In Kabarole District IRC's support is driven by strengthening WASH in healthcare facilities.
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:
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:
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 Uganda has supported Kabarole District’s efforts in the prevention and mitigation of the virus in the following ways:
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.
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:
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.