Moses Mulumba, Executive Director -CEHURD

As the state and non-state actors take steps in dealing with COVID-19, I would wish to remind them of the need to urgently strike a balance between these prevention approaches and rights with collective responsibilities. While the state must take efficient intervention, which includes undertaking the right to health impact assessment of interventions, individuals should be taking responsibilities of complying with guidance from the Ministry of Health including social distancing, hand washing and taking other measures that have been identified as effective in preventing the further spread of the virus.

From a right to health perspective, it is important for the government of Uganda to ensure that prevention and treatment measures in form of supplies and commodities, such as sanitisers of sufficient quality, are available, accessible, and affordable for the most vulnerable communities including: the older persons, those under incarceration, refugees and the very poor. There is also dire need to devise strategies on how poor households, communities and hard-to-reach places without access to clean water, or those who cannot afford and / or access soap, detergents and sanitisers can utilise the prevention measure on hand washing with soap and water. Equitable access to information on COVID-19, must be availed to those that may not access it through the conventional avenues.

Community participation and solidarity are pillars that have historically been critical in controlling and managing similar outbreaks in Uganda. The effective use of the formal and informal community participation structures in our health system will ensure that communities are active and informed participants in the creation of a responsive health system. In the social isolation mechanism, identification of cases and first management of these cases starts from the family unit and the communities and as such; communities must be viewed as active participants who need to be provided with sufficient, updated and timely information including clearly defined referral systems for the management of COVID-19 cases.

In times like these, the Government’s obligation of protecting the public from third parties violating the rights of communities becomes very important. We envisage that cases of private actors seeking to make earnings out of the desperate situation on COVID-19 will be on the rise. The much-needed commodities like sanitisers, soaps, masks etc will be faked and/or counterfeited and in some cases sold on the black market much more expensively to the communities. In places where there is absence of government isolation centres, private sector facilities may be provided as an option but at a cost that is unaffordable and out of reach for many of those that are subject to quarantines. Research attempts, including clinical trials will be common and some of these may threaten the key ethical and human rights principles of research. The government needs to make full use of the policy space Uganda has in intellectual property as an LDC to enable it utilise new innovations. We therefore call upon the state to pay particular attention to the right to health implication of commercialisation of commodities and other key services in the era of COVID-19. 

We call upon the Government of Uganda to pay extra attention to vulnerabilities in the communities and those faced with the burden of being healthcare providers and carers in the times of COVID-19. While the majority of the reported cases in different regions are men, women are the care-givers which, not only puts them at a higher risk of contracting the virus, but also neglecting their other health and human rights. With social distancing and self-isolation, no alternative options are being proposed and implemented to ensure that girls and women continue to access sexual and reproductive health services. Those in prisons and police custody have particular vulnerabilities and interventions packages should be defined to reduce their risks.

We need to evaluate the extent to which information is reaching those in hard-to-reach areas such as islands, remote and inaccessible areas, pastoral communities, and settlements for refugees and internally displaced persons.

Lastly, as General Comment 14 on the Right to the Highest Attainable Standard of Health provides, violations of the right to health occur when the state, among other things deliberately withholds or misrepresents information vital to health protection or treatment. This can also happen when the state suspends a legislation or when it adopts laws or policies that interfere with the enjoyment of any of the components of the right to health. Given that Uganda’s legislation on public health is over 85 years old, we must make an urgent effort to review the key provisions under the Public Health Act that are central for Uganda to have effective responses for global pandemics like COVID-19. Regulatory approval for new medicines and speedy attention to developing new formulations for the prevention and treatment of COVID-19 are important considerations too.

Let us all take care of ourselves, those around us and stay healthy.

The writer is the Executive Director of Center for Health, Human Rights and Development (CEHURD)

A version of this article was originally published in the Daily Monitor.

Christopher Baguma | Community participation and COVID-19

Community health was an idea mooted by world leaders in 1978 that created the Declaration of Alma-Ata, which reaffirmed access to health as a fundamental human right and identified primary health care as the key to attaining the goal of health for all. During the 30^th anniversary of Alma-Ata in 2008, leaders discussed the role of primary health care in achieving the United Nations’ Millennium Development Goals. This led to rejuvenated calls for use of community health workers (CHWs) as a form of community participation. 

Since the Alma-Ata declaration, successive Ugandan governments have acknowledged the relationship between health and poverty and in the 1990s, with the help of development partners, community health interventions were implemented. In 1999, Uganda’s health policy included community empowerment and mobilisation for health as key elements of the national minimum health care package and subsequently made a commitment to the Abuja Declaration of 2001 This also demonstrated the benefits of community-based interventions and opened the way for a strategy based on Village Health Teams (VHTs). The National Village Health Team (VHT) strategy and guidelines in Uganda were developed in 2000 and by 2003 country-wide roll outs of the VHT strategy had commenced. VHTs are lay people, working in a voluntary capacity, acting as a link between the formal health sector and their communities. They are given basic training on major health issues, including childhood diarrhea, malaria and pneumonia, and play a role in disease surveillance through activities such as data collection and reporting. 

In the wake of COVID-19, the Government of Uganda under the leadership of President Yoweri Museveni issued guidelines initially including the closure of  all schools and places of worship for 30 days and the suspension of travel both in and out of the country with the hope that such measures will slow the spread of the disease. However, as the number of infections increased and the president announced more guidelines ranging from quarantine, restricted internal movements and a curfew. These preventive measures are certainly a good start, but they may not be enough, especially given the systemic and deep-rooted challenges facing Uganda’s public health system.

However, there is no clear mechanism from the Ministry of Health that links communities with existing health care services which is done by the Community Health Workers and Village Health teams using community-based approaches. Accessing health facilities is challenging and expensive for those living in remote and rural areas. Most of the information regarding the COVID-19 pandemic is in English, which means rural communities might not have access to or might find it difficult to understand publicly available information. This raises challenges in accessing timely and relevant information as well as  health services. Prolonged periods of quarantine and movement restrictions are causing emotional unrest and anxiety, gender-based violence including sexual exploitation, interrupted access to sexual and reproductive health services, including access to family planning within the communities.  

To address all these issues, the communities must meaningfully participate in health programmes at the local level. The government should therefore engage community health workers and village health teams to increase coverage and cost-effectiveness of health services delivery in the COVID-19 period. To the CSOs, use the existing community structures like peers, champions and paralegals, among others in rural and urban areas to engage these structures to build strong grassroots coalitions that could reach out to the marginalized communities in the response to COVID-19.

Center for Health, Human Rights and Development (CEHURD) in the fight to reduce the spread of COVID-19 has engaged its community structures; known as Community Health Advocates (CHAs) by designing communication materials highlighting COVID-19 prevention strategies and a toll free line 0800313131 to report any health issue arising within the community that need our intervention. The CHAs work with communities to navigate the healthcare system at the local level by providing information on health, community resources and their rights to health. They work with the communities in identifying and reporting health issues and concerns to the duty bearers. These CHAs have a strong understanding of the healthcare system and resources available within the community as they provide health education to the community related to disease prevention, screenings, and health practices. They do promote community action and garner support to motivate them to seek specific healthy policies by engaging local authorities, healthcare providers and other organisations to develop a more coordinated approach in accessing health services. The coordinated approach is realised due to the existing structure which starts from the community, parish, sub-county and district level with the leadership of the district coordinator and strategic support and coordination from CEHURD secretariat. 

The writer is the Programme Manager -Knowledge Management Program at Center for Health, Human Rights and Development (CEHURD)

A version of this article was originally published in the Daily Monitor.