A total of 36 (21 males, 15 females) study participants with age (range, 28–63 years) were interviewed in this study. Participants included: 21 health workers (clinical and administrative staff), five members of the security forces, two members of the civil society, four politicians, and four members of the local government administration who were members of the district task forces (Table 1). Participants’ experiences on the COVID-19 response varied according to the service type, geographical location, and roles played. However, all participants overwhelmingly conveyed numerous COVID-19 pandemics and lockdown-related challenges and opportunities (Additional file 3).
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Table 1: Socio-demographic characteristics of participants
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Variables
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Frequency (n=36)
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Percent (%)
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Sex
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Male
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21
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58.3
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Female
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15
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41.7
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Occupation
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Health workers
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21
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58.3
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Members of security forces
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5
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13.9
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Politicians
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4
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11.1
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Members of civil society
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2
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5.6
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Members of local government administration
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4
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11.1
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Ages (years)
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<40 years
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13
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36.1
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>40 years
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23
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63.9
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Districts
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Gulu
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12
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33.3
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Pader
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5
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13.9
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Nwoya
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6
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16.7
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Gulu City
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13
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36.1
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In Table 1, most participants were males 21(58.3%), health workers 21(58.3%), more than 40 years of age 23(63.9%), and from Gulu City 13(36.1%).
The following sections of the results present participants’ descriptions of opportunities and challenges faced by communities during the COVID-19 pandemic, the impact of the changes on staff, community, health systems, the dilemmas and challenges encountered, and the opportunities created in these low resource settings.
For the health workers, changes in services and the nature of work were enormous. The most immediate consequence of the pandemic as described by participants (health workers) was the rapid reorganization of the in-and outpatient departments and community services to minimize risks of infection with the COVID-19, where essential and non-essential services were defined. Some health workers’ annual leaves were canceled, and those on leave were recalled, joining others to provide the COVID-19 treatment services and other prioritized essential services. These decisions were usually within the management team structure and were cascaded to service managers in different sections of health facilities.
Results of the interviews are presented according to participants’ views and perspectives. In addition, the participant’s code, age, sex, and roles played in the management of COVID-19 were included in each quotation.
On question1: In your opinion, what were the reasons for the surge in cases of coronavirus in this region?
Themes developed from interviews were: (i) Open defiance to COVID-19 Infection, Prevention, and Control (IPC), Standard Operating Procedures (SOPS) compliance, (ii) uncontrolled movement of persons and porous borders, (iii) A lack of IPC materials and poor living conditions
Open defiance to the COVID19 IPC SOPs compliance
Participants mentioned community members’ non-compliance to COVID-19 infection, prevention, and control (IPC) standard operating procedures (SOPS) as the main reason they thought led to the surge in COVID-19 in Northern Uganda, which was experienced one month before this study. They mentioned that community members did not observe IPC SOPS for many reasons, including open defiance with compliance to IPC SOPS due to stubbornness and general knowledge gaps among community members on how the virus was transmitted and how to prevent its spread. Cultural beliefs that diseases such as COVID-19 existed spiritually made it challenging to prescribe IPC SOPS.
Also, there were beliefs among members that COVID-19 was non-existent but a creation by the government of Uganda to curtail opposition politicians from their campaign rallies.
“This increase in numbers of COVID-19 cases in the region came because of the relaxation of the public in following guidelines given by the government to protect and prevent the spread of the virus ... I have also seen mass community gatherings during this period,” said GX#5 (a 59-year-old, male, member of security forces).
“There is inadequate knowledge on prevention and control of COVID-19 in the community. The charcoal business has become a problem where person-to-person contacts have increased, food transportation and truck movements into and out of districts have not been restricted. There is negligence to adhere to SOPs, and there is no observation of presidential directives limiting the number of people in social gatherings to less than 20,” said GX#32 (a 47-year-old male health worker).
“There is inadequate population sensitization; most people believe coronavirus disease is only for the rich. There are many violations of SOPS; there is no wearing on facemasks by most people, no observation of social distancing, hand washing, and social gathering standard procedures. Also, there are selfish behaviors among community members where people intentionally transmit infections to others, claiming that they cannot die alone. In addition, people could not differentiate the COVID-19 symptoms from other diseases, so those who had symptoms continued to mix freely without limitations. Also, there are many stigmas related to COVID-19 cases; some did not want to test for fear of stigma related to the disease. Lastly, social media posts have portrayed a lot of negative information on COVID-19 vaccine, vaccination, and the disease,” said GX#21 (a 28-year-old male health worker).
“Poor cultural beliefs and practices in some communities, for example, gathering for burials, weddings, sports, markets, and lack of researched information. Coordination gaps between lower and higher stakeholders in many communities were responsible for the surge in COVID-19 cases in Northern Uganda,” said GX#14 (a 44-year-old male, DTF).
“……. those who got immunized with the COVID-19 vaccine gained false confidence and stopped wearing facemasks even when in public. Lastly, the community did not differentiate between the COVID-19 vaccination from other forms of vaccinations, and this led to the failure to complete the recommended dosages of the vaccine and the care during and after COVID-19 vaccination,” said GX#4 (a 40-year-old female member of security forces).
Uncontrolled movement of persons and porous borders of Northern Uganda.
The study participants also believed the uncontrolled inter-district and cross-border movement of persons too fueled the second wave of COVID-19 in Northern Uganda. The failure of authorities to control activities of international truck drivers within the country, lack of COVID-19 testing facilities at border points, overcrowding at border points, uncontrolled contacts between community members and international truck drivers who were not tested for COVID-19, and porous borders with South Sudan were factors of great concern mentioned by participants. The porous borders allowed uncontrolled movement of people between Northern Uganda and South Sudan, a country that has instituted limited COVID-19 control measures. The unplanned and uncoordinated movement of people before the second lockdown across different districts was mentioned by many study participants as a significant cause for the second wave in Northern Uganda.
"... porous borders with South Sudan and northern Uganda are traversed by the East African highway from Mombasa to South Sudan with many resting stopovers for international truck drivers in Gulu district facilitated regular contacts between the community with the truck drivers. This could have been one of the reasons for the surge in the COVID-19," was mentioned by GX#33 (a 52-year-old male, DTF).
“…..movement of people from Kampala to Acholi subregion before the second lockdown brought COVID-19 infections from Kampala to Acholi subregion. The inadequate sensitization of the community on the disease was yet another problem. Most communications from the Ministry of Health were made over televisions and radios. Yet, most people do not have televisions and radios, and so many people miss information from the government. In addition, there was disbelief in what the government said about the COVID-19. They thought it was a political disease and people never observed SOPS during the campaigns,” said GX#35 (a 38-year-old male, Politician).
“The uncoordinated and unplanned release of students from boarding schools caused the surge of COVID-19 as most students in boarding schools had already been infected with the coronavirus. The announcement of a second lockdown a week before its implementation allowed people to move upcountry where SOPS were not observed in buses and public transports. This movement made several families and students move upcountry; amongst them were people infected with COVID-19. Hence, they caused the huge infection and surged in this region,” said GX#36 (a 39-year-old male health worker).
“……… people in Northern Uganda should note that this is a pandemic and a global health issue. Northern Uganda is no exception. The East African highway traverses Northern Uganda from Mombasa to Sudan. There are many stopovers in the Gulu district that international truck drivers use. These stopovers are commercial centers in Gulu where truck drivers mingle freely with the local population. This could be one of the reasons for the surge in cases of COVID-19 in the region,” said GX#33 (a 52-year-old male, DTF).
“…….the virus took the population by surprise; long-distance truck drivers were responsible for spreading the virus in communities in Northern Uganda. Congestions and failure to follow SOPS at border points were part of the reasons for the surge in cases in the region,” said GX#2 (a 55-year-old male, member of the security forces).
The lack of Infection, prevention, and control materials and poor living conditions among community members. Many participants mentioned the lack of IPC and poor living conditions among residents of Northern Uganda as part of the reasons that led to the surge in COVID-19 cases. Other issues mentioned were the high poverty-related matters in many communities, especially the inability to buy IPC materials such as facemasks, hand sanitizers, drugs for treatment. Overcrowding in poorly ventilated rooms, failure to avoid public places and high-risk places because of the nature of their jobs were issues of concern. On the other hand, health workers lacked the required IPC materials and PPEs, had work burnout, work fatigue, lacked facilities for COVID-19 isolation, and supplies and drugs to treat cases. In addition, many participants believed that most health workers got infected with the virus, and they could have been responsible for the surge in COVID-19 cases in Northern Uganda.
“… most community members did not believe that the COVID-19 virus existed in their community. They thought it was a rumor. People found it hard to wear face masks, and masks were uncomfortable. The high rate of poverty forced people not to follow the SOPS. The community could not afford basic requirements for infection, prevention, control, and management of COVID-19,” said GX#13 (a 31-year-old female, member of security forces).
“…..Failure to isolate contacts of COVID-19 from the community. There was ineffective case management using the home-based care model because the community could not afford proper places for isolation. Suitable rooms for isolation and other requirements for treatment at home were lacking,” said GX#10 (a 54-year-old female Politician).
“Health workers, especially nurses who had worked so hard in the first wave, had become fatigued and relaxed from following infection prevention and control (IPC). The lack of PPEs, drugs and supplies greatly affected health workers. The community, too, did not prioritize looking for other incomes to feed themselves during the lockdown. So, they became involved in risky activities to find a living,” said GX#23 (a 44-year-old female health worker).
On question 2, in your opinion, what were the most typical complaints/presentations of COVID-19 patients in your hospital or district?
There have been no uniform clinical presentations of the COVID-19 cases in this community. Some were asymptomatic, while others presented with varied symptoms including headache, sore throat, general body pains, malaise, chest pain, running nose, difficulty in breathing, dry cough, itchy throats, high-grade fever, loss of appetite, loss of smell and tastes, and excessive sweating.
“In the first wave, most COVID-19 patients suffered from dry cough, running nose, sore throat, loss of smell and taste, headache, chest pain, malaise, back pain while in the second wave, fatigue/exhaustion/tiredness, headache, loss of smell and taste, cough and running nose, malaise, myalgia, and backaches were the commonest presentations,” said GX#28 (a 38-year-old, male, health worker).
“Fever (high-grade fever), dry cough, sore throats, running nose, and difficulty in breathing were the commonest clinical presentations of patients with COVID-19,” said GX#25 (a 63-year-old male health worker).
“Cough, headache, breathing problems, and fever were the commonest reported complaints,” said GX#14 (a 44-year-old male, DTF).
On question 3, in your opinion, what were the challenges you faced with the COVID-19 patients, and what remedies do you recommend?
Participants mentioned several issues which were classified as (i) COVID-19 Case management issues (there was no standard treatment protocol, there were multiple drug use, lack of fuel for referral of COVID-19 patients, lack of personal protection equipment (PPEs), and inadequate space for isolation of patients in health facilities), (ii) Violent reactions on security forces (iii) Widespread community stigmatization on COVID-19 (iv) Inadequate health management systems in health facilities.
“There were varying and multiple drugs used for the treatment of COVID-19, and this was problematic. There was a lack of fuel which affected referrals of patients from one health facility to another. There was a widespread stigma on COVID-19 in communities, which affected commitments, especially among health workers. In addition, the low uptake of COVID-19 vaccines among health workers was demoralizing to communities. The proposed remedies are increased risk communication to communities. Implementing partners (IP) should support districts and continue with risk communication through their IP agents and the media,” said GX#1(a 43-year-old female health worker).
“There were shortages of PPEs for the management of COVID-19 patients. Psychological distress, including fear and anxiety among health workers, was widespread. My proposed remedies are to provide adequate PPEs, increase incentives to staff and give psychological support to health workers,” said GX#6 (a 45-year-old male health worker).
“There is a lot of psychological and emotional stress among health workers and community members. There is a need for ongoing counseling of patients and psychosocial support to health workers and communities,” said GX#1(a 43-year-old female health worker).
The security forces faced challenges: These were mainly on where to detain COVID-19 suspects, how to avoid exposing detainees in detention centers, how to transport suspects who were COVID-19 positive, how to interrogate them, and present them to courts of law.
“We had problems with where to detain COVID-19 suspects in police cells and how to isolate them from other suspects considering that there were no isolation rooms designated for cases, how to interrogate them in police stations and how to transfer them to the courts of law for prosecution. Unfortunately, the courts were also closed during the lockdown period,” said GX#13 (a 31-year-old female security forces member).
Widespread community stigmatization and denials of COVID-19. Many participants mentioned widespread stigma on COVID-19 patients, contradictions, difficulty in accepting positive test results, fear of death, anxiety, panic, and loneliness among community members during the period.
“There is a high level of stigmatization among communities on COVID-19 cases, and knowing one’s status has become a problem,” said GX#4 (a 40-year-old female security forces member).
“…..challenges of the widespread social stigma of people diagnosed with COVID-19 who were isolated from other members of the community have reached a level of concern. Many medics had inadequate case management and follow-up information, creating many uncertainties and fear in communities. In addition, the home-based care management of COVID-19 has been challenging due to a lack of funds, drugs for treatment, PPEs, and human resources for care. Management of moderate-severe cases in the community has become problematic as there are no health workers assigned for that purpose,” said GX#32 (a 47-year-old male health worker).
“Heavy drinking, overcrowded markets with vendors who do not follow SOPS, failure to follow social distancing rules and wearing of facemasks in public, and an unregulated number of passengers in public vehicles were the main reasons for the surge in COVID-19 cases in Northern Uganda. Inadequate PPEs made health workers fear handling COVID-19 patients. In addition, there was a denial of positive test results, especially when the patients were stable, yet many people were at risk of contracting the virus. I propose that the government should provide PPEs and continue sensitizing the community as the immediate remedy to the problem,” said GX#8 (a 33-year-old female health worker).
“……. Challenges of inadequate information, limited aeration in dwelling/sleeping places with limited resources to afford the purchase of drugs and proper diet were major problems in the community. I propose improved research and dissemination of information on the virus; get patients in well ventilated facilities and houses; drugs for treatment should be centrally procured and given to patients,” said GX#14 (a 44-year-old male, DTF).
“……. generally, there is lack of money in the community, lack of drugs, widespread stigma on the disease in the community. Most community members lack food to enable them to stay at home, and patients take longer to recover during this second wave of COVID-19,” said GX#1(a 43-year-old female health worker).
“Keeping infected COVID-19 patients isolated in the home-based care management has become problematic and should be limited because it has become unbearable for the community due to lack of resources for home-based care,” said GX#2 (a 55-year-old male member of security forces).
A member proposed the following as remedies, “There is a need for psychosocial support and counseling to patients and their caregivers. More training of health workers, village health teams (VHTs), and community leaders on COVID-19 case management and referrals. There is a need to lobby for more support from partners and well-wishers, training and recruiting volunteers to provide additional labor support to the health workers are required. There is also a need to hire tents to serve as holding or treatment centers for moderate-to-severe cases awaiting referrals,” said GX#36 (a 39-year-old male health worker).
Inadequate health management systems in health facilities. Participants mentioned many challenges experienced in many health facilities during the COVID-19 pandemic and the effects of the lockdown measures implemented across the county. These included the lack of proper isolation units for COVID-19 cases, lack of oxygen, inadequate staff to manage cases, and lack of ambulance in some health facilities.
“There were several problems in the COVID-19 treatment centers, including an inadequate number of staff, inadequate space for isolation, and sometimes shortage of oxygen. Some health facilities lacked ambulance for referral of patients,” said GX#34 (a 28-year-old female, DTF).
On Question 4, what opportunities did the coronavirus pandemic present to your hospital or district?
Themes developed from interviews included: (i) Better support to health facilities (ii) increased support to health workers, and district leaders (iii) Improved security of persons and property (iv) Increased community engagement, sensitization, and mobilization on COVID-19 (v) Improved performance of the health sector
This question was the most extensively discussed questions among participants and cut across many issues categorized as (i) better support to health facilities. Participants reported increased funding from central and local governments, donors, and local communities to health facilities during the COVID-19 pandemic. The government established oxygen plants in all regional referral hospitals; put up handwashing facilities at most entry points to and from public buildings. It procured and provided beds and mattresses for patients in health facilities; procured and increased the numbers of ambulances in most health facilities; it increased sizes and spaces of CTUs for the management of COVID-19 patients; and more infrastructural improvement at the Regional Hospital, especially the construction and equipping of ICUs.
“Hospitals received donations of oxygen cylinders, oxygen concentrators, mattresses for patients and PPEs for staff, and all equipment and supplies were beneficial during the pandemic,” said GX#7 (a 37-year-old male, Politician).
“…….. Government has improved drug supplies and deliveries, and this was accompanied with an improved screening of patients at many points in government facilities, in addition to the increased allocation of fuel for ambulances and hospitals for running vehicles and standby generators,” said GX#16 (48-year-old, female, health worker).
“There is increased funding support from local and external donors to health facilities, and there are better IPC measures that can improve other service indicators such as WASH, personal hygiene, incidences of diarrheal diseases, and water-borne illnesses in communities. There are increased health workers’ refresher training, improved coordination, and discussions on health issues,” said GX#1(a 43-year-old female health worker).
Increased support to health workers and district leaders during the COVID-19 pandemic. Participants reported many supports accorded to health workers and district leaders during the pandemic and lockdown. These included increased allowances and training of health workers on care and management of COVID-19 and allowances for the district leaders (especially RDCs). In addition, there was an increased fuel allocation for operating emergency vehicles, expanded logistics, including more cars, especially ambulances, facemasks, sanitizers, and hand washing materials.
“……….…. there is a dedicated and well-facilitated team of health workers at the CTU that could not sleep during the second wave of COVID-19. In addition, intensive training of health workers by WHO and UNICEF has been beneficial. Health facility management support has become crucial and increased cooperation among staff at all levels,” said GX#14 (a 44-year-old male, DTF).
“Beneficiaries of funds from the government, for example, the Resident District Commissioners (RDCs), had increased allowances. More fuel, new vehicles, funds, hand sanitizers, soap, and water dispensers for the different government facilities have been procured and delivered. However, there was the unequal distribution of these materials,” said GX#5 (a 59-year-old male, member of security forces).
“Gulu was one of the districts severely affected by the COVID-19 pandemic, with the CTU managing more than 800 cases with a recovery rate of over 96%. This is something to be proud of…...” said GX#27 (a 36-year-old female health worker)
“Ambulances were acquired for the district. Now we have four which has made referrals of patients a little easier. It has exposed weaknesses of our leaders in the district and how they are not considerate to communities,” said GX#24 (a 39-year-old male health worker).
Improved security of persons and property during the COVID-19 pandemic: Participants mentioned the general improvement in the safety of persons and property during the COVID-19 pandemic and the lockdown. Night curfews imposed by the Government helped reduce the workload of security forces and reduced incidences of crimes, especially burglary and petty thefts.
“There is a general security improvement because of adherence to night curfew regulations. Restrictions to public places, for example, markets, bars, and lodges helped reduce numbers of COVID-19 cases,” said GX#2 (a 55-year-old male, member of security forces).
“There is improved coordination of responses at district level and community's attitudes have changed to the positive. People got tired of seeing COVID-19 patients die in large numbers. This has led to a change in people’s attitudes, and there is increased wearing of a facemask in public among community members,” said GX#4 (a 40-year-old female member of security forces).
“Many people who became sick with COVID-19 were treated and recovered. This pandemic brought in some level of discipline, including regular hand washing, regular use of hand sanitizers, and restricted movements at night. This has improved the general security and has eased the work of the police. Night curfews have done well in reducing crimes in the community,” said GX#13 (a 31-year-old female, member of security forces).
“…………the success stories are that the home-based care management of COVID-19 has reduced the burden on health facilities. The pandemic has also improved productivity/revenue/employment, especially around factories that provide PPEs, facemasks, and hand sanitizers,” said GX#1(a 43-year-old female health worker).
Increased community engagement, sensitization, and mobilization on COVID-19. Many participants mentioned regular sensitization and mobilization of communities on the management, prevention, and control of COVID-19, improved hygiene and sanitation at the personal and community level, increased good willpower with communities donating funds and materials to support the most vulnerable members of their communities, and creation of internal funding mechanisms in communities. In addition, there were reduced incidences of water, sanitation, and hygiene (WASH) related diseases and road traffic accidents.
“Community engagement on the COVID-19 prevention and control resulted in a decrease in the rising cases in the high-risk area of Puranga Ongonyo. The political and technical team addressed the community, which resulted in a decrease in new cases. After that, there was massive uptake of testing by the community. Positive cases were followed up and managed through a home-based care model. There were no referred cases from the same community for hospital care and management during the period. In addition, the transmission rate of COVID-19 was reduced through the risk communication team that engaged the community. The district task force reactivated teams and formed task forces from village to district levels. Importantly, continuous surveillance ensured early detection and management of positive cases of COVID-19,” said GX#32 (a 47-year-old male health worker).
“Sensitization, engagement, and mobilization of the community increased during the pandemic. Communities were encouraged to erect handwashing facilities to improve hygiene, in addition to regularly using hand sanitizers,” said GX#35 (a 38-year-old male, Politician).
“Many residents donated to district task forces so that the donations could be used to break down the cycle of COVID-19 transmission. An 80-year-old woman demonstrated this by donating her UGX10,000 shillings to support DTF. In addition, people supported the COVID-19 treatment centers by donating food items, amongst other things. Residents were so committed to the task force’s activities that many members of DTF would travel long distances to attend DTF meetings. This self-motivation and commitment among the DTF were awesome as it was not common. Furthermore, radios and other media houses were used for disseminating information to the local community, and this demonstrated collective efforts to fight and eradicate the virus,” said GX#33 (a 52-year-old male, DTF).
“……personal and household hygiene has improved; hand washing is now commonly practiced in homes and trading centers in the region,” said GX#34 (a 28-year-old female, DTF).
“There has been improvement in family hygiene, and this has caused a reduction in numbers of diseases caused by poor hygiene such as diarrhea,” said GX#36 (a 39-year-old male health worker).
“The COVID-19 pandemic led to better maintenance of roads for easy movement of ambulances. There were reduced cases of road traffic accidents due to restrictions of movements of vehicles and motorcycles,” said GX#33 (a 52-year-old male, DTF).
Improved performance of the health sector. Many participants mentioned improved disease surveillance and management performance during the COVID-19 pandemic in many districts. In addition, the pandemic created an opportunity for health system reforms especially using a multisectoral and multistakeholder approach to disease management from the local level to the center by creating multistakeholder committee from the village, parish, sub-county district task force, districts, and national level, which helped improve disease surveillance among community members.
“There is a significant improvement in the epidemiological surveillance of diseases but particularly on COVID-19,” said GX#21 (a 28-year-old male health worker).
“The use of local medicines and herbal medicines have promoted quicker recovery from COVID-19. Adherence to SOPS keeps one safe from contracting the virus,” said GX#12 (a 49-year-old male health worker).
“Many more of our teaching staff became sick but luckily recovered from the illness following our treatment. In addition, many staff was trained on the COVID-19 pandemic and the management of cases. It is important to know that almost all my staff have received COVID-19 vaccines, and a certificate of vaccination completion has been issued to them, including students,” said GX#25 (a 63-year-old male health worker).
“The capacity of health service providers from VHTs to health centers was enhanced and built for disease surveillance and management. Ambulances were bought by members of Parliament (MP) and the government. This supported and eased the management of COVID-19 patients. In addition, the COVID-19 pandemic attracted more funds to districts through government supplementary budget allocations and donor support,” said GX#33 (a 52-year-old male, DTF).
On question 5, what were the main COVID-19 success stories from your hospital/district that you wish to share in your analysis?
Themes developed on this subject were: (i) Successful implementation of the home-based care for COVID-19 patients (ii) increased productivity of industries that produce IPC materials (iii) Improved security of persons and property during the COVID-19 pandemic (iv) Increased community engagement, sensitization, and mobilization on COVID-19 and other health indicators (v) Improved performance of the health sector.
Several success stories were reported during the COVID-19 in this community of Northern Uganda, for example, the successful implementation of the home-based-care model, which helped reduce the burden of COVID-19 patients in healthcare facilities.
“Home-based care for COVID-19 patients has improved the standard care of patients and clients. Many community members have been able to buy some of the medicines required by themselves and have improved,” said GX#18 (a 45-year-old female health worker).
“A staff from our hospital who tested positive, was treated, became negative and recovered successfully, and has returned to work,” said GX#23 (a 44-year-old female health worker).
“……..the success story is that the home-based management of COVID-19 has reduced patients’ burden on health facilities,” said GX#1(a 43-year-old female health worker).
There was increased productivity in industries, especially those that produce facemasks, hand sanitizers, and protective wear.
“Success stories are that …………... during the COVID-19 there has been increased productivity, revenue, and employment especially around factories that produce IPCs, PPEs, sanitizers, and facemasks,” said GX#1(a 43-year-old female health worker).
The night curfew imposed on the population improved the general security of persons and property of the community in northern Uganda.
“The general security in our community has improved because of adherence to the night curfew regulations…………” said GX#2 (a 55-year-old male, member of security forces).
There are a reduced incidence and prevalence of road traffic accidents WASH-related infections such as diarrhea and cholera.
“The COVID-19 pandemic led to better maintenance of roads for easy movement of ambulances in communities. There were reduced cases of road traffic accidents in the period due to restrictions on the movement of vehicles and motorcycles,” said GX#33 (a 52-year-old male, DTF).
“There has been improvement in family hygiene, and this has caused a reduction in cases of diseases caused by poor hygiene such as diarrhea,” said GX#35 (a 38-year-old male, Politician).
Participants have mentioned that restrictions on public gatherings have reduced the incidence and prevalence of COVID-19 and other diseases that spread through physical contact from person to person in the community in northern Uganda.
“……. Restrictions on congregate settings, for example, churches, markets, bars, and lodges have reduced the spread of COVID-19 infection by reducing persons to persons’ contacts,” said GX#2 (a 55-year-old male, member of security forces).
In addition, participants also observed that many people adopted more care of themselves through wearing facemasks in public and followed SOPS guidelines instituted by the government of Uganda.
“………. adherence of SOPS can keep one safe from contracting the virus,” said GX#12 (a 49-year-old male health worker).
“………………Improved responses to the coronavirus and community's attitudes have changed positively. People got tired of seeing people die in large numbers. A change in the attitude of people came, and there was increased facemask wearing in public by community members,” said GX#4 (a 40-year-old female, member of security forces).
Lastly, there was improved coordination of district-level responses and attitudinal change of the population to the COVID-19 pandemic and its management.
“……a significant improvement in the epidemiological surveillance of diseases in our district has occurred with the COVID-19 pandemic,” said GX#21 (a 28-year-old male health worker).
“There has been increased commitment of health workers, especially those in CTUs. Government improved drug delivery and supplies, improved screening of patients at many points, increased fuel allocation for ambulances and hospitals, and this has eased work in hospitals and health facilities,” said GX#6 (a 45-year-old male health worker).
“A dedicated team at the CTUs that could not sleep were handy for the period of the pandemic. Intensive training of staff by WHO and UNICEF was beneficial. Health facility management support became essential and increased cooperation among staff at all levels,” said GX#1 (a 43-year-old female health worker).
“Community engagement on the COVID-19 prevention and control resulted in a decrease in the number of cases in the high-risk area of Puranga Ongonyo. Political and technical teams addressed this community’s problem, decreasing new cases and massive testing uptake. Positive cases were followed and managed through the home-based care approach. Only a few cases were referred from the same community for hospital care and management. In addition, the transmission rate of the virus was reduced through risk communication by teams engaging, sensitizing, mobilizing, and supporting the community. Taskforce reactivation and formation was done from the district up to village level, and continuous surveillance ensured early detection and management of COVID-19 positive cases,” said GX#32 (a 47-year-old male health worker).
“Many people were willing to donate funds towards facilitation of activities of the district task force so that the cycle of COVID-19 transmission was broken; an 80-year-old woman demonstrated this by donating her UGX10,000/= shillings [equivalent to 2.5$USD] to support her district task force (DTF). The community supported the treatment center by donating food items, amongst many other things. People were so committed to the task force’s activities, and many members of the DTF would travel long distances to attend meetings to share their experiences and recommend what else to be done. This self-motivation and commitment to the DTF were awesome. Radios and other media houses got involved in the dissemination of information to the local community, and this demonstrated collective effort to fight and eradicate COVID-19 in their communities,” said GX#33 (a 52-year-old male, DTF)
On question 6, what were the main challenges faced by your staff and hospital/district during this COVID-19 pandemic?
Themes on the challenges were: (i) Lack of IPC materials for health workers, (ii) difficulty in accessing families by the community and task force members (iii) lack of cooperation of the community to guidelines (iv) widespread stigmatization among community members
Many participants mentioned several challenges health workers, security forces, district task forces, and communities faced during the COVID-19 pandemic.
Lack of IPC and PPEs for health workers.
“Health workers were not fully involved at the beginning of the pandemic, and there were problems of proper planning for the response. Lack of PPEs was one of the major problems, and health workers were not being protected,” said GX#9 (a 45-year-old male health worker).
“There was an inadequate supply of personal protection equipment (PPE) while the Ministry of Health (MOH) was recommending double masking whereas getting a single mask was already an issue and therefore individual health workers had to purchase their PPEs,” said GX#8 (a 33-year-old, female, health worker).
“…allowances for the frontline workers were not delivered. The general fatigue among health workers, an inadequate workforce, and funding gaps were problematic during the response to the pandemic,” said GX#12 (a 49-year-old male health worker).
“Some health workers contracted the virus, became very sick, while others died. There was an increased workload for health workers due to staff shortage, resulting in the cancellation of leaves for some staff. The discriminatory payment of allowances was witnessed as only staff in CTUs were paid, and therefore managing staff in other departments became difficult. PPEs were very few and inadequate; some were of poor quality,” said GX#16 (a 48-year-old female health worker).
“There was overwhelming patients' load due to an overwhelming number of COVID-19 cases and shortage of staff to care. In addition, health workers had movement disturbances at night due to the night curfews imposed by the government, where on some occasions, even health workers going to and from work were arrested and detained. Furthermore, supplies urgently required for treatment such as warfarin and vitamin C were unavailable in many health facilities. These were the many challenges faced by the health workers during the pandemic,” said GX#27 (a 36-year-old female health worker).
“We had many problems with other medical emergencies, for example, maternal emergencies which were often referred to hospitals very late and many other medical and surgical emergencies that arrived late with many adverse events due to the movement restrictions imposed by the government,” said GX#29 (a 56-year-old female health worker)
“Lack of adequate facilitation, lack of PPEs, infection with COVID-19, inadequate staffing, overworking, burnout effects, and limited resources were problems experienced by health workers during the pandemic,” said GX#20 (a 41-year-old male health worker)
“Loss of dear ones and relatives, the fear of isolation, stigmatization, and high costs related to the treatment of COVID-19 grossly affected many health workers in this region. Many people lost their jobs, especially with the lockdown, and could not afford many basic requirements, leading to poor feeding due to lack of money to buy food. In addition, our school was closed, and many of our students became pregnant during the long layoff. This was combined with the lack of IPCs and other materials for the management of COVID-19, which negatively affected our work,” said GX#25 (a 63-year-old male health worker).
District task force members had problems accessing their families during the COVID-19 pandemic and the lockdowns.
“During the lockdown, we had problems accessing our families, friends, workplaces, and the current economic recession has adverse consequences in our lives, and it is giving us a lot of anxiety and stress,” said GX#3 (a 54-year-old female, Politician).
“…there were problems with family interaction due to long-duration without physical contacts for some security officers. Many security officers did not go on annual leave. In contrast, others had their annual leaves canceled to ensure that there were enough officers available to handle the situation,” said GX#5 (a 59-year-old male, security forces).
Members of security forces faced violent reactions from the public, and others became infected with the COVID-19.
“Some communities became violent to the police during the lockdown when poverty was biting hard. There were violations of standard guidelines as a defiant response to government directives, and some community members physically attacked members of the security forces,” said GX#5 (a 59-year-old male, security forces).
“Some officers got infected with the COVID-19, many were sick for long and while others passed on during the period. The workload became greater because we lacked the workforce to handle all the assignments. In addition, people have been working under tension because of the fear of the virus. Family contacts have reduced because of curfew implementation and restrictions to the security forces,” said GX#13 (a 31-year-old, female, security forces)
Stigma among community members during the COVID-19 lockdowns and reduced engagement and sensitization of community due to the fear of the disease. Participants expressed widespread incidences of stigma in the community during the pandemic.
“Stigma on COVID-19 patients was widespread in the population. Communities thought that all health workers had the virus already, which created fear and anxiety in communities where health workers live. Health workers also became fearful that they may contract the virus considering the level of exposure they go through. There were inadequate IPC materials for health workers in the general ward and outpatient departments. There was overwhelming pressure on health workers to perform, and yet the work overload was too much, and equipment was in short supply” said, GX#11 (a 41-year-old male health worker).
“……. challenges faced during the pandemic included reduced access to public transport. Limited community engagements and sensitization to achieve the desired health indicator, especially on routine immunization, in addition, there were too many bureaucracies at the task force offices,” said GX#1 (a 43-year-old female health worker).
On question 7, what advice would you give to the region’s population on how to protect themselves against the Coronavirus infection?
Themes that evolved were: (i) Follow the IPC SOPS guidelines (ii) COVID-19 vaccination (iii) More research on drugs for treatment (iv) Adopting good feeding practices
In theme (i), many participants suggested several ways in which communities could respond during the COVID-19 pandemic to limit the spread and protect themselves against the virus.
“Stay at home, practice social distancing, use the SOPS, avoid large gatherings such as churches, markets, funerals, and games. Children and teachers should first be vaccinated before schools can re-open, and children should be taught in nearby schools,” said GX#2 (a 55-year-old male, member of security forces).
“All members of the community should undertake enrollment for mass vaccination, and this should be combined with social distancing and a general change in the mindset to fight the disease,” said GX#3 (a 54-year-old female, Politician).
“Accept it as a new situation and move away from traditional practices of conducting huge funerals, rituals, marriage ceremonies and embrace COVID-19 SOPS, and infection prevention and control (IPC),” said GX#10 (54-year-old female, Politician).
“Adopting good practices, document herbal medicines and encourage good practices on the COVID-19 pandemic. All community members should practice resource accumulation and hard work to make resources available for the family. This should be followed by encouraging the culture of saving and strengthening facilities at home, schools, and hospitals to avoid importing COVID-19 infections,” said GX#14 (a 44-year-old male, DTF)
“We should encourage vaccination, observe the SOPS, regular hand washing and use hand sanitizers, regular exercises, and eating well as a means of surviving the pandemic,” said GX#1(a 43-year-old female health worker).
“We need to increase the uptake of COVID-19 vaccines, increase the use of IPC SOPS, for example, regular handwashing with soap and water, social distancing, emphasis on the home-based care model of management and adherence to the ministry of health guidelines,” said GX#20 (a 41-year-old, male, health worker).
“Listening to the health authorities and ensuring adequate observance of SOPS, utilizing the lockdown period to have quality family time to care for and parent children. In addition, we should increase food production through farming. Furthermore, we should develop a comprehensive plan to address the issue of long-term consequences of the lockdown, which remains a critical intervention for the future,” said GX#24 (a 39-year-old male health worker).
“Adhere to standard operating procedures (SOPS), taking advantage of the vaccination exercise currently being rolled out, and if eligible, one should become vaccinated. The vaccines are free of charge. Health systems should invest in various methods of reaching out to the public and communities, involve religious and cultural leaders to mobilize the communities,” said GX#29 (a 56-year-old female health worker).
“Eat a well-balanced diet to enhance immunity that can fight against the virus, observe the COVID-19 SOPS, go and seek medical attention when the signs and symptoms appear,” said GX#30 (a 35-year-old female health worker).