The country has learnt from its experience of Ebola to control the coronavirus – but its hard lockdown has disrupted health services.
Coronavirus killed Francis Balitamuto’s wife and newborn child. However it was not the infection itself that took their lives, but the restrictions imposed by the Ugandan government in a bid to contain the disease.
Flavia Nambi went into labour in a private medical facility in the eastern Uganda district of Kamuli on May 1.
“Being a midwife herself, she thought that she could push the baby out. However, her uterus got a tear, and the baby died shortly after birth. She also lost a lot of blood in the process,” says Mr Balitamuto.
The clinic where she gave birth did not have any of the blood Mrs Nambi desperately needed to keep her alive. But the nationwide lockdown and overnight curfew that Uganda had introduced to prevent the spread of coronavirus meant that she could not be transferred to another facility fast enough to get the care and blood she needed.
The 39-year-old died in the small hours of May 2.
“I was too distraught when I was told that my wife had also died just as I was coming to terms with the death of our child. Everything happened so fast, and I was very confused. If it wasn’t for the lockdown, it would have been easy to get emergency care faster,” Mr Balitamuto says.
“We did all we could, but it was too late,” he adds.
Uganda has been widely lauded by the World Health Organization and the Africa Centre for Disease Control (Africa CDC) for its decisive reaction against the pandemic. Strict measures have kept the confirmed caseload in the country to under 2,500 cases and 25 deaths – although WHO figures show that the number of cases has increased by 300 per cent in the last seven days.
The landlocked East African nation has performed better on testing than most countries on the African continent. According to the Africa CDC, Uganda has conducted more than 350,000 coronavirus tests on its 45 million population since the pandemic began, almost the same as Nigeria has done for its 200m people.
However, campaigners say enforcement measures to prevent Covid-19 have led to a surge in violations of human rights and knock-on effects on other health services.
Citizens have been killed by local defence units for breaking curfews and expectant mothers, such as Mrs Nambi, have died while attempting to access health facilities.
In March, Uganda introduced one of the most stringent lockdowns in Africa, banning cars and public gatherings, shutting down shopping centres, places of worship, schools and entertainment centres, and putting in place a night-time curfew.
Most of the measures have been relaxed since June, although schools, bars, gyms and places of worship remain closed and the curfew remains in place.
Mask wearing is now compulsory in public spaces, while public transport operators have been permitted to cut passenger numbers by half.
The Ministry of Health has also carried out a round of population testing, with a second one ongoing, to determine the extent of community transmission of the virus.
Experts say this approach, coupled with strong political leadership and Uganda’s previous experience of dealing with deadly viruses such as Ebola and Marburg, have contributed to its strong management of the Covid-19 pandemic.
“We saw early strong leadership from the President in the way the disease has been handled. From the lockdown that was imposed to limit infections, to the aggressive public education, early detection and initiation of treatment have all contributed to the management of the disease,” says Professor Francis Omaswa of the African Centre for Global Health and Social Transformation.
Bernard Lubwama, a senior epidemiologist with Uganda’s Health Ministry says the country has developed strong capacity to trace, identify and manage cases in the crucial early stages, subsequently limiting the spread of the virus.
“By the time Covid-19 was registered in Uganda, we had recently been dealing with Ebola from the Democratic Republic of Congo. So, the same human resource that was managing Ebola metamorphosed into the Covid-19 team,” Mr Lubwama says.
“The containment of these diseases [such as Ebola] is largely based on you being able to have an efficient contact tracing mechanism in place. This is the capacity that we already have in place and are now riding on to manage Covid-19,” says Mr Lubwama.
Village health teams have been reporting suspected Covid-19 cases to the government; then tracing contacts of people who might have the virus or been in contact with positive or suspected cases.
Once a Covid-19 case is confirmed, a “protective ring” is formed around the individual to ensure that as many contacts as possible are reached and tested for the disease, says Mr Lubwama. These contacts are then tested twice for Covid-19 and followed for up to 14 days. Positive cases are sent to isolation and treatment facilities.
“Communities have been very active in alerting us of suspected Covid-19 cases. And because of the capacity that we have developed over time, our teams are able to trace contacts in a timely manner – usually within 24 hours of an alerted case,” says Mr Lubwama.
While this proactive response has helped slow the spread of the virus there is a darker side to Uganda’s coronavirus fight. Human rights groups say any measures to control the spread of Covid-19 needs to ensure the rights of Ugandans are protected.
During the lockdown, beatings and killings by security officials tasked with enforcing lockdown restrictions were also reported across the country. A number of people were also arrested and imprisoned for violating night curfews, including.
Restrictions on movement also meant people were unable to access health service. For example, several people living with HIV were unable to get vital life-saving drugs because they could not travel to clinics.
“A complete lockdown that shuts down public transport and cuts the public from essential services such as health will not be appropriate,” says Primah Kwagala, who heads the Women’s Pro Bono legal initiative.
Professor Peter Waiswa from Makerere University School of Public Health says, analysis from national health facility data on the impact of the lockdown on maternal and child health shows an increase in mothers giving birth to babies with low birth weight.
“This could be attributed to the stress the women were going through but it could also have been because of their limited access to proper food and diet during the lockdown,” says Prof. Waiswa.
President Yoweri Museveni has defended the country’s stringent approach, saying it has helped keep infections relatively low and enabled the country to prepare.
“The lockdown was meant to achieve three things: avoid infections, understand where infections were coming from and prepare better for treatment and disease management,” Mr Museveni said.
But for people like Mr Balitamuto, this is not something to celebrate if citizens die from other easily preventable causes.
“It is not enough to say we are managing Covid-19 when people are dying from other conditions. We need to give equal attention to other health emergencies,” he says.
This article was published by The Telegraph.