Interventions for Maintenance of Essential Health Service Delivery during the COVID-19 Response in Uganda, between March 2020 and April 2021

Steven Ndugwa Kabwama (), Rhoda K. Wanyenze, Suzanne N. Kiwanuka, Alice Namale, Rawlance Ndejjo, Fred Monje, William Wang, Siobhan Lazenby, Susan Kizito, Christopher Troeger, Anne Liu, Helena Lindgren, Neda Razaz, John Ssenkusu, William Sambisa, Rebecca Bartlein and Tobias Alfvén
Additional contact information
Steven Ndugwa Kabwama: Department of Community Health and Behavioral Sciences, School of Public Health, Makerere University, Kampala P.O. Box 7062, Uganda
Rhoda K. Wanyenze: Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
Suzanne N. Kiwanuka: Department of Health Policy Planning and Management, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
Alice Namale: Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
Rawlance Ndejjo: Department of Disease Control and Environmental Health, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
Fred Monje: School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
William Wang: Gates Ventures, Kirkland, WA 98033, USA
Siobhan Lazenby: Gates Ventures, Kirkland, WA 98033, USA
Susan Kizito: School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
Christopher Troeger: Gates Ventures, Kirkland, WA 98033, USA
Anne Liu: Gates Ventures, Kirkland, WA 98033, USA
Helena Lindgren: Department of Women’s and Children’s Health, Karolinska Institutet, 17177 Stockholm, Sweden
Neda Razaz: Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
John Ssenkusu: Department of Epidemiology and Biostatistics, School of Public Health, Makerere University, Kampala P.O. Box 7072, Uganda
William Sambisa: Bill and Melinda Gates Foundation, Seattle, WA 98109, USA
Rebecca Bartlein: Gates Ventures, Kirkland, WA 98033, USA
Tobias Alfvén: Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden

IJERPH, 2022, vol. 19, issue 19, 1-14

Abstract: Introduction: The COVID-19 pandemic overwhelmed health systems globally and affected the delivery of health services. We conducted a study in Uganda to describe the interventions adopted to maintain the delivery of other health services. Methods: We reviewed documents and interviewed 21 key informants. Thematic analysis was conducted to identify themes using the World Health Organization health system building blocks as a guiding framework. Results: Governance strategies included the establishment of coordination committees and the development and dissemination of guidelines. Infrastructure and commodity strategies included the review of drug supply plans and allowing emergency orders. Workforce strategies included the provision of infection prevention and control equipment, recruitment and provision of incentives. Service delivery modifications included the designation of facilities for COVID-19 management, patient self-management, dispensing drugs for longer periods and the leveraging community patient networks to distribute medicines. However, multi-month drug dispensing led to drug stock-outs while community drug distribution was associated with stigma. Conclusions: Health service maintenance during emergencies requires coordination to harness existing health system investments. The essential services continuity committee coordinated efforts to maintain services and should remain a critical element of emergency response. Self-management and leveraging patient networks should address stigma to support service continuity in similar settings and strengthen service delivery beyond the pandemic.

Keywords: COVID-19; health care; learning health systems; health services; public health (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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