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Overcoming the Challenges of COVID-19 Together Responding to a Global Crisis

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Overcoming the Challenges of COVID-19 Together Responding to a Global Crisis Overcoming the challenges of COVID-19 together Responding to a global crisis Adara believes that everyone has the right to quality health and education services, no matter where they live. The COVID-19 pandemic has exposed communities around the world to significant challenges in accessing healthcare, education, and other basic needs and services like food, protection, and social interaction. Crises like these tend to worsen existing inequalities, and we know from previous epidemics that children and women, particularly the most deprived and marginalised, will likely be impacted for months and years to come. Adara is seeking support for our COVID-19 response in Uganda which seeks to: • undertake all mitigation, prevention, and response activities within our means to limit the impact of COVID-19, including providing training and awareness campaigns to health workers and the broader community; • provide protection to health workers through PPE and support health facilities with the necessary protocols, equipment, and supplies for addressing COVID-19, including our partner, Kiwoko Hospital; • and ensure continued access to essential Maternal Newborn and Child Health (MNCH) services to ensure mothers and babies continue to survive and thrive. The structures and tools we have developed over the last two decades in disaster relief, long term community development and maternal and newborn health will be useful as we respond to this pandemic and deal with its long term social and economic repercussions. 2 The Challenge The Ugandan government and Ugandan people have done an admirable job of holding back a significant outbreak of COVID-19 so far. Many years of experience in dealing with infectious disease, including Ebola outbreaks, along with a swift response to the crisis has meant that Uganda has so far avoided the devastation being witnessed in many other countries across the globe. While the Uganda response should be commended, there is no place for complacency while a vaccine is still out of reach.. The country is on a bad trajectory, with the latest projections from the University of Washington’s Institute for Health Metrics and Evaluation (IHME) released on 9 October suggesting that Uganda will reach its peak of COVID- 19 cases in mid-January and could see as many as 157,341 infections per day at the peak. In countries such as Uganda, where the health system is weaker, prevention is the key to protecting lives. It is expected that all hospital beds nationally will be completely full by early January. If these numbers continue, Uganda’s fragile health system would be overwhelmed. Apart from the obvious health risk COVID-19 presents, we are seeing significant and immediate secondary impacts that have resulted from efforts to contain the spread of the disease. Uganda enforced some of the strictest lockdown measures on the continent to curb the spread of the virus and these will undoubtedly have harsh economic and social repercussions through loss of income, loss of access to essential services and increased isolation. We expect to see a significant increase in extreme poverty and hardship in remote communities in Uganda. Women and children living in these communities will likely be the ones hit hardest by the socio-economic consequences during and after the COVID-19 pandemic. Recently, the WHO, UNICEF and the Sabin Vaccine Institute reported that disruptions in routine vaccination are already putting the health of 80 million children at risk and the Johns Hopkins University published estimates that up to 9,450 additional maternal deaths and 193,000 child deaths were at stake from disruptions to routine health services. Adara’s expertise in, and commitment to, delivering maternal, newborn, and child health services to rural communities is more important than ever during COVID-19, to ensure more the most vulnerable women and children can survive and thrive. Our work in maternal, newborn and child health In Uganda, Adara specialises in delivering high-quality healthcare to women, newborns, and children at health facilities, in the community and at home. We have worked in Uganda since 1999, developing deep expertise and strengthening services that have significantly improved the wellbeing of mothers and their children. We have carried out much of this work in partnership with Kiwoko Hospital, a 200-plus-bed, non-profit hospital occupying a 30-acre site in the Nakaseke district of Central Uganda. Last year 1,311 newborns were cared for in the neonatal intensive care unit (NICU) at Kiwoko and 4,010 women received care in the maternity ward. Uganda’s Ministry of Health now recognises Kiwoko Hospital as a National Centre of Excellence in Newborn Care. More recently we have begun working with Nakaseke Hospital, a public hospital located a short distance from Kiwoko. Kiwoko Hospital serves a catchment area of approximately one million people and each year looks after approximately 70,000 patients. The majority of the patient demographic are living in extreme poverty and many are malnourished, which will potentially increase the impact of COVID-19. Nakaseke District also has the sixth-highest prevalence rate of HIV/AIDS among Uganda’s 112 districts, and the health system serves large numbers of people who are immunocompromised. The work at Kiwoko also reaches health facilities across the country, with the Ministry of Health calling on Adara and Kiwoko to help train others in the care of small and sick babies. In 2019, 63 people from 24 health facilities or organisations visited to learn about the NICU and receive training from Kiwoko’s experienced and knowledgeable staff. These visits have inspired many groups to establish newborn units of their own. Centre of excellence Building capacity in Safe Bubble CPAP Early intervention for Knowledge sharing Hospital to Home With our partner, Kiwoko newborn health services In low resource settings, high-risk newborns We share our knowledge and Our Hospital to Home Hospital, we have Adara is advising the respiratory distress syndrome Adara has partnered with expertise on a global stage to programme is designed to give demonstrated the impact of Ugandan Ministry of Health to (RDS) is one of the most the London School of help touch more lives. Adara newborns the best start in life an integrated model of care develop newborn care units common causes of death for Tropical Medicine and is a member of The National and ensure vulnerable infants that encompasses training, around the country. We have babies born preterm. Adara is Hygiene to trial a world- Newborn Steering Committee receive support after discharge clinical support and high written guidelines of care and partnering with PATH and the first early-intervention in Uganda, committed to from the Kiwoko Hospital NICU. standard facility and are working on a nursing University of Washington to programme in central increasing newborn survival. The programme aims to community based care. The curriculum. We are currently develop a Safe Bubble CPAP Uganda to ensure better We are members of the Every strengthen hospital discharge Kiwoko Hospital NICU is a piloting a newborn training kit, specially designed to treat quality of life for families Woman Every Child processes, and ensure babies centre of excellence in programme at Nakaseke babies suffering from RDS in and children at risk of movement. We regularly receive follow up care at home neonatal health in Uganda government Hospital. settings where there is no disability. present on a global stage from trained volunteers in their and East Africa. consistent power supply. about our MNCH work. communities. 4 Supporting essential health services through COVID-19 Adara’s goal: Prevent the spread of COVID-19 as much as possible, support Kiwoko and Nakaseke Hospitals to respond to COVID-19, protect health workers, undertake public health awareness campaigns, and ensure continuity of essential MNCH services. Unfortunately at the beginning of August, Kiwoko Hospital and the surrounding communities of Nakaseke, Luwero and Nakasongola recorded their first cases of COVID-19. All confirmed cases have received care from the Ministry of Health in institutional quarantine. The hospital is working closely with Adara, the district taskforce and the Ministry of Health to contain the spread of the disease. The hospital is a key health facility in the area and it is imperative we act to ensure that all physicians, nurses, team members and patients have everything they need to stay safe, so Kiwoko can continue caring for the community. It is a challenging time for health workers everywhere. These challenges are only amplified in settings with such constrained resources, like Kiwoko. Keeping Sustainable Development Goal 3 on track for 2030 We must continue to move towards the target of ending preventable maternal and newborn deaths by 2030. According to the WHO, many countries are off track for every newborn to survive and thrive and this is being set back further because of the impact of COVID- 19. Some countries may meet SDG3.2 for newborns over 100 years late. In order to achieve the SDG targets by 2030, the WHO has identified gaps and associated midpoint 2025 targets to ensure we meet the 2030 targets. A major gap that has been identified is in maternity care and care for small and sick newborns. The recent launch of the Every Newborn Coverage Targets and Milestones for 2023 has identified four new targets to be rolled out, including the need for 80% of districts in every country to have at least one inpatient newborn care unit. It is critical that we not only help every person that we can, but that we keep operating this centre of newborn excellence that has been built in deep partnership with the local community over the last 22 years. If we don’t manage to do this, the cause of newborn health in Uganda will be set back many years.
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