How did Uganda respond to the COVID-19 pandemic?

The following information is on the key interventions, policy decisions and strategies employed in Uganda between March 2020 and December 2021 for the response to COVID-19 and the maintenance of essential health services.

Ugandan officials had started to coordinate the country’s pandemic response months before Uganda reported its first COVID-19 cases on March 21, 2020. At the end of January 2020, when the World Health Organization (WHO) declared COVID-19 a public health emergency of international concern, the Ugandan Ministry of Health (MoH) activated its Public Health Emergency Operations Centre (PHEOC). The PHEOC was established in 2013; since then, it has been the MoH’s “central focal point for organizing, coordinating, supporting, and managing all aspects of evidence-based public health emergency response efforts.”,

The MoH also established a multisectoral, multidisciplinary National COVID-19 Task Force chaired by the prime minister, whose members and subcommittees were responsible for coordinating Uganda’s pandemic preparedness activities. For instance, the Scientific Advisory Committee worked to ensure decision making based on evidence and data, and the Technical Inter-Sectoral Committee pushed for public enforcement of, and adherence to, official policies and guidelines.

In March 2020, the National Task Force’s Incident Management Team published a COVID-19 Preparedness and Response Plan with five key objectives:

• To strengthen leadership, stewardship, and coordination of preparedness and response efforts for COVID-19

• To develop country capacity for early detection, reporting, investigation, confirmation, and referral of suspected cases to designated isolation units

• To raise public awareness on the risk factors for transmission, prevention, and control of COVID-19 and promote the infection prevention and control practices including water, sanitation, and hygiene (WASH) to mitigate spread of COVID-19

• To develop capacity for case management and psychosocial support for COVID-19

• To strengthen the social protection mechanisms and mitigate the impact of COVID-19 on vulnerable groups.

The COVID-19 Preparedness and Response Plan managed the key pillars of Uganda’s direct response to the COVID-19 pandemic, including coordination and oversight, surveillance and laboratory systems, case management, risk communication, community engagement, logistics, and the continuity of essential health services (EHS). It also activated and coordinated response teams for key pandemic response activities such as surveillance, contact tracing, and isolation in local districts nationwide, even before most had reported a single case of COVID-19.

On March 31, 2020, Uganda’s Parliament approved a supplementary COVID-19 response budget that included $30.7 million (104 billion Ugandan shillings) for the country’s health sector. Further funding came from partnerships with international agencies such as the World Bank (which approved a $300 million budget support loan in June 2020), the International Monetary Fund (which approved a $491.5 million disbursement to stabilize the Ugandan economy in May 2020), and the Asian Development Bank.

Uganda’s president also established a National Response Fund for COVID-19 to collect private contributions for essential supplies, such as test kits and personal protective equipment (PPE), and for direct relief for the country’s most vulnerable people.

In response to the delta surge in the early part of 2021, authorities in Uganda developed a National Corona Virus Disease-2019 (COVID-19) Resurgence Plan to cover the period between June 2021 and June 2022. The new plan reintroduced COVID-19 control measures, including a lockdown, and restricted travel from high-risk countries. It updated interventions in all the key areas the previous plan covered. For instance, the new plan shifted focus to home-based care for COVID-19 patients instead of institutional case management, to make more efficient use of limited resources as case counts increased, and it proposed the establishment of new regional emergency operations centers to improve subnational pandemic response. (Unfortunately, resource constraints delayed operationalization.)

The Resurgence Plan also added a new area of focus—vaccine delivery, coverage, and outreach—and reemphasized that EHS maintenance is a key component of pandemic response.

Uganda also implemented strategies to maintain EHS delivery as soon as flagging performance across EHS indicators made it clear that they were necessary.

In the early months of the pandemic, Uganda’s health system-level response measures divided into two main categories: direct responses to COVID-19, and interventions for the maintenance of EHS.

In many countries around the world, the COVID-19 pandemic and efforts to mitigate it caused supply- and demand-side barriers to EHS delivery. These barriers included provider and patient fear of infection in health facilities; inability to travel due to lockdowns; budgetary shortfalls; and delays and stockouts of essential health commodities such as PPE, reagents, some vaccines (such as for HIV), and critical diagnostic tools (such as GeneXpert cartridges).

In Uganda, movement restrictions and physical distancing guidelines were significant obstacles to EHS delivery, especially in the early months of the pandemic (see figure below). For example, lockdowns—and the deployment of police and other security personnel to enforce them—kept many health care providers from their workplaces. Media reports that police prevented patients from seeking routine care, contrary to lockdown guidelines, might have affected public demand for that care.

Among Ugandan households that needed medical care in the first six months of the pandemic, more than half delayed or skipped it. The most frequently cited reason for skipping health care visits was lockdown-related mobility restrictions (see figure below).

Indicator data appears to show that the movement restrictions Uganda implemented in April 2020 undermined the delivery of EHS such as immunization for diphtheria, tetanus, and pertussis and outpatient treatments for noncommunicable diseases such as diabetes mellitus and hypertension. This appears to have been especially true in urban areas in the central region of Kampala and Wakiso.

After movement restrictions were lifted in May 2020, indicator data appears to show that some barriers to key services, such as in-facility births and outpatient health visits, persisted. Other factors, such as patient fear of contracting COVID-19 at health care facilities may have affected these trends as well.

Maintaining the delivery of EHS during and after the 2020 lockdowns was a key pillar of Uganda’s early COVID-19 response. To fund it, officials deployed resources from international partners, NGOs, and other pillars of the pandemic response. UNICEF, the Netherlands Embassy, and the Global Fund to Fight AIDS, Tuberculosis and Malaria contributed millions of dollars to support the emergency response and maintenance of EHS.