Recently, there were reports that out of the 75 new Covid-19 cases in Kampala, most were healthcare workers. This statistic, which roughly translates to one in seven new Covid-19 cases being amongst health workers, is one that all Ugandans should be concerned about.
While health workers, as a result of occupational exposure, have a higher likelihood of coming into contact with Covid-19 cases, their likelihood of being infected in that interaction should ideally be extremely low given the extensive resources, measures and preparation in place to protect them.
A case in point, in early May, New York, which at the time was the epicenter of the infection, had a 12 per cent infection rate amongst healthcare workers compared to 20 per cent infection rate amongst city residents in a citywide survey.
This anomaly seen in the case of Kampala leads to a couple of questions. Why is the Covid-19 infection rate higher amongst Uganda’s healthcare workers in Kampala? Should the one in seven new Covid-19 cases being diagnosed amongst healthcare workers in Kampala be seen as a one-off statistic or should one interpret it as foretelling of what is to come?
Is enough being done to protect Uganda’s healthcare workers? If not, what else needs to be urgently instituted for their wellbeing? Will Uganda, which already has one of the lowest healthcare worker-to-patient ratios in the world, maintain enough healthy frontline workers to address this pandemic?
As one ponders all these questions, the first concern that comes to mind is the wellbeing of these heroic healthcare workers and their families, who in addition to other hardships associated with being a healthcare worker in Uganda, have to now worry about this too.
On whether or not enough is being done to protect Uganda’s healthcare workers, one has to look at the international context. Worldwide, healthcare workers’ professional bodies have repeatedly urged governments to institute protective measures like ensuring wide availability of personal protective equipment (PPE) and effective standard operating procedures to prevent unnecessary Covid-19 infections and deaths.
In the UK, the Doctor’s Association UK went a step further and initiated legal action to force the government into starting a government inquiry into the shortage of PPE for NHS and other facilities like nursing homes. It is important, as demonstrated in other nations, that the government partners with private, public health institutions and other stakeholders to institute protective measures for this at-risk population.
As expected, there is a varying prevalence of these protective measures amongst public and private institutions based on their sizes and resources available. Government will, therefore, need to focus on entities like small private clinics, which are most likely to default on such measures and support them as needed.
As demonstrated in Uganda thus far, a robust Covid-19 data reporting and tracking system is critical. A few of the insights that can be gained from this robust Covid-19 data reporting and tracking system in this regard are stratification of healthcare workers that are disproportionately impacted and where the infections are originating from - whether it is occupational workplace exposure or within healthcare worker’s homes or their communities.
The Kaiser Health Network in an August 11 article, showed that a significant number of the deaths that occurred amongst USA healthcare workers were amongst either nurses or people of colour.
Likewise, a University of Pennsylvania research study showed that family medicine physicians who mainly work in outpatient department settings were overrepresented in the 1,004 reported cases of Covid-19 healthcare workers’ deaths as compared to physicians like anesthesiologist, ICU and emergency department physicians who generally had more access to PPE.
These data points, as seen in the USA, can be informative on the actions to take and where to allocate resources like PPE equitably. One last key component to supporting healthcare workers is to continue creating a ‘just culture’ environment both within healthcare institutions and at the government level.
A just culture framework is a balanced accountability mechanism that is designed to improve safety at the workplace by first and foremost recognizing that human and institutional errors play a role in adverse outcomes. Government and healthcare institutions alike should aim to continue to create an environment where health workers can comfortably report human and institutional errors at their workplace without fear of repercussion.
As seen in the ‘Masaka video’ case and several other cases around the world, attempting to suppress transparent resolution of ongoing issues doesn’t address those concerns but instead allows the possible harm posed by these flaws to continue unmitigated.
As the government partners with public and private healthcare institutions and other stakeholders to institute and mandate sufficient-enough measures to protect healthcare workers, the public needs to continue to support healthcare workers and their families in all ways possible, including emotionally and financially where possible.
Uganda’s healthcare workers are Uganda’s last layer of protection against the spread of Covid-19, which in all scenarios is likely to be a long protracted battle. They, therefore, deserve as much support as possible.
The author lives and works in Washington, DC, USA.