Working to ease the pressure on an already crowded health system in Uganda
More than a million people in Uganda are living with HIV and many of those are receiving antiretroviral therapy (ART), but there are barriers to treatment that are exacerbated by the spread of COVID-19. Dr. Rosalind Parkes-Ratanshi, Director of the Ugandan Academy for Health and Innovation at the Infectious Diseases Institute, Makerere University explains how innovation is supporting HIV patients whose treatment may fall by the wayside as concerns switch to look at the COVID-19 pandemic.
Traditionally in Uganda, HIV/AIDS care and treatment relies upon frequent in-person monitoring by healthcare workers, but facilities are congested and waiting areas are often full to bursting. “There is overcrowding in facilities, a shortage of healthcare workers, and a widening gap in supply chain systems and infrastructure,” Dr. Parkes-Ratanshi explains. “This puts patients and medical workers at high risk of transmitting or acquiring COVI-19 during their visits. This is now even worse due to curfews.”
Ugandans also experienced lockdowns much like the rest of the world, but of course these restrictions often lead to situations where patients are unable to access their medication at all which jeopardises their ability to continue their treatment efficiently. “Healthcare workers need more information to handle the pandemic,” Dr Parkes-Ratanshi says.
Easing healthcare congestion
Over the past few years, Uganda has implemented assorted service delivery systems to try and decentralise HIV care away from health facilities to try and ease congestion and make drug refills more efficient. Dr. Parkes-Ratanshi and her team see the COVID-19 pandemic as an opportunity to accelerate decentralisation and transform HIV healthcare delivery.
Dr. Parkes-Ratanshi heard about the spread of the pandemic in early 2020, “It was a typical day at the office,” she says. “My first thoughts were about how much this pandemic was going to affect everyone’s life, I was particularly concerned about how to provide services to different communities, especially during a possible countrywide lockdown. Since then there has been panic and anxiety as the pandemic has brought so many livelihoods to a halt, cost so many lives, and caused a lot of mental health problems.”
As an initial response, Dr. Parkes-Ratanshi and her team worked on developing robust continuity plans and worked on a national response to the pandemic with an emphasis on customising existing technologies. The team started innovating around existing technologies to create Digital Prevention, Care and Treatment — D-PCT. This system manages the continuity and quality of HIV and TB care during the pandemic combining clinical patient support and a call centre called the Advanced Treatment Information Centre — ATIC and computer-operated mobile phone-based technology known as (IVR) Interactive Voice Response. In addition to this, a supply chain solution has been included to help ensure that people can get the medication they need. All of these are linked to the Uganda OpenMRS HMIS — the Medical Record System of the Ugandan Government.
The impact of COVID-19 restrictions
While lockdowns work to keep people at a safe distance from each other, they are also proving to be a barrier for some areas of innovation. Dr Parkes-Ratanshi says that IT infrastructure at some sites has been hindered, slowing down the roll-out of the system which does little to ease the fatigue of facility staff under pressure from an influx of new patients. “Due to the pandemic, a lot of focus has been diverted from other critical areas to the management of COVID-19,” she says. “This has greatly slowed down progress and resources.”
“When the planning and strategy processes are aligned and resources are well located, strong health systems can be built and they will thrive.”
To improve the resilience of healthcare in Uganda, Dr. Parkes-Ratanshi says that there needs to be better collaboration between policymakers as well as greater transparency. “Health systems in a country like Uganda are only resilient when this happens,” she says. “When the planning and strategy processes are aligned and resources are well located, strong health systems can be built and they will thrive.”
In order to scale and progress, Dr. Parkes-Ratanshi’s work needs more developers to work on further integration of more health solutions into the National Healthcare system. “This comes with complexity that will need more capacity,” she says. “We also need an effective business model that is tailored to our environment.”
The plan for this system is expansion and country-wide implementation. “It’s going to save time and lives, provide access to medication when it is needed and improve the quality of life for so many people,” says Dr. Parkes-Ratanshi. “In the future, we can see this opening up to support people with other chronic conditions like hypertension and diabetes.”
COVIDaction is proud to be supporting this work by providing financial support, technical assistance, and peer learning opportunities to contribute to D-PCT. Through this partnership, IDI is creating and deploying a stock management module in pharmacies in Kampala and enrolling patients onto the D-PCT platform while coordinating with the Ministry of Health in Uganda to integrate these tools into their national health management systems.
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