A DGF supported study done by Advocates Coalition for Development and Environment (ACODE) in 31 districts in Uganda tracked every Covid-19 government intervention and the performance of the implementing district task forces.
Behind every reported Covid-19 intervention or response, the study has a qualitative and quantitative assessment of the level of effectiveness, efficiency and functionality of the district task forces. Here are some of the study’s findings by ACODE, an independent public policy research and advocacy Think Tank based in Uganda, working in the Eastern and Southern Africa Sub-regions.
About 1,507 community members were interviewed. The central region (Buganda sub-region) had the biggest portion of respondents constituting 40.2 per cent, followed by the western region at 12.2 per cent. The results also show that 54 per cent of the respondents interviewed resided in urban areas compared to 46 from rural areas.
Findings show there was a general lack of coordination in communications sent out to local governments from the central government ministries and agencies.
“The district taskforces (DTFs) got directives from several fronts including: ministry of Finance, Planning and Economic Development (MoFPED), minister for Presidency, Office of the Prime Minister, UPDF and each entity sent their communication to its representative on the task force to implement most times without the knowledge of the line ministry.”
According to the study titled; The Performance of the COVID-19 district task forces in Uganda. Understanding the Dynamics and Functionality, membership of the core DTFs in several districts ranged from 19 to 22 members. Some sub-committees supported the core team.
Many of the respondents interviewed, according to the study, reported that there were issues regarding the functionality of isolation and quarantine centres. As part of measures to combat Covid-19, the ministry of Health established Isolation and Quarantine Centres to protect the public from exposure to contacts, suspected and confirmed cases of Covid-19.
Isolation Centres, which were majorly in regional referral hospitals were used to manage positive Covid-19 cases while the quarantine centres were established to hold suspected cases and those who had contacts with previous cases.
“…Most respondents in districts like Arua, Amuru, Gulu, Bududa, and Kisoro among others noted that isolation and quarantine centres lacked basic equipment, were overwhelmed with the overflowing number of cases and did not have enough food to support those admitted at the centres…”
“In Arua for instance, a member of the DTF core team noted that the 40-bed capacity isolation centre had become overwhelmed with the rising positive cases admitted. The health facilities, quarantine and isolation centres were well equipped to receive the Covid-19 suspects and patients in the beginning but due to the increase in community infection, the facilities are being overwhelmed by the increasing number of suspects and patients at the moment…” said an interviewed DTF member in Arua.
He added that, “At the regional referral hospital treatment centre we have 40 beds which are all occupied already, there is food which is only sufficient enough for the patients already under treatment in the treatment centre, the drugs and protective gears are available for the health workers.”
There were also concerns about the shortage of equipment at the facilities. In Buliisa district, it was reported by a member of the DTF that the quarantine centre lacked ad-equate blankets and mattresses and toilets among others.
“I can say they are still ill-equipped, beds are not adequate, even mattresses, no separate toilets for the Covid suspects,” said a DTF core team member in Buliisa. The same was reported in Rukungiri.
A member of the DTF noted that the quarantine centre also lacked personal protection equipment (PPEs) for health workers at the centre.
“We still lack enough blankets and mattresses at the quarantine centre given the increasing number of infections. The few trained personnel at the district level do not have all the necessary protective equipment when handling Covid-19 suspects and patients,” a DTF team member in Rukungiri district said.
There are concerns too about the availability of food for people admitted at the quarantine centres. In the eastern district of Bududa, for instance, there was a shortage of food and lighting in the quarantine centre.
“No, they were not well equipped because many things were not available, there was no food, no drugs, manpower was a problem, security, for example beddings, people were encouraged to use their own, there was no facilitation for anyone so generally the place was so much lacking, even lights was another problem, can you imagine people were encouraged to use their lights,” an interviewed taskforce member in Bududa district said.
According to the study, risk communication is an essential intervention in any response to disease outbreaks and is equally necessary to manage infodemics. Community engagement and sensitization bridge knowledge gaps related to disease outbreak and discourage discrimination and stigmatisation towards community health workers.
The study found a high level of awareness about the coronavirus pandemic amongst communities. The study further found that citizens were aware of the risk factors and preventive measures for containment of Covid-19 as issued by the ministry of Health.
It was found that the district taskforces invested heavily in carrying out community sensitisation. A representative of the CSO in the western Masindi district said that; “the district task force has actually done their best on sensitization of the community on Covid-19 and actually if I was a teacher, I should have given them a distinction. These people have been on all radio stations in the district and sometimes using different languages given that the district is cosmopolitan.”
Another CSO representative in Luwero noted that, the DTFs have tried to alert people. He said they (the DTFs) deserve credit on that. Alertness has been 90%. At least people know about the disease. In Masindi district, for instance, the District Task Force and civil society partners carried out daily community sensitization.
A key informant respondent said; “The district task force has worked tirelessly to sensitize the community of Masindi through radio talk shows both provided by the radio stations themselves, the district task force and, CSOs among others. In fact, at the beginning of the pandemic, the sensitization would be almost every day since the air time on radio was readily available. The district task force has also used the public address system and drives have been made in the different trading centres, which were also very successful. We take the opportunity to thank all the three media stations of Masindi for the airtime provided and other stakeholders for the support rendered.”
Because of the restrictive nature of the guidelines for the prevention of Covid-19, radios were the most viable option for community sensitisation. In the northern district of Nwoya for instance, a key informant respondent noted that, “we are using radios to do talk shows and run spot messages, music systems mounted on cars, we also have community forums where health personnel speak to the community.”
Meanwhile, in Rukungiri, Mukono and Luwero districts, mobile radios mounted on vehicles moved from village to village doing community sensitization. The Speaker of Mukono district council noted that, “The sensitization was happening almost every day around Mukono with the trucks, and over the radio especially our radio Dunamis. It would be done at least once or twice a week. And even the enforcers would enforce every day. But as for now, there is no sensitization.”
In districts like Buliisa, the village health team (VHT) and the local councils were relied on to create awareness at the village level to supplement the radio messages and talk shows according to the resident district commissioner and chairman of the District Task Force. In an interview, the RDC-Buliisa noted that, “We have used radios and me as the chairman of the task force I have moved and met the LCs. We try to move around and educate the people on how to wash hands and about the preventive measures against Covid-19. Also, we meet weekly with the LCs to do sensitization every Thursdays and after meeting the LCs I go to the radio.”
HUMAN RIGHTS VIOLATIONS
In slowing the march of the pandemic in districts, there were instances of violations by state actors/authorities. Some of the victims were persons with disability who had failed to comply with directives due to their impairments. Some of these disabled persons were assaulted by police or the army while enforcing guidelines, especially on the curfew,” the study found.
A member of the taskforce in Lira reported that: “Yes, there was one case, where the RDC asked his men to assault him yet he had a hearing impairment. These people beat the deaf man and when he was rushed to hospital, he lost his life. But after that incident, the RDC stopped giving orders for people to be beaten. But now it’s better, the cases of human right violations have greatly reduced.”
A related incident was also reported in Mukono District by a respondent from the CSOs. The respondent noted that: “There have indeed been human rights violations. For example, there is a deaf and mute youth who was beaten by an officer of the law, but the boy could not defend himself because he could not talk. He just did not know what the officer was saying. He was savagely beaten but we took the responsibility to ensure he receives medical attention. As PWDs, we felt bad about this.”
“Secondly, the RDC had given PWDs permission to move and access medical care but this was not understood by the LDUs who would beat these people and the boda-bodas they used to move. Others could not access ARVs and mental illness tabs because of the lockdown. The health workers, mothers and children who move past the curfew time have regularly been assaulted by the security personnel enforcing curfew,” the respondent said.
In Jinja district a member of the district taskforce reported that: “…we have seen mothers who are going to the labour ward. We have seen mothers carrying children with asthma, malaria being beaten because they are travelling on the boda-boda past curfew time.”
The LDUs enforcing curfew handled people roughly. And they could not listen to complaints of the DTF since they were getting their instructions from the military and the police. In Lira district, a member of the DTF noted that, “We had a lot of complaints when the Local Defence Unit was brought on board, but as I told you earlier, for us as the DTF we follow the guidelines sent from the ministry of Health. The LDUs were sent by the UPDF and so we had no say on what they were doing, yet these are people trained to fight wars but not to police the community.
They were very violent while handling people without observing any human rights. As a result, many people were beaten, motorcycles impounded, money robbed from the arrested peoples’ pockets. Some people were denied access to healthcare services, which was a denial of the right to health care. This was during the total lockdown when transport was closed, and people could not move by any means. This affected the right to reproductive health care by the women in reproductive age,” the taskforce member said.
A member of the CSO in Masindi district reported that, “Denied access to health care services was a great violation especially among women, girls, mothers who used to walk long distances to Masindi main hospital. This prompted me to go on radio talk shows sponsored by RDP Uganda and pronounced that police officers should allow pregnant women going to health centres to move freely.”
VIOLATIONS FROM THE NON-STATE ACTORS
According to the study, violence against children took several forms. It included corporal punishment, early marriages, neglect and, rape/defilement. Interviewed, a member of the Kabale district taskforce said, many parents failed to fulfill their obligations to their children and instead began getting violent with them. Cases in Kabale and Kabarole were reported.
“Yeah!...we have seen some cases of domestic violence, child neglect, teenage pregnancies, early marriages because of failure by parents to carry out their roles of proper parenting, our girls are getting impregnated, poverty issues, somebody wants to be paid dowry/ bride price, what! So, he marries the daughter at an early age but if those cases are thoroughly investigated, I think the law takes its course,” he said.
A CSO representative in Nwoya district said; “Many of the girls that we support with school fees through the sexual reproduction health programme once school opens, they will not be in position to go back because some of them are pregnant due to child molestation and defilement and also these children have been engaged in certain work because parents think children should learn how to work during the lockdown, which government would call child labour.”
Interviewed, a member of the Kampala district taskforce said, “There were reports of sexual violence in some districts. Some women had their sexual rights violated when they were forced to have sex by unknown persons during curfew time. Yeah, I will just tell you one, in Mutundwe, we had a young lady who was raped during curfew time, that is during the time of lockdown.”
STIGMATISATION OF COVID-19 VICTIMS
A health worker at HCIV in Lira district said in an interview that “When communities suspect a person or homestead is infected, they completely close them off. I have heard people saying for example that they locked up the suspected person in the house for three days without food, no bath not even allowing them to use a toilet.
So, I think there was some kind of violation of human rights but l didn’t see it physically. But we would receive phone calls and we would send our team to respond to them.”
“…Yeah, maybe we can talk about how this pandemic has caused several issues mostly domestic violence…People have nothing to eat. People have no money, so there is stress and because of that, cases of domestic violence have increased. There is need for psychosocial programs to be conducted in communities because now the numbers are overwhelming and you find the district task force… cannot handle the issues,” CSO representative, Mukono district said.
SATISFACTION WITH FOOD DISTRIBUTION
During the Covid-19 induced lockdown, all non-essential services were closed and people working in non-essential sectors were required to stay at home. Government started a food distribution programme at household level.
This was also supported by the distribution of other home supplies. The study thus sought to establish the level of satisfaction of community members with food distribution in their localities. The study found that 20 per cent of the total number of respondents received this form of social assistance from the government. Out of those who received food and other supplies, 21 per cent were highly satisfied while 40 per cent reported that they were moderately satisfied.
Findings from Kampala, Wakiso and Mukono revealed that 44.6 per cent, 29.9 per cent and 24.8 per cent of the respondents were moderately, lowly and highly satisfied with food distribution respectively. These findings, therefore, demonstrate the DTFs performed better in other districts in food distribution than in Kampala, Wakiso and Mukono.
As part of ensuring that people stayed at home to control the spread of Covid-19, the national task force demanded that non-essential workers intending to move about should acquire movement permits from the office of the RDC or at the sub-county.
Results show that majority (61%) were never satisfied with the efficiency and timeliness of issuance of travel permits in their localities.
Also, 22 per cent of the respondents reported that the level of satisfaction with this service was low. In addition, findings reveal that in the districts of Wakiso, Kampala and Mukono, 79.2 per cent were never satisfied with the efficiency and timeliness of issuance of travel permits while 21.4 per cent in these districts rated the performance of this service as low.
The study also sought to establish the ease and timeliness of accessing services provided by the DTFs. The areas of focus included information sharing, ambulatory services for the sick, food distribution, security for people and property, and sensitization among others.
The respondents were asked whether those in need of services received them easily and on time. The study found that 20 per cent of respondents were able to easily access services from the DTFs while 56 per cent were not. Further, results from Kampala, Mukono and Wakiso reveal that 70 per cent of people who needed services from DTFs didn’t receive them.
It should be noted that given the high population in these districts and the relatively high demand for services, the supply side was overwhelmed. Fifty per cent of the community revealed that food distribution was inefficiently handled. In terms of regional dimension, mid-western sub-region has the highest proportion of responses (80%) from community members reporting that food distribution was poorly handled and that they could not easily and timely receive it.
This was followed by Teso sub-region at 78 per cent, Busoga Sub-region (63%), Lango (54%) and Western (51%). Karamoja represents the highest proportion of community members reporting missing out on food distribution completely at 91 per cent, followed by Bugisu at 85 per cent, mid-western stands at 83 per cent, Teso and Lango both at 77 per cent.
Further, in Buganda and Acholi sub-regions 73 per cent and 72 per cent respectively did not receive any food items distributed by the Covid-19 taskforces. The services easily and timely delivered to the community were information and sensitization on Covid-19 as reported by 64% of community members who received services from the DTF.
Constant feedback from members of the community reveals that enforcement of presidential guidelines on containing Covid-19 was a resounding success. This success was particularly visible in the strict enforcement of the lockdown and curfew.
Sensitization and awareness Creation: Several stakeholders in the local governments undertook rigorous sensitisation campaigns about Covid-19, how it spreads and how it should be prevented amplifying the information and communication messages provided by the Ministry of Health. Most districts reported having conducted hundreds of radio talk shows about Covid-19.
Surveillance and contact tracing: The district task force with the help of health departments had a surveillance system in place to immediately detect and report cases, alerts, contacts and suspected cases of Covid-19. Members of the community were vigilant enough to report any new member of the community coming in from hot spots of Covid-19 or countries with high cases of Covid-19.
Lack of isolation centres in some districts: Results revealed that most districts did not have isolation centres for alerts, contacts and suspected Covid-19 cases. They thus had to transport most of the suspected cases to regional referral hospitals.
There were several reports of inadequate or lack of personal protective equipment for health workers in several local governments. This put health workers at risk of contracting the deadly virus.
Inadequate resources: Several members of the district task forces noted that inadequate resources for the taskforces were a major challenge in executing their mandate. This was reported in all the districts covered by this study.
Food distribution and coordination: There were challenges associated with food distribution across all the districts, which mainly related to criteria for selecting beneficiaries, inadequate proportions, failure to deliver food to some places, and poor quality of foods distributed, among others.
Corruption, Lack of transparency and accountability: There were some reported cases of corruption, lack of transparency and accountability by the Covid-19 district task forces. There were reported cases of extortion, corruption and lack of transparency, especially in food distribution.
Non-inclusion of the vulnerable groups: There were reports of neglect of vulnerable groups in some districts of Nwoya, Rukungiri, and Mbale, especially during food distribution.
Violation of human rights. The findings also revealed that there were cases of human rights violations especially in the Districts of Rukungiri, Kanungu, Wakiso, Kampala, and Mukono perpetrated by the Police and Local Defence Unit (LDU) personnel.
Delay in the delivery government masks: As a Covid-19 containment measure, the government promised to deliver free face masks to all Ugandans above the age 10. Reports from the study indicate that government delayed to deliver these masks to communities and that those that were delivered were of poor quality.
Slow response to emergency: The district task force was expected to respond to emergencies within the district. As such they pooled all vehicles for the district and parked them at the district headquarters so that they can be able to respond to any alerts for emergencies.
Members of the community were given contacts of members of the district task forces to reach out to in-case they needed any help, alerts, or emergency. However, results show that the DTFs were slow to respond to emergencies reported by the communities.