{UAH} PRESS ON UGANDA’S HEALTH AND COVID19 MANAGEMENT

30th June 2021

HEALTH (especially public health) is a PUBLIC GOOD that's created through collective choice; paid for collectively; and supplied to recipients without charge (or below cost). That's why the Government is indispensable in the delivery of healthcare.

Since Covid19 was first confirmed in Uganda in March 2020, there has been strong concern on it's management. These concerns were generally ignored or, even, ridiculed by the Government.

Uganda reached Stage 3 of Covid19 transmission in June 2020 and the 4th and last stage- WIDE-SCALE COMMUNITY TRANSMISSION- by Aug/Sep 2020. That meant that Uganda had, by that time,  lost the battle of tracing and controlling the spread of the disease.

The main reasons for the early loss of transmission control can be traced to 1) wrong framework and structures for managing the pandemic and 2) poor planning and implementation.

LEGAL and INSTITUTIONAL FRAMEWORK:

We pointed out at the onset that circumstances created by the pandemic, which threatened the economic life and public safety of our country necessitated a declaration of a State of Emergency, provided for under Article 110 of Uganda Constitution.

This would have offered Parliament (and the country) an opportunity to scrutinise and approve a plan for managing the Emergency and for monitoring the implementation of such a plan.

Apart from the absence of continuous parliamentary involvement, there was also over-reliance on political (PM & RDCs), rather than technical structures in managing the pandemic. 

PANDEMIC MANAGEMENT PLAN:

Right from the onset, it was necessary to have and widely share a plan that dealt with the following:

Controlling the spread of the virus.

 Monitoring the Covid19 transmission;

Increase in healthcare facilities, healthcare workers and their motivation.

Socioeconomic and healthcare support for the population.

Research on pandemic; including, the mutations, medicines and vaccines.

Long term socioeconomic recovery.

The above two cardinal weaknesses translated into three major negative outcomes from which loss of Covid19 transmission control was inevitable:

Firstly, lack of effective, timely and continuous communication of information on the pandemic to the population.

Secondly, wrong policies; especially 1) allowing continued 24/7 importation of virus by truck operators; 2) absence of a post-lockdown containment plan and 3) general elections, starting with NRM primaries, that ensured countrywide dissemination from the urban centres. 

Thirdly, loss of faith/good-will in Government's response generally. This was especially occasioned by: 1) widespread brutality and abuse of Human Rights in enforcement of poorly understood measures; 2) abrupt lockdown without corresponding attention to people's socioeconomic (food, rent, water, energy etc) and healthcare needs; 3) massive government borrowing (~ $ 2bn) followed by a corruption bonanza, as people's suffering intensified; 4) Government and NRM leaders violating Covid19 SOPs with impunity, while others were brutally treated for far less or no violations at all; 5) absence of post-lockdown socioeconomic recovery measures for most hard-hit sections of the population; and 6) Weaponising Covid19 to grab power again in 2021 "elections", where NRM/M7 Junta opponents were totally crippled on account of controlling the pandemic.

DECEPTIVE DECLINE OF COVID19 TRANSMISSION:

In spite of losing the control of Covid19 transmission, illness and hospitalisation declined. Illness results from a combination of the aggressiveness of the virus, quantity of virus (load) in the body and the body immunity (ability of body to fight off the infection). 

It would appear that Africans may have had greater immunity against the original virus (SARS-CoV-2) from China. It also appears that the young population of African countries meant that there was a high level of infected people without any symptoms.

This was, on one hand, celebrated as being a result of good Government response to the pandemic; while, on the other, it confirmed to a skeptical population that Covid19 was a hoax all along, being politically and corruptly driven!

Covid19 waves are driven by, both, human behaviour and changes in the virus itself. 

The skeptical population had abandoned any attention to the SOPs for controlling Covid19 spread and, having lost control of transmission, meant new types (variants) were being imported or locally generated and widely spread. 

The deceptive decline was the calmness before the storm. 

UGANDA'S 2ND COVID19 WAVE:

The current Covid19 wave rampaging the country is the result of the lost control of transmission, lack of population observing the SOPs, progressive decline of people's immunity and at least 5 new variants of the virus that are more aggressive.

Regrettably, because of the weaknesses outlined above, the 2nd wave came when the Government preparedness wasn't much different from March 2020 and when the population had become much more vulnerable.

All the concerns outlined above remain up to now and some have become worse:

Lack of constitutional and  institutional management of the pandemic has led to increased marginalisation and deprivation of the population.

Lockdown without social, economic, medical  welfare support.

Education for the majority of the population stopped, while privileged few continue uninterrupted. The promised TVs and radios for home teaching are yet to come!

Industries, shops and supermarkets work; while small and informal businesses are shut down.

Commercial transport (including those importing viruses) and private transport (for "essential" people) work, while public transport is shut down.

No beds, ambulances, oxygen and other facilities in public health facilities, while private health facilities charge prices beyond the public's ability.

Foreign tourists are welcome to tour the country during lockdown, while locals aren't allowed to tour. 

Lack of a clear and publicly approved plan, means that the arbitrary knee jerk responses continue:

Lockdown without clear targets and a workplan to achieve them and, hence, end the lockdown.

The shambolic healthcare system continues; the majority of Ugandans unable to access healthcare; healthcare workers continue being poorly facilitated and motivated.

Institutional capacity and Research in the virus and its control/ treatment will remain unachievable.

Socioeconomic recovery for the majority population will never be realised.

Borrowing and stealing/ corrupt use of public money will continue unabated just like the nearly $2billion borrowed last year.

CLARION CALL:

A plan for managing the current crisis should be urgently presented to parliament that includes immediate social welfare support for vulnerable sections of the population (food, rent, water, energy & medical).  

It should be noted that those holding our country hostage and arbitrarily using our resources will continue doing so unless the population asserts its will over them and regains influence in running our public affairs. All pro-democracy forces and the general public must once again rally together for this purpose. Further guidance on this will be given in due course.

As the people of Uganda struggle to get democratic and accountable public institutions, domestic and external lenders to Uganda government should stop until what was borrowed last year is adequately accounted for and a proper legal and institutional framework for its management put in place. The IMF approving a new loan of $1billion in spite of the above situation shows how it's a part of Uganda's problem! 

Meantime, let's attempt to support each other to the extent possible since the provider of public goods is largely absent.

Dr. Kizza Besigye

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