Uganda: a primary health care case study in the context of the COVID-19 pandemic

The experience of the COVID-19 pandemic strengthened Uganda’s commitment to primary health care (PHC). The country’s previous experience with several epidemics and other political factors helped to shape PHC, which in turn influences its pandemic response. This case study examines PHC in Uganda in the context of the COVID-19 pandemic from early 2020 through to mid-2021.

Although there were strengths in the response, public health interventions introduced to limit virus transmission had a significant impact on vulnerable individuals and livelihoods. There were also reports of stigma around the virus, which in some instances was propagated by the negative language used by authorities.

Scaling up and managing critical emergency services requires efforts to strengthen public-sector governance – involving political leaders’ efforts to mobilize multisectoral networks and ensure accountability. Case study findings suggest that these efforts should not overshadow investment in technical expertise, which provides scientific evidence for decision-making. Opportunities can be harnessed to strengthen health information systems and reporting structures to help improve community diagnosis, planning, referrals and monitoring. Moreover, to reduce the health burden in Uganda and establish sufficient capacity during emergencies, public systems may need to involve the

private sector to meet the needs of the population. Although Uganda’s response to COVID-19 throughout 2020 and 2021 utilized a multisectoral approach, some have noted challenges in engaging with and supporting the Ministry of Health (MoH) during the early phase of the pandemic.

Within the pandemic context, medical teaching universities adapted their curricula to emphasize self-directed learning, learning in small groups, and community-based learning and practice. Looking to the future, there are opportunities to explore a hybrid model of in-person and remote learning, and to review the training curricula of health workers to achieve a balance between specialization and general practice training to meet primary care needs.

While community engagement initiatives were limited in initial response efforts, the National Community Engagement Strategy proved invaluable in guiding action and it is expected that this strategy will lead to the institutionalization of integrated people-centred PHC, especially for infectious disease management