Cheered in the early stages of the pandemic for taking decisive steps to limit the spread of Covid-19, Uganda is now battling a fast-growing spike in community transmission that is overwhelming government hospitals and has caused a rise in deaths.
The pace and the severity of the Covid-19 transmission in the country has spurred new concerns that people who were initially frightened and easily adhered to standard operating procedures have since thrown caution to the wind. As the rest of the world grappled with slowing the spread of the coronavirus in the early months of the pandemic, Uganda largely remained unscathed until March 21 when the first case was reported.
Even when the first case emerged, the rate of transmission remained very low, until later in the year. The country never reported any Covid-19-related death until July 23, 2020. Compliance with standard operating procedures (SOPs) especially washing hands and social distancing was religiously adhered to.
The fear of contracting the dis-ease stood between 70 and 80 per cent between March and May, according to survey results from the ministry of Health. But that changed in just months. To date, Uganda has about 31,187 Covid-19 cases and 231 deaths and is still counting.
However, these numbers still pale in comparison to hundreds of thousands of confirmed cases and fatalities in Europe, Asia and USA. Our rising curve though is a big worry for ministry of Health officials. There are many reasons to explain the climb in Covid-19 cases. People interviewed for this story, with knowledge of the country's laboratory testing regime, blame the spike in Covid-19 cases on the actions and inactions of ministry of Health officials.
They said a few stumbles in the testing regime allowed people with the virus to circulate freely within the local population.
TESTING
Interviewed, some health workers at some border testing centers said many of their colleagues had broken from the rigid testing script. To slow the spread of the highly infectious coronavirus, President Museveni initially closed all Uganda's borders with the obvious exception of merchandise-carrying long-distance trucks.
Government also demanded that before any person is allowed into Uganda, he or she must provide a negative Covid-19 test. But our sources say the vigilance, and meticulous-ness used to handle coronavirus testing has since waned.
"We used to have government health workers who were backed up by volunteers who used to do the testing, but now many of the volunteers were de-mobilized because government says they don't have money. Where we used to have four people, now we have two or one," the source said.
A source at another border testing center said the ministry doesn't adequately provide personal protective equipment [PPE] anymore.
"People are generally demoralized, that's why many are not doing their job as they should," the source said. Interviewed for a comment, Emmanuel Ainebyoona, the spokesperson for the ministry of Health, confirmed personnel at border points were Using a temperature gun scaled back after the epicenter of the virus changed.
"We concentrated so much on borders at the time when all our cases were coming from outside the country. Now we have community infections everywhere. Naturally we had to shift our resources to other places where they are needed most," Ainebyoona said.
Another source said the ministry is no longer rigidly tracing contacts of Covid-19 victims. Many contact tracers were laid off. By August the ministry of Health had be-tween 40 and 60 contact tracers, a source said, but that number was slashed to 8-10.
And those remaining haven't been paid for the last four months. Sometime in August, Bettina (name changed on request) took her husband to Lancet Laboratories for a Covid-19 test at Shs 345,000, because he had presented with all the symptoms – including chest pain, fever, loss of sense of smell/taste, headache and difficulty in breathing – for at least five days.
"When he received a positive result the following day, through connections we secured an ambulance to transfer him to Mulago as our car was impounded for fumigation," Bettina said.
"As soon as the technician gave us the results, he told us to go home and wait for a call from the ministry. Had we not used our connections to deliver my husband to Mulago, the ministry would probably never have called, because he has never received the said call since his positive test."
"After his admission, I was told to self-isolate for 14 days, and also find my way to Kiswa health centre in Bugolobi for a test, because the Mulago sample collection centre had been closed and reserved for VIPs."
"Meanwhile, they told me not to use public means to go to Kiswa, but there was no vehicle or ambulance to take me. How was I supposed to get there and go back home?" Bettina said. That was August 20. By August 31 when The Observer interviewed her, Bettina was yet to receive her test results, despite repeated calls to Kiswa.
Also, no contact tracer had been to Bettina's neighbours/community, neither had she received a follow-up phone call from health workers as a primary contact to a Covid-19 patient. At Mulago too, her husband reported that no one asked for his list of contacts!
UNPAID SALARIES
Our sources also said the ministry has not paid salaries for frontline health workers for three months, starting from August. Other unpaid workers include those of Entebbe Grade B hospital, one of the first health facilities to handle Covid-19 cases.
"Every time we ask for our money, they tell us that the supplementary budget is not yet approved. How do they want us to do the job properly without pay?" the source said.
However, Ainebyoona said some health workers who were testing for Covid-19 at the borders were volunteers who were paid by other aid organizations.
"Before someone says they have not been paid, first ask them whether they have a running contract with us. Otherwise, many continued working even after organizations that were paying them pulled out," Anebyoona said.
SELLING OF RESULTS
Going for months without pay, according to these health workers, has triggered vices like doctoring of covid-19 certificates especially at the Busia border. Travellers pay to get a negative Covid-29 result. According to our source, negative results are sold between Kenya Shillings 1000 and 2000 [Ushs 32,000 to 64,000]
To achieve this, the source said results, are edited to put negative results or postdated to remain valid even after they expire. This source added that at checkpoints, no due diligence is done to ascertain whether the results are genuine or not.
"They need to first check those results in the system to ascertain whether they are legit or not because each result has a serial number which, if checked, will bring the valid results and then ascertain whether they are legit and then stamp them. But what happens, when one brings results, they are just stamped," the source said.
Interviewed, Ainebyoona said, "From our side, it's hard to forge results because each has a distinct serial number that makes
it easy to verify. However, there could be some people who try to change these results but it's easy to catch them."
Uganda is said to be at stage four of the virus transmission that is mainly among the community. In just one week, the country recorded more cases of Covid-19 than those reported in the first four months after the first case was reported in Uganda.
FINGER-POINTING
How did the country slip up and how did Ugandans lose trust in government's handling of Covid-19. At the start, President Museveni and his Covid-19 government taskforce had built a solid fortress of credibility and trust with their timely and swift interventions against Covid.
That trust was slowly but steadily diminished when government officials started violating the Covid SOPs. The once-praised ministry of Health officials came under fire too. The minister of Health, Jane Ruth Aceng, christened Mama Corona, for her relentless campaign against the highly infectious viral disease, lost the spark too, when pictures emerged showing her meeting a big group of people in Lira without wearing a face mask.
Her explanation did little to reassure the public. Aceng said she did not wear a mask because it was not a political rally. She said the meeting was meant to distribute face-masks to the people of Amoro Sub-county, Lira district.
"They got excited when they heard about face masks, and specifically the minister for health whom they call 'Mama Corona' and rushed to see me. They were difficult to control as seen in the picture as many wanted to take pictures and also get masks from me," she wrote.
On June 25, when the country had 848 cumulative cases, 780 recoveries and no deaths, the president of the Society of Uganda Private Medical Practitioners Dr Lulume Bayiga told a press conference that it was going to be an uphill task to convince Ugandans that the health impact of Covid-19 was as big as projected.
Lulume urged Uganda to emulate Tanzania and Burundi that had not locked down their countries but had kept their economies running amidst the pandemic, in hope for herd immunity (a form of indirect protection from an infectious disease that occurs when a sufficient percentage of the population has become immune either through vaccination or previous infections).
When businessman Ben Kavuya used his connection to have his wife Barbara, daughter Blanche Kibaju and grandson Isaiah Tiba Byabashaija, approved to travel back home against the restrictions that had seen Entebbe International Airport shut off to passenger flights since March 21, the public uproar said it all.
There was a glaring failure in providing leadership. The violence-plagued NRM elections for flag bearers this year and the sheer lack of respect for Covid-related SOPs laid the ground for the ongoing violence-scarred presidential elections. Government has and continues to find difficulty in convincing Ugandans, more-so opposition politicians, that the health impact of Covid-19 is as big as projected when NRM candidates are violating the SOPs too.
In a statement issued on November 19 2020, the minister of ICT and National Guidance Judith Nabakooba called upon all presidential candidates to make an effort and respect the election guidelines provided by the Electoral Commission and the ministry of Health especially the one limiting the number of people at rallies to only 200.
In the statement, she singled out and appreciated presidential candidates Yoweri Kaguta Museveni and General Mugisha Muntu for restraining the public against crowding and called out other candidates that if they really care about the lives of their supporters, they should make an ef-fort and restrain them from crowding.
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