management, private facilities were called upon to increase the scope of participation to include isolation of suspected cases, awaiting results confirmation, and eventually sample collection for testing, finally to test and manage COVID-19 cases.

This became critical as number of infections surged especially in urban centers such as Kampala which has 98% private facility coverage.

As the Ministry of Health expanded the role of the private sector unfortunately technical know-how, capacity to implement and guidance to the private sector was scanty. So while the private sector scrambled to have capacity to respond to the demands of sample collection, testing using PCR technology, Antibody testing, Antigen Rapid testing and case management several accredited private health facilities lacked the PPE, IEC materials and the cash flow to apply the much needed infection prevention and control measures required. Thus while most of the reported COVID-19 cases are first identified and treated in the private sector facilities and as the COVID-19 cases surged in the first wave, private sectors providers from Kampala and across the country increasingly needed support and access to information and knowledge on how to adequately and appropriately fulfil the important role in the overall national response to the pandemic.

This project offered a much needed tailor made solution to the awning gaps and limitations on knowledge, understanding and guidance in private facilities. While the Ministry of Health Risk Communication Pillar was generating messages and communication addressing the changing situation, the private facilities which differ significantly in human resource make up, facility structure both in infrastructure and operations from the public facilities were left uncatered for. This resulted in a number of private facilities resorting to downloading material off the internet from other countries, or relying on social media posts for guidance on how to support the national response. Uganda Healthcare Federation with support from ThinkWell institute and the IFC World Bank carried out a number of online training sessions, however, there was need to complement this training with materials and IEC content that could be displayed at facilities to reinforce learning and remind both health workers and the general public on safe methodologies, risks and guidance at community level on how to navigate through the pandemic. Furthermore, private facilities faced challenges to retain staff, and thus with staff turnover and constraints having all health workers participate in the training offered, it became a challenge to sufficiently pass on information at a standard that was meaningful to those that did not participate in the actual training.

Through this project, UHF was able to ensure availability of the training content not only to participants the desired to refresh what they learnt, to keep up with the latest information, and to access a platform through which they could test their understanding using the eLearning platform. Additionally, this project allowed for the development of content pertinent to the changes and shifts in the pandemic that was shared electronically using social media, but was also printed and disseminated through existing UHF networks and logistics partners to various facilities across the country. Uniquely the project put a lens on the private sector role in the pandemic response but it also gave crucial information on incidental outcomes of the pandemic. Uganda faced a surge in teenage and adolescent pregnancies, gender based violence and other undesirable effects. This project presented content that guided facilities on how to provide support to patients with these concerns, as well as other essential health care services in a COVID context.

Project Objectives

The objective of this project was to develop and produce multi-sensory capacity building IEC materials, in the form of info-graphics targeting technical and non-technical health workers in private facilities to support the safe provision of essential health services in the COVID-19 context.

METHODOLOGY / PROCESS

Assessment of private sector COVID-19 national response readiness.

UHF in collaboration with the Ministry of Health and Kampala Capital City Authority carried out a rapid assessment to ascertain the gaps and challenges faced by the private sector in the context of the pandemic. This readiness assessment took the form of a short questionnaire with questions structured to ascertain infrastructure, human resource and knowledge gaps. As a membership association of associations, UHF held several engagements with its members as well as development partners, and through these interactions priorities for action were determined, which informed the activities selected for this project.

Situation analysis and scan of existing regional and local communication and COVID-19 training material.

A review of the capacity building tools and materials available to address the gaps identified revealed that while government of Uganda made concerted efforts to train health workers, the pandemic forced training to take place online, and this limited participation due to data constraints as well as access to gadgets was limited. Additionally, private facilities were not engaged to participate optimally in this training and thus while they received walk in clients or patients that insisted on receiving care through private outlets, there was insufficient knowledge and capacity to appropriately serve these patients. A deeper review of the materials used for the training revealed that it was structured to be applied in a public facility setting, and while resources were made available through ThinkWell institute and IFC World Bank to adapt the materials used in the training for a private sector setting, these materials were bulky and required a facilitator, which was a challenge because there were no funds to support a facilitator to be available to keep training private facilities.

Therefore, it was resolved that through this project, UHF would adapt the content to be available on an online eLearning platform, supported by reading materials, infographics and posters that would be disseminated to private facilities to support the content taught through the training.

Development of list of key content required by private facilities and adapt content available for private health setting.

Through participation in the case management pillar in the national taskforce committee UHF was able to identify and prioritize key social and medical priorities that were stemming from the lockdown and the economic downturn. Through media reports and health development partner analyses, it became evident that the content being developed by the project had to broaden beyond just the management of COVID-19, it was crucial to ensure that the materials also addressed provision of essential healthcare and ongoing conditions that existed before COVID-19 and persisted throughout the pandemic threatening life such as maternity, youth inclusivity and management of chronic conditions. Paramount in this decision was that in urban centers where the virus was spreading quickly, the private sector is the health care provider of choice and outnumbered the public facilities significantly.

The materials developed were structured to be printed to be posters for display for public information, they were also designed to remind health workers of what they had been trained to do in the modules, lastly the materials were also to support mental health fortitude and support health workers in their day to day. 

Digitize COVID-19 training materials onto eLearning platform

UHF through support from the IFC World Bank and ThinkWell Institute, trained 2600 private health facility workers using training materials developed by the Ministry of Health. These materials were adapted for a private sector setting and were initially developed for workshop format for delivery. Unfortunately due to the pandemic, this was a concern and thus it was resolved to deliver the content online. UHF used this opportunity to capture recordings of the trainings to support future translation of the material from workshop format onto the eLearning platform.

UHF developed terms of reference that clearly outlined the need for an interactive easy to navigate eLearning platform. Through a process of open bidding, UHF identified a consultant who was contracted to support the development of the materials received from the Ministry of Health and used in the online training to digitize the 13 Covid-19 training modules;

  • Epidemiology.
  • Infection Prevention and Control.
  • Diagnosis of COVID-19.
  • Clinical Management and Vaccination.
  • Oxygen therapy.
  • Mental Health and Psychosocial Support.
  • Nutrition.
  • Continuity of Essential Services.
  • Emergency Medical Services.
  • Documentation and Reporting.
  • COVID-19 Referral Pathway.
  • Occupational Health and Safety-Protecting Health Workers and Respondents.
  • Home Based Isolation and Care for COVID-19 in Uganda.

OUTCOME / RESULTS

This project has resulted in 13 COVID-19 modules being digitized onto a free access eLearning platform available for private facility health workers of all cadres to understand how to manage a range of issues from mental health, to sample collection to managing COVID-19 patients. These modules are accompanied by a pre-test and post-test and will be updated as the management protocols evolve. This has been made possible by this project because as the eLearning platform was developed a UHF staff member was trained on how to keep the content updated. 

For more information, visit the UHF eLearning Platform via; uhfug.com/elearning

Through this project, UHF has 52 different designs for posters and infographics to complement the 13 COVID-19 training modules digitized onto the eLearning platform. These infographics and posters cover a wide range of topics that have become crucial in the day to day health service delivery in communities as a result of the impacts of the lockdown and social pressures of the economic downturn. Topics covered include:

a) Gender based violence.
b) Managing chronic conditions.
c) Essential healthcare in the COVID-19 context.
d) COVID-19 Home Based Care.
e) Mental Health.
f) Handling deaths due to COVID-19.
g) Youth and Young People in the COVID-19 context.
h) COVID-19 Vaccination.

COST EFFECTIVENESS

The country Federations in the region were at different stages in the pandemic, with different national response approaches, as well as significant differences in the engagement of the private sector, the Federations in each country used this project to share ideas, concepts and solutions being explored locally in respective countries, in order to fast track application of a localised solution.

The approach used to empower each country to identify and determine local priorities allowed for a lot of resource efficiency, and took into account local barriers, challenges and political concerns. This in itself resulted in cost effectiveness.

Due to each country taking its own path, synergies and efficiencies of doing things through a single country were difficult to achieve. Using Kenya as the secretariat helped in avoiding duplication and costs of setting up a team to oversee the execution. We believe the way the project was executed was through the most cost effective and cost efficient method.

LESSONS LEARNT

Through the project implementation, UHF has built internal capacity to develop eLearning content onto a platform. Furthermore, through this project, UHF has also established a working understanding of the wider gaps in epidemic and pandemic response that have informed future programming priorities. A key lesson is the stark weaknesses and lack of coordination in the mechanisms available to deliver oxygen to patients, poor referral structures and processes linking the public facilities and private facilities, and lastly the potential to use technology as an educational tool which has previously not been explored as an option, with project focusing on the cost heavy workshop format.

CHALLENGES

Two challenges were encountered during the implementation of the project;

  1. The evolving pandemic as it transitioned through the various stages threatened the relevance of the materials being developed, especially as the role of the private sector for whom we were catering was also changing. This meant the content had to be broadened to cater for all eventualities, mild, moderate and severe. Additionally, the content had to be more broadly appealing to be approved by the Ministry of Health, in so far as the content had to be harmonized with the national risk communication and this was achieved by building on the content developed by the World Health Organisation and adapting it to the local context, folding in the health system challenges faced uniquely in Uganda to ensure relevance and relatability of the audience.
  2. The content being adapted for the eLearning platform was designed for workshop format, meaning the material was in PowerPoint slides and lacked participant’s manuals or facilitator manuals to guide the team developing the material for online application. As a result, UHF worked with IFC World Bank to support online delivery of the training using Zoom in order to capture recordings of the trainers delivering the material. These recordings were then used to adapt the content for the eLearning platform to give meaning and context for the users.

FUTURE STRATEGIES

The pandemic has exposed the need for an increased supply of Oxygen in facilities for effective treatment of the severe and critical COVID-19 patients. The urgency of Oxygen supply is compounded by the already existing demand for provision of essential health care (emergency, surgery, maternity, neonatal and child cases) which is not sufficiently met by the Oxygen plants in the Public facilities let alone the private facilities that are supplied by one major oxygen production company in the capital city. UHF is determined to establish an oxygen delivery mechanism, which leverages the Uber model at an affordable cost while providing Oxygen handling and therapy training to the private facilities.

UHF through its ICT Hub members has contributed to the development of the Uganda Telehealth guidelines and shall continue to advocate for alternative healthcare delivery through telehealth within a regulatory framework not only to the underserved communities but now more than ever for the provision of essential health services in the context of COVID-19 where restrictions in movement and overcrowding play an important role in the containing the spread amongst individuals.

UHF will establish a Medical Credit Scheme to boost the recovery of Private Health Provider Businesses affected by the Pandemic. A number of private healthcare businesses were affected during the first lockdown and continue to struggle during this recovery as the second wave is underway. UHF will provide short term loans at affordable interest rates to small and medium facilities that make the bulk of the private health service delivery in Uganda specifically to improve the quality of healthcare services and increase the scope of service delivery in the communities.

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