Uganda reported its first confirmed case of COVID-19 on 21 March 2020. The country has since implemented a series of public health measures to limit the spread of the virus. The pandemic has progressed from imported cases through sporadic community cases to stage four, with widespread community transmission. This paper documents how evidence and analysis were used to support decision-making for an adaptive health system response to COVID-19 in Uganda in 2020. A desk review was thus implemented using published and grey literature covering the period from February to October 2020 to document the nature and organisation of different data and related evidence used to support projections, planning and decision-making on the surveillance, prevention, care and health system response to COVID-19. The desk review also looked at how evidence was used and communicated across different actors to support adaptive responses. While there have been challenges, Uganda’s response to COVID-19is reported to have been dynamic, responding to different sources of evidence, and through different institutional channels and actions, with the latter generating evidence and experience that feeds back to the response.
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This information sheet is the second presenting work summarising evidence as of July 17 2020 from official and scientific population data across countries in east and southern Africa (ESA) on the COVID-19 pandemic, the responses to it and the relationship with other indicators of population health, health systems and health determinants. The information sheet aims to address four questions: What is happening with COVID-19 testing and detection? How and where is the epidemic progressing over time? How has the health system responded? What are the implications for wider vulnerability? In terms of the epidemic profile, increased testing has improved case detection, although still at low levels for an effective public health response. The pandemic continued to take different forms in different ESA countries. In terms of the health system response, the evidence in July indicated continued constraints in accessing diagnostics, limiting case detection, despite reasonable surveillance capacities. In terms of wider vulnerability, the slower, sustained increase in cases in the ESA region were noted to raise concern on the effects of sustained implementation of measures such as school and workplace closures.
This paper outlines how for ESA countries, COVID-19 has exposed the weakness in being dependent on research and production outside the region of commodities that are needed in good time for communities and services across the region. This not only relates to current demand, like test kits. It forewarns that African countries will be last in the queue when COVID-19 treatments and vaccines are approved. Tariff reductions and reduced protections for domestic industry have suited a global strategy of ‘lowest-cost-production’ but leave ESA countries vulnerable in the global competition for products. The author also notes that COVID-19 has pointed to resources in the region that could play a more significant role in public health. The Ebola experience showed that an effective response demands collaborative work that involves communities and is supported by professionals, governments and accessible, capable public services. This is the same lesson learned from the gains made in health by applying primary health care strategies in the region, despite their being weakened by underfunding of public services. In contrast, the response to COVID-19 has often generated a self-protective response across countries in global trade and a command-and-control response within countries. Yet neither are effective strategies for a global pandemic that demands distributed local capacities and action. Noting the UN call to use COVID-19 as an opportunity “to rebuild differently and better, the author observes that this begins with how we respond to COVID-19 today, and raises what this implies.
This paper presents the current situation and projected trends related to climate change in east and southern Africa (ESA); the implications for the health of current and future generations of these trends and; the policy choices and alternatives to respond to them. ESA contributes the least of any world region to global greenhouse gas emissions yet will be more vulnerable to the impacts of climate change than any other region. Extractive sectors exacerbate climate change through deforestation and high emission levels of greenhouse gases. Climate change is expected to cause reduced rainfall and a greater frequency of extreme events in the region, and ESA countries will be vulnerable due to their economic reliance on rainfed agriculture and water resources.The region faces resource and other constraints to implement adaptation policies, or for key areas such as the development and production of green technologies.
This paper presents the current situation and projected trends related to biodiversity and genetic resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The biodiversity, genetic diversity of plants, animals and forests in ESA countries are declining at alarming rates, risking the health and wellbeing of populations in the region. Losses of biodiversity and genetic resources have led to poorer diets, poorer living conditions, encroachment on areas with animal populations and an erosion of wild foods and medicinal plants that raise the risk of chronic and zoonotic diseases and pandemics. Current policies have not reversed these trends, nor met the targets of the Convention on Biodiversity (CBD). The authors argue that this calls for an urgent paradigm shift from industrial agriculture to diversified agro-ecological systems and a one health approach, that recognise the complex, intergenerational interconnections between human and animal health, plants and a shared environment. The authors call for a movement to defend genetic diversity as a common good, not something that can be extracted and privately profited from.
This paper presents the current situation and projected trends related to extraction of mineral resources in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. The author notes several changes in the coming decades that have numerous implications for health and wellbeing in ESA, including as a result of land displacement and precarious jobs. A demand for greater and wider health and developmental benefits from current and future mineral extraction has led to resource nationalism. The paper notes that it means effectively projecting, monitoring and preventing the impacts of mineral extraction on health and environments; adopting financial transparency and accountability measures and employing strategies and responses that are built from bottom-up through consultation with small scale miners, communities, workers and the wider public.
This paper presents the current situation and projected trends related to water in east and southern Africa (ESA), the implications for the wellbeing of current and future generations of these trends, and the policy choices and alternatives to respond to these trends and the factors that influence policy design and uptake of choices. Maldistribution and water scarcity and stress are predicted to intensify in coming decades. Southern countries will become significantly drier and east Africa will have higher rainfall. Climate change will amplify existing variability but may be less critical than growing demand for water. A growing, urbanised population, expanded enterprise and agriculture will deplete and can pollute water resources, with lowest income households least served. Water scarcity contributes to ill health, food insecurity, poverty and increases women’s burdens. There is a potential for vicious or virtuous cycles between these impacts and water resources, depending on the policy choices made. Inequality and stress is not inevitable. There is potentially adequate water to meet the basic needs of all in the region and for sustaining ecosystems if managed through co-operation, paying attention to equity, interdependence and long-term outcomes. The dividends from investments in water systems thus need to be made more visible as well as the harms of competitive, short term choices.
Written in response to the United Nation’s High Level Political Declaration on UHC in September 2019, this issue has a focus on universal health coverage (UHC). Written before the COVID-19 pandemic, the articles reiterate that robust health systems matter and that the implications of a system’s universality, accessibility and quality reach far beyond any particular nation. The articles are open access for a limited period of time. This paper in the series examines the experience of advancing UHC in East and Southern Africa, drawing in part on learning from work in EQUINET. Underpinning the UHC agenda is the belief that access to health care is a fundamental human right that advances equality and safeguards human dignity. Achieving UHC is a huge endeavour and requires buy-in at all levels of the system. It calls for strategic leadership, evidence and review. There has been a significant expansion in the technical information and knowledge available to support UHC. Making progress towards achieving it is, however, not simply a technical issue: it is an issue of power, political choice and leadership.
The ability of African countries to mount effective and equitable responses to COVID-19 reflects in part the access that countries have to reliable, sustained, distributed supplies of diagnostics (antigen and antibody test kits and equipment for decentralised laboratories) and health technologies (personal protective equipment (PPEs), oxygen and constant positive airway pressure equipment). As medicines and vaccines are developed and approved for COVID-19 they too need to be available at mass scale and locally distributed. Currently, African countries, like many others, face shortfalls in all of these essential commodities relative to need. Various global, multilateral and bilateral arrangements have been proposed to address innovation in and access to these technologies. This brief shares information on initiatives related to diagnostics, health technologies, medicines and vaccines, the issues for African countries and options for addressing them in the dialogue and negotiations at global fora. It covers African interests and options in relation to (i) securing solidarity-based bilateral and multilateral resource streams for supply needs; (ii) using existing TRIPS flexibilities (iii) enabling open innovation and sharing of intellectual property and (iv) enabling open manufacturing and distributed and local production of these technologies. The pressure is thus growing for all COVID-19 related drugs, diagnostics, vaccines and health products, existing or future, to be considered global public goods, as expressed by the UN Secretary General on 24 April. At the same time, the brief argues that the way to make these products available to everyone, everywhere, must be by structurally linking open innovation and open manufacture to distributed production and access. Current experience suggests that any other approach may fall short on delivering timely and equitably distributed access for African countries.
This desk review, commissioned by EQUINET through TARSC as part of the ongoing work on the extractive sector in the region aims to inform public sector professionals, policy-makers, civil society and parliamentarians on the population health impacts of large- and small-scale mining activities in East and Southern Africa. The paper specifies the known health risks for the different types of small- and large-scale mines in the ESA region. Poor communities are likely to be more affected as they have limited choices for employment, sub-optimal housing and limited access to safe drinking water. People living close to mining sites or near mine dumps and those whose livelihoods are tied to rivers for domestic and agriculture water are exposed to polluted environments due to mining wastes and contaminated air and drinking water. Discrepancies exist between what is documented and known about the health risks of mining globally and documented levels of these health outcomes in the ESA region. The author presents various reasons for this. Health impacts assessments are not always done before mines are licensed. After mines are licensed, these health outcomes may be poorly monitored. Information on the numbers and health status many living and working in mining and of ex-miners remains limited.