Kampala, 24th April 2019:- Uganda's Ebola Virus Disease (EVD) preparedness and response have capacity gaps that need urgent attention to be able to effectively respond to a potential outbreak of the disease. The gaps were identified during a Simulation Exercise (SimEx) that was conducted recently in Wakiso (Entebbe) and Kasese (Mpondwe and Kagando) districts.
Specifically, the SimEx tested the functionality and coordination of the preparedness pillars, identified weaknesses and proposed urgent actions for improvement. It critically evaluated readiness at national, district and community levels.
Among the challenges identified was inadequate coordination and communication between the Public Health Emergency Operations Centre (PHEOC), district authorities and health workers in Ebola Treatment Units (ETUs) and at Points of Entry (PoEs). This challenge was evident at the Entebbe Grade B hospital Ebola Treatment Unit (ETU), Entebbe International Airport and at Kagando hospital in Kasese district. In a real EVD outbreak, this challenge would lead to delayed identification, notification, transfer and management of patients which is potentially dangerous.
Surveillance preparedness had gaps in designation and preparation of isolation areas, tracing of contacts and security at the ETUs for patients and property. At Mpondwe border Point of Entry and at Kagando hospital, major gaps identified included inconsistent screening of travellers, inadequate deployment of screening staff, and improper use of Personal Protective Equipment (PPE) and poor observance of infection prevention and control (IPC) protocols. Case definition forms were also not available at Mpondwe PoE.
For case management, the inadequacies were in patient management; wearing and removing PPEs by health workers; knowledge on preparing chlorine solution; observance of the five moments of hand hygiene; waste management; and adherence to the buddy system. Others gaps were on patient documentation and signage in the ETUs.
Regarding IPC the SimEx pointed out inadequate disinfection of surfaces, adherence to IPC protocols and poor handling of patient property which can expose health workers and other people to the disease. At the ETU, the exercise identified a lack of well-defined roles for the laboratory team members which affects sample collection and management. Risk communication preparedness was lacking adequate IEC materials in local languages at PoEs, in the ETUs and in the communities.
However, there were a number of positive aspects observed in all the pillars. For instance, the National Task Force was found to be on top of the process and can easily mobilize different pillars to respond to an outbreak in record time. Communication between the Public Health Emergency Operating Center (PHEOC), and public health emergency sites was also good. Primary and secondary screening at the PoEs and in the community were also well done. There are adequate materials such as thermometers, PPEs, hand washing facilities and chlorine in all the sites an indication that the country has taken major prevention and control precautions, should an outbreak occur.
The ETU at Bwera was noted to be adequately prepared and the health workers demonstrated good knowledge of EVD management. The unit was also well maintained with good hygiene, waste management and availability of enough water. There was an excellent collaboration between security and health workers at Mpondwe PoE.
In addition, the SimEx found heightened community risk perception pointing to the good work done on community engagement and risk communication. The Village Health Teams, especially in Kasese district, were prepared and demonstrated the ability to identify suspect cases and promptly pass on EVD information in the community.
Ambulances were also found in all the designated areas and transported "patients" as required in an outbreak situation. Logistics such as PPEs, infrared thermometers and hand washing facilities were found in all places as required and were being used.
At the closure of the SimEx Dr Allan Muruta, the Incident Commander for disease outbreaks in the Ministry of Health noted that "the exercise has given us a lot of information and indicated to us areas we need to strengthen. We are going to develop and implement a Corrective Action Plan as soon as possible to improve our preparedness", he added.
The PHEOC Director Issah Makumbi concurred saying that "we have a lot of work to do. We must grab this opportunity to prepare not only for Ebola but also for other diseases that might break out in the country."
The WHO Representative in Uganda Dr Yonas Tegegn Woldemariam emphasized the importance of IPC as central to any EVD prevention and control efforts. "We have to build a sustainable system not only for EVD but also for other health problems. The more we do this the better we shall get at it. WHO is there to support the process," he said.
The Director of the Centers for Disease Control and Prevention (CDC) in Uganda, Dr Lisa Nelson, commended the government and partners for organizing and conducting the SimEx "which has given all of us renewed focus". She advised MoH and partners to urgently address gaps identified in the SimEx so that the country is better to effectively respond to EVD.