Journal of Interventional Epidemiology and Public Health (Oct 2023)

Implementing COVID-19 home-based care (HBC) using community health volunteers: Early experiences and lessons learned in Uganda, January - May 2021

  • Ben Masiira,
  • Atek Kagirita,
  • Herbert Kazoora,
  • Bernard Lubwama,
  • Emmanuel Kaggwa,
  • Faith Nakiyimba,
  • Issa Makumbi,
  • Winyi Kaboyo,
  • Daniel Albert Cohn,
  • Simon Nyovuura Antara,
  • Henry Mwebesa

DOI
https://doi.org/10.37432/jieph.supp.2023.6.3.06.13
Journal volume & issue
Vol. 6, no. 4

Abstract

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Uganda's initial coronavirus disease 2019 (COVID-19) response strategy was institutional isolation and management of confirmed cases, and physical monitoring for contacts of confirmed cases. However, this strategy was replaced by the home-based care (HBC) strategy once the epidemic expanded and overstretched the country's health system. The Ministry of Health (MoH) in collaboration with African Field Epidemiology Network (AFENET) rolled out the HBC strategy in Masaka District from January-May 2021. The objective was to document experiences and lessons learned to guide the rollout of the HBC strategy elsewhere in the country. Implementation of the HBC strategy involved identification and orientation of the key stakeholders on COVID-19 infection, HBC procedures and criteria, and activation of the COVID-19 coordination structures. We enhanced COVID-19 surveillance and conducted community sensitization on COVID-19 and the HBC strategy. Essential supplies for HBC were procured and distributed to community volunteers/ village health teams (VHTs). Monthly supervision visits were conducted to assess progress, provide technical support, and review data quality. Findings showed that the HBC intervention was initially met with skepticism among health care workers due to the fear of delayed detection of severe symptoms by VHTs and risk of infection among household contacts. When VHTs were empowered with knowledge and skills, and provided with the required supplies, they managed to safely implement COVID-19 HBC. The HBC strategy was accepted within the community and among patients diagnosed with COVID-19 infection. Lack of adequate space for home isolation and stigmatization by the community were the main challenges reported by patients. Community-based approaches should be therefore used to address stigmatization and to make patients feel secure in the community.

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