Integrate community role into health sector budget

Community involvement in the Covid-19 response has not been fully exploited. Strengthening community structures such as local councils, churches and cultural institutions as well as community extension health workers in mobilising and engaging residents to effectively respond to Covid-19 is invaluable.

The pandemic has strained health systems and disrupted essential health services in Africa. Countries are working to restore and strengthen key services to better withstand shocks and ensure quality care. 
Many governments in Africa took measures to combat the spread of Covid-19. However, some of the measures totally disrupted the supply chains and health care service delivery systems as all efforts were focused on Covid-19.

 Governments diverted personnel and resources away from priority diseases. Patients with HIV/Aids, tuberculosis, malaria, cancer, hypertension, hepatitis B, epilepsy, sickle cell, as well as mental health, maternal or childhood conditions, faced an increased risk of complications and death due to inability to access health care because of transport restrictions, curfew, and fear of contracting the virus from health care settings. 
The situation was made worse by existing healthcare system challenges which include among others inadequate human resources, financial, infrastructural, supply chain and logistical challenges.

Access to medication has been a major problem for patients with chronic conditions who rely on drugs for their survival and improved quality of life, as they were unable to get their refills while others could not afford medication due to lack of income. On the other hand, self-purchasing and stockpiling of antibiotics and other medicines for those who could afford presented another challenge of medication safety, including antimicrobial resistance.

In Uganda, patients who had been newly diagnosed with cancer were not able to be enrolled  on treatment while others missed their three-month refills for hormonal treatment. These delayed initiations and interruption of treatment cycles resulted in increased stress, anxiety, disease progression, recurrence and premature death.
Initially the top-down approach worked very well where top leadership was a key factor in mitigating the impact of the Covid-19. This led to governments instituting lockdowns and other preventive measures, including social distancing, national, regional and local lockdowns, quarantines, wearing of masks and hand washing. 

The lessons learnt have shown that the lack of community engagement and patient involvement right from an early stage in the Covid-19 response was a big oversight. Community systems must be urgently strengthened.
Empowering patients to self-manage chronic conditions, especially during such unusual times where they cannot access medical centres as often as possible, is necessary while emphasizing health literacy and telemedicine.
Efforts by key stakeholders to address the psychological needs of the population to mitigate the impact of mental health issues resulting from the challenges of this epidemic is required and should be integrated in all aspects of the response.

It is important to prioritise health care by increasing health sector budgets and reducing reliance on foreign funding. Governments also need to fast track universal health coverage through national health insurance schemes to ensure that vulnerable people access safe and quality health care.

In Uganda, community health workers are usually the first point of contact in the community and source of health information. They are trusted, well connected and use appropriate community engagement approaches to mobilise and sensitize the community. 
They are best placed to demystify the myths and perceptions relating to Covid-19 in the community and address complacency. Involving them in community-based surveillance, case management, contact tracing is a winner.
            Ambrose Byamugisha Muhoozi, [email protected]