When a storm hits, having a solid foundation is advantageous.
Over the last two decades, the Global Fund has invested in strengthening health-care systems because we cannot end diseases without a solid foundation.
Uganda reported its first cases of COVID-19 a year ago, in March 2020. COVID-19 appeared to be more of a hurricane than a storm as word of the pandemic spread around the world. However, Uganda's health infrastructure has stood the test of time. Since the start of the pandemic in 2020, this country of over 44 million people has recorded relatively low COVID-19 numbers: 40,593 cases and 334 deaths.
Given the dire situation in many countries and the fact that the virus has killed over 2.6 million people worldwide, Uganda has been a huge success in combating COVID-19.
Uganda accomplished this feat by rapidly deploying health systems and community responses designed to combat other infectious diseases such as HIV, tuberculosis, and malaria. The successful rollout of testing, which is the first line of defense against COVID-19, was made possible by a strong network of laboratories and surveillance systems, as well as well-trained human resources, including over 150 trained field epidemiologists spread across the country.
Testing for COVID-19 is done through antigen rapid diagnostic tests (Ag RDTs) and polymerase chain reaction (PCR) tests, which require laboratory facilities to be carried out. Fortunately, Uganda was well prepared to accommodate this. “We have strong laboratories built over the years with support from partners,” explains Uganda’s Minister of Health, Dr. Jane Ruth Aceng. These partnerships, including with the Global Fund, were critical in the response to COVID-19. With support from partners and the Global Fund’s investments over the years, Uganda has built a good laboratory system with a network of hubs that covers over 97% of the country. In addition, the country has a strong centralized testing capacity, including through the Central Public Health Laboratories (CPHL), the Uganda Virus Research Institute, and the country’s WHO-accredited Supranational Reference Laboratory.
The Global Fund responded quickly and significantly to Uganda's national response to the COVID-19 epidemic, disbursing US$51,935,105 in additional funding for their COVID-19 response and assisting Uganda in utilizing US$10,510,356 in existing grant savings. The Global Fund enabled countries such as Uganda to use grant savings and reprogramming to quickly adapt existing HIV, tuberculosis (TB), and malaria programs, purchase personal protective equipment (PPE) for front-line health workers, diagnostics, and medical supplies, and launch prevention campaigns. Because of this intervention, Uganda's Ministry of Health was able to immediately ramp up its fight against COVID-19 and order diagnostic tests funded by the Global Fund.
"Over the years, Uganda has built very strong partnerships, including partnerships with the Global Fund, and you came in well on time to support the response in Uganda," says Dr. Aceng.
When COVID-19 struck, Uganda's Ministry of Health quickly formed a national response team, including a committee tasked with streamlining laboratory coordination and managing COVID-19 response efforts.
In response to the rapidly spreading virus, the country's Ministry of Health began decentralizing laboratory testing in order to meet testing needs across the country while continuing to provide other essential health services. This was critical in ensuring that communities throughout Uganda had access to preventive and diagnostic services. Three COVID-19 testing laboratories were also established at strategic points along the border with Tanzania, Kenya, and South Sudan in order to reduce turnaround time and improve cross-border virus surveillance. Decentralizing these lab services expanded testing coverage across Uganda, giving more people access to tests.
Uganda was able to improve access to COVID-19 testing by utilizing and leveraging existing health systems and diagnostic infrastructure. For example, the existing transport system for other disease samples is now also used for COVID-19 samples. Because tuberculosis testing systems, such as GeneXpert, can detect COVID-19, health facilities are performing multiplexing - testing for multiple conditions in a single molecular diagnostic test procedure. The existing data management system is also being used to report and track COVID-19 cases.
However, the battle is far from over.
"We are concerned about the possibility of a second wave," Dr. Aceng says. "We will need more PPE in preparation for that, because previous experience from other countries has shown that the second wave is usually more aggressive than the first." We need test kits that are easily accessible, not only at the center but also throughout the country."