Increasing Health Access for All through Immunization: HEPS POST

From us, HEPS@25

• Uganda’s Ministry of Health hosted HEPS-Uganda on a virtual meeting that held discussions on the Implications of the Executive Order by President Donald Trump on Health products
• The New York Times confabulated the Implications of the Foreign Aid cut-off highlighting HEPS-UGANDA community work and impacts in Uganda and globally. Link.https://www.nytimes.com/2025/02/08/health/trump-usaid-health-aid.html?smid=nytcore-ios-share&referringSource=articleShare
• HEPS Uganda, under its project, Leave No One Behind (LENOBI) – Increasing Health Access for All through Immunization, conducted orientation of VHTs in four sub-counties of the districts of Kassanda, Kiboga, Mubende, and Kyankwanzi. The project aims to reduce zero-dose cases and under-immunization among children under five years.
• Uganda’s Ministry of Health hosted HEPS-Uganda on a virtue meeting that discussed the Community Engagement Pillar SVD and M-pox response on February 14^th

From our partners:

• PrEP Ban Betrays Decades of Global HIV Prevention Efforts: AVAC says the world is witnessing a catastrophic and entirely avoidable rollback of progress in the fight against HIV. In the past two decades, the US President’s Emergency Plan for AIDS Relief (PEPFAR) has been a lifeline, providing treatment and prevention services that have saved millions of lives. But a dangerous new directive from the US government has frozen critical HIV prevention programs, including access to Pre-Exposure Prophylaxis (PrEP).
• Makerere University Public Health students recount a hands-on experience in Ebola case finding in Uganda: The African Field Epidemiology Network (AFENET) has shared the experiences of Makerere University School of Public Health (MUSPH), who were deployed to three sites following the latest outbreak of Ebola in Kampala: Saidinah Abubakar Islamic Hospital, Mulago National Referral Hospital, and a buffer zone within a 2km radius around Saidinah Hospital. At each site, the teams reviewed inpatient and outpatient medical records, particularly in cases where IPD records were unavailable. When patient signs and symptoms suggested a potential Ebola infection, their files were retrieved and analyzed against the case definition for suspected cases.
• Seeking Proposals for Media Mapping and Media Monitoring in the East Africa Community, Ethiopia, Nigeria, and Uruguay for Food and Nutrition: The Global Health Advocacy Incubator (GHAI) is seeking proposals (RFP) for media monitoring and media mapping services for Food and Nutrition. “This is a fantastic opportunity to collaborate with us in delivering insightful analysis and comprehensive media landscape mapping in these regions to guide communication strategies to advance food and nutrition policies,” the call states. The deadline for submitting proposals is February 17, 2025.

From Uganda

• Jinja Hospital sets up an Ebola isolation center: Jinja Regional Referral Hospital sets up an Ebola isolation center, which will attend to all the probable contacts traced from the different parts of the Busoga sub-region. It will also serve as a treatment center for all Ebola cases traced from the different parts of the Busoga sub-region. Dr Michael Mulowoza from Jinja Hospital says that they currently have enough capabilities to handle Ebola cases across the Busoga sub-region.
• ARV clinics battle false closure alerts amidst Trump’s aid freezes: Due to President Donald Trump’s order a suspension of US foreign aid that came with a funding halt on HIV treatment has come with wide misinformation about drug access. This has caused fear among clients and could also cause client negligence in picking their refills and this affects their progress in care and endangers their health.
• Health minister calls for precaution in the face of Ebola Sudan: On 7^th February 2025, Uganda’s Minister of Health Dr. Jane Ruth Achieng emphasised that the outbreak is real and that people must treat it with utmost attention and vigilance. She has also warned the public not to engage in burials of loved ones who have died of the disease.
• Wakiso health facility closed over Ebola: Authorities in Wakiso District have temporarily closed Saidina Abubaker Islamic Hospital located in Wattuba, Matugga following confirmation that an Ebola victim visited the facility before succumbing to the virus disease at Mulago National Referral Hospital on January 29.
• EBOLA: More than 100 contacts of patients under isolation in Mbale: More than 100 contacts of a patient who succumbed to the deadly Sudan Ebola virus are under isolation in Mbale City, the 32-year-old male declared by the Ministry of Health to have succumbed to the virus was buried in Mbale, and there were more than 100 contacts during the burial.
• UDB injects shs27bn in first local diagnostics manufacturing plant: Uganda Development Bank has announced that it supported Microhaem Scientifics (MHS), the first local IVD manufacturer in Uganda and Sub Saharan Africa. MHS on 3 February flagged off the first locally manufactured testing kits for Malaria destined to the National Medical Stores (NMS).
• Ebola cases in Uganda rise to 9: Uganda has recorded six new Ebola cases, bringing the total number of laboratory-confirmed infections to nine, including one death, the Ministry of Health said on Monday. Seven patients are currently receiving treatment at Mulago National Referral Hospital in Kampala, while one patient is being treated at Mbale Regional Referral Hospital.
• JCRC starts world-class stem cell therapy in Uganda: The Joint Clinical Research Centre (JCRC) at Lubowa in partnership with Asea BioTherapeutics (ABT) today successfully treated their first client with cutting-edge stem cell therapy.

From the region

• Kenya scrambles for Sh28bn annual HIV budget after Trump’s foreign aid directive: Kenya needs to secure an annual budget of Sh28 billion for HIV commodities in the coming years to ensure continued access to life-saving drugs and interventions amid changing foreign aid policies and global health financing trends. This was revealed by the Ministry of Health in collaboration with the National AIDS and STIs Control Programme.
• Tanzania’s Success to Reduce Maternal Mortality Ushers in a Model for Africa: Tanzania has reduced maternal mortality by 80% in seven years, from 556 deaths per 100,000 live births in 2016 to 104 per 100,000 in 2022. The success is attributable to increased political commitment, an increased number of Emergency Obstetric and Newborn care (EmONC) facilities, a growing health workforce, a strengthened obstetric referral network, capacity building, mentorship, and the conduct of Maternal and Perinatal Death Reviews and Surveillance at all levels.

Global health security

• Uganda starts Ebola screening at border points to prevent the export of virus: Uganda started screening departing travelers for Sudan Ebola virus disease (SVD) at the East African country’s border points to prevent the exportation of the virus. Travelers departing through Uganda’s 53 designated border points and Entebbe International Airport, the country’s main international gateway, are being screened for the deadly viral hemorrhagic fever, Henry Kyobe Bosa, incident commander at the Ministry of Health, told Chinese news agency Xinhua.
• Nearly 130 Mpox Patients Leave Quarantine Sites in DRC Amid Clashes, Health Ministry Reportedly Says – 05.02.2025, Sputnik Africa: Almost 130 mpox patients escaped from isolation centers in the DRC’s North Kivu province, due to armed clashes between the Congolese army and M23 rebels, the country’s Health Ministry reportedly said.

• Fifty countries affected by USAID freeze, says WHO chief: Programs to tackle HIV, polio, Mpox, and bird flu have been affected by the freeze on tens of billions of dollars of overseas aid from the US, says the head of the World Health Organization (WHO).  on 12th  February, Dr Tedros Adhanom Ghebreyesus said that HIV treatments and other services have been disrupted in 50 countries.

• More dangerous bird flu variant spreading among US cattle: A more dangerous strain of H5N1 bird flu has been detected in cattle for the first time, the US Department of Agriculture announced on 12 February. Whilst D1.1 has been found before in migrating birds and poultry in North America, it is different from the version that has been spreading through US cattle herds since late 2023. 

Our opinion, HEPS@25

Ministry of Health has cut out its job – and the jobs of others – in improving health service delivery

HEPS-UGANDA @25 appreciates Ministry of Health for committing itself – and rallying the rest of us – on strengthening the health system in the midst of, and timely response to, the current global geopolitical dynamics. The country is currently battling Mpox and Ebola, and grappling with a freeze on aid from the world’s single biggest donor, the United States.

On 7 February 2025, the Ministry issued a circular with a set of directives for integrating the treatment of HIV/TB and other chronic conditions into regular healthcare – a very reasonable decision amidst funding uncertainties for parallel programs – alongside other measures to “ensure efficiencies while optimizing limited resources for better health outcomes”.

The circular is addressed to the charge of Government health facilities at all levels and to District Local Government accounting officers, directing them to phase our HIV clinics and pharmacies and implement a set of measures to ensure physicians are capacitated to attend to all cases forwarded by the out-patient department, monitored for attendance, and held accountable for medical supplies.

The circular was signed by Ministry of Health Permanent Secretary Dr. Diana Atwine, and copied to the Permanent Secretary, Ministry of Local Government and Resident District Commissioners (RDCs), referenced the commitments and aspirations stated in the 4^th National Development Plan (NDP IV) and the election campaign manifesto of the governing NRM political party.

In a set of 11 interventions, the Ministry of Health has committed to directly take responsibility for the implementation of Two:

• Prioritizing recruitment of critical staff: It is stated that Ministry of Health will support “health care managers” who are unable to prioritize the recruitment of “critical health workers”, where districts that are unable to fill critical positions are urged to “immediately refer back” to Ministry of Health and Ministry of Public Service “for support”.
• Waste management planning and budgeting: The Ministry of Health has committed to issuing guidelines detailing procedures for waste collection, transportation, treatment, and disposal.

Other actors in the directive are presumed to be those that the Circular is addressed to: Executive Directors of National Referral Hospitals; Directors of Regional Referral Hospitals; Medical Superintendents of General Hospitals; Health Facility In-charges; Chief Administrative Officers (CAOs); and District Health Officers.

To these, the directive is for them to provide training and mentorship on integrated service delivery to all health workers; accounting officers and facility managers were directed to prioritize staff training on the usage and equipment maintenance of the Electronic Medical Records (EMR) system; and health facilities must analyze and use the system for planning and budgeting.

These and other interventions in the directive have several implications. In principle, the integration of HIV services into the OPD triage system should eliminate duplication and reduce HIV-related stigmatization. However, OPD’s are typically congested. Adding people living with HIV (PLHIV), patients of TB, and chronic diseases to the congestion could increase hospital-acquired infections unless there are substantial investments in the expansion of OPD spaces.

Program managers who have been explicitly mentioned as critical staff must be prioritized for recruitment. However, DHOs, CAOs, District Service Commissions, the Ministry of Health, and the Ministry of Public Service will have to ensure adherence to staffing norms and ensure that Medical Officers who head Health Center IVs (HC IVs) are not consumed by administrative duties and that all referral facilities have well-equipped theater and laboratory – with the latter critical for a rational prescription.

To achieve the directive of registration, timely notification, and reporting of facility deaths and their causes, each referral facility will need a functional mortuary and a pathologist to do autopsies. Community health workers (CHEWs) and Village Health Teams (VHTs) will have to be facilitated to report all community deaths – and births.

To enforce accountability for health staff time and essential medicines and health supplies (EMHS), support supervision strengthened to ensure compliance with requirement of continuing medical education (CME), fight absenteeism, and stamp-out EMHS pilferage. Health Unit Management Committees (HUMCs) and hospital boards to oversee facility responses to client feedback.

Poor facility management and disposal of medical waste is not only leading to high-occasion hospital-acquired infections among healthcare providers, patients, and caregivers but also polluting the environment and spreading drug-resistant pathogens. The nearest incinerator to facilities in eastern Uganda, for instance, is in Mukono, which makes medical waste disposal too expensive due to the long distance. In addition, some health facilities are choking with expired medicines due to the inability to pay the National Drug Authority (NDA) to pick them up.

The thinking behind the all these and other actions in the Ministry of Health directive is appreciable. However, for them to come to fruition and to improve service delivery, efficiency and equity as the objective states, actors at all levels will have to demonstrate commitment to improvement, and the central Government and local governments will have to invest more resources in implementation and sustainability of the circular’s directives.

 #HEPS@25