Uganda’s Community Engagement Strategy (CES) for COVID-19 response will empower individuals and their households to fight the pandemic as well as address other social challenges.
“The strategy is not limited to COVID-19 alone. It addresses everything from food production, nutrition, to hygiene and so on,” said Dr. David Okello the Director of Health Systems at the African Center for Global Health and Social Transformation (ACHEST) and member of the Community Engagement sub-committee that developed CES.
Dr. Okello made the remarks while delivering a keynote address on CES, at a webinar hosted by the Palliative Care Association of Uganda on November 27, 2020.
CES was launched by the Uganda government on October 20, 2020, with the objective of ensuring that all people in Uganda are aware, empowered, and are participating in the prevention and control of the COVID-19 outbreak as both a duty and a right, using existing structures, systems and resources as much as possible. It is based on the premise that good health starts with and is created by individuals, their families, and the communities; and is supported, where necessary, by the skills, knowledge of professionals. Individuals have the primary responsibility for maintaining their own health and that of their communities.
If well implemented, Dr. Okello, explained that CES would strengthen the existing Community Health System for Integrated People-Centered Primary Health Care (IPCHC) and ensure that infections are minimized in the community. It will enable prompt identification, testing, treatment and rehabilitation as needed in communities.
“IPCPHC for the current COVID-19 response will be the foundation of a strong health system. This approach will also accelerate the achievement of Sustainable Development Goals and Universal Health Coverage, through enhanced ownership of health and development agenda by communities themselves,” he elaborated further.
CES is modeled on the project undertaken by ACHEST on intersectoral collaboration for health using a Whole of Society Approach. The project, implemented in Ngora District Local Government, mobilized local political, religious, and cultural leaders, extension workers, and CSOs to implement IPCPHC. Village Health Teams (VHTs) are trained to make household maps, maintain health registers; observe health practices, hygiene, and share advice on healthy living. They also follow up patients at home, refer the sick to health units, ensure children are immunized, and counsel pregnant women on antenatal and postnatal care. Every month local leaders convene a community dialogue to identify local solutions to issues emerging from the community. They also talk about the COVID-19 prevention guidelines and look out for suspected cases.
“This is something we find exciting and will be helpful once rolled out to other parts of the country. Communities are becoming each other’s keeper,” remarked Dr. Okello.
Asked by a participant in the webinar how this would address stigma against confirmed COVID-19 cases, Dr. Okello said: “Stigma is minimized if people know what to do. Knowledge and information about the pandemic is the only way that will demystify stigma.”
He emphasized the importance of using the existing governance structures as the entry point for healthcare. “The LC system is very strong in this country and working very well. When the pandemic started, some of the cases that sneaked into the country were traced through alerts from the LCs. You have to work with LCs to reach the communities.”
Responding to another question from a participant on how VHTs can be supported and motivated to undertake their roles, Dr. Okello said there is an already established curriculum developed by the Ministry of Health which will be used to train them. The government has also committed to paying a monthly allowance to full-time community health workers. Furthermore, the Ministry of Local Government is mobilizing leaders at local council and parish levels to sensitize them on the role of the COVID-19 taskforces which are to be established in every village as guided by CES. The Ministries of Health and Finance are working on modalities to finance the CES.
“This is a political agenda as much as it is a technical agenda. We must mobilize our people to respond to this crisis. It is our hope that politicians and local leaders take it as part of their responsibility, led by the RDC. The Prime Minister has already issued a directive to this effect,” said Dr. Okello
The implication of CES for palliative care, therefore, is that the integration of home-based care is an important element.
“It cannot be experts coming to homes to take care of the terminally ill. Communities need to know about palliative care and the issues of SOPs. Integrate and see what support people need; food, water, and issues of hygiene. If VHTS are mobilized, they would offer strong support in pushing palliative care,” explained Dr. Okello
“We need to find a way of involving families and other community members to deal with terminally ill at home. Ensure access to medicines and painkillers; train people how to use palliative care equipment at home and appropriate social support system, emotional and bereavement support if people die at home,” he added.
Compiled by Carol Natukunda