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. A recent World Health Organization (WHO) report has suggested that countries in Africa could experience a prolonged COVID-19 outbreak over several years with up to 44 million infections and 190,000 deaths in the first year alone if containment measures fail. The report concluded that the potential 5.5 million COVID-19 hospitalizations, almost 170,000 requiring oxygen, would overwhelm the available medical capacity in much of Africa. The Centre for Disease Dynamics, Economics & Policy (CDDEP) has also estimated the potential COVID-19 case burdens in each country in Africa. In Uganda peak COVID-19 infection is predicted to occur between mid-July and September 2020 with between 3 and 4.5 million cases, 40,000 to 60,000 of which would require hospitalization, well beyond the available medical capacity in Uganda. In countries such as Uganda, where the health system is weaker, prevention is the key to protecting lives. If just 50% of the predicted number of severe cases were to seek hospital care at the infection peak, CDDEP estimate that Uganda would have 8,000 too few hospital beds, 1,400 too few ICU beds, and 610 too few ventilators to adequately care for those in need. 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. Adara’s Approach 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 around 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. 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. This includes: Supporting Kiwoko Hospital and Nakaseke Hospital to deliver MNCH safely through the pandemic • Protect health workers and support health facilities with the necessary training, protocols, equipment, and supplies for addressing COVID-19 including by procuring appropriate PPE (including surgical masks, N95s, coveralls, and gloves), and other supplies, such as infrared thermometers, hand sanitizer, and soap for Kiwoko and Nakaseke Hospitals; • Create specific MNCH protocols and guidelines to assist hospital staff in the management of maternity and NICU patients at Kiwoko and special care baby unit (SCBU) patients at Nakaseke Hospital, including protocols specific to the management of suspected or positive COVID-19 patients in the maternity ward and NICU; and • Maintain (and where necessary, adapt) essential Kiwoko Hospital health services, including maternity, NICU, Hospital to Home, HIV, diabetes, immunisation, and family planning. Supporting community outreach services • Provide COVID-19 training to Village Health Teams (VHTs) and supply them with masks, soap, and water so they can educate families on protecting themselves and their newborns from COVID-19; • Raise community awareness of public health, hygiene, and prevention measures through the distribution of posters, handbooks, and education announcements through multiple channels, including SMS and regular radio broadcasts; • Provide education to vulnerable client groups on nutrition and balanced diet during COVID-19 and work with VHTs to identify families in extreme need and explore opportunities for providing nutrition relief; and • Provide education and support to the 2900 clients enrolled in Kiwoko Hospital’s HIV/AIDS programme, including the provision of cloth masks to keep them safe. 4 Evaluation Monitoring and evaluation is integral to all Adara programs. Key indicators that will be measured include: • # of health workers, village health teams, NICU families and community members trained • # of NICU patients trained in COVID-19 prevention • # of PPE items delivered to hospital staff and patients • # Hospital to Home community clients receiving phone assessments or counselling • # of suspected and confirmed cases of COVID-19 amongst patients and health workers • # of protocols, training and education materials developed and disseminated • # of essential drugs/medicines supplied, including contraception • # NICU and maternity admissions and # of babies born • # maternal and newborn deaths • # of pregnant women and children immunized • # families receiving food relief Our Funding Need Adara is seeking US$750,000 to support our health work in Uganda in 2020 as we tackle the COVID-19 crisis. We would be delighted to partner with you to strengthen the reproductive, maternal, newborn and child health services that Kiwoko and Nakaseke Hospitals provide to one of the most vulnerable communities in the world. 5 Kermi Village About Adara The Adara Group was founded in 1998 by Audette Exel to bridge the worlds of business and international development with a special focus on serving the most vulnerable communities. Today the group comprises two different parts, an international development organization called Adara Development and two corporate advisory businesses - Adara Advisors Pty Limited and Adara Partners (Australia) Pty Limited. The sole objective of the businesses is to help support Adara Development’s administrative costs. This allows 100% of all other

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