ABSTRACT
ContextThe SCALE critical care project is a collaborative health workforce capacity and educational development initiative, between the Ministry of Health Uganda, and the NHS in the UK. The clinical leads are consultants in Anaesthesia and Intensive care from Cambridge, UK and Kampala, Uganda.Issue/ChallengeUganda faces a many challenges with the workforce in critical care, for both medical and nursing staff. There is significantly limited critical care training burdened with difficulties in retention of staff. In 2020 there were 1.3 ICU beds per million population, however this has been expanded as a result of the COVID 19 pandemic. There is now a need to ensure that skilled human resources are available to ensure functional critical care capacity and development of the speciality.The SCALE critical care project is structured around 3 co-dependent initiatives:A distance learning programme including online learning and medical grand roundsLong term placements in the UK for medical and nursing staffLong and short term placements for UK volunteers, with a focus on practical support and educational deliveryAssessment of issue and analysis of its causesKey stakeholders include senior intensive care doctors leading the development of critical care in Uganda and Cambridge, the Ugandan Ministry of Health, the Uganda UK Health Alliance (UUKHA) and many other partners including RCOA, Association of Anesthesiologists of Uganda, Health Education England and Cambridge Global Health Partnerships.There have been reciprocal visits on both sides, including the permanent secretary for health visiting Cambridge in April 2022. During the UK team’s visit to Uganda we were able to gain a broad understanding of critical care delivery, meeting nurses, doctors on the unit to senior hospital directors at a range of hospitals in both Kampala and Mbarara.ImpactAnticipated long term benefits include increased critical care staffing experience, capacity and job satisfaction. Improvement in multidisciplinary working (training of doctors and nurses is occurring in parallel, involvement of physiotherapy and biomedical engineering also proposed).Ultimately, we hope that in the future this work will be characterised by improved patient outcomes and reduced mortality as well as development of research capacity alongside the clinical aspects of the project.InterventionThere has been development of leadership and management for both sides of the partnership at many levels. The junior members of the team are able to participate in high level discussions and gain an understanding of how sustainable and reciprocal partnerships are developed and evolve. The more senior leaders are able to learn from healthcare in another culture, and mentorship of the future healthcare leaders in critical care.Involvement of stakeholders, such as patients, carers or family members:Patients are not currently directly involved in the project.Key MessagesSustainable partnerships require investment from senior leaders in order to develop and affect meaningful change.Development of critical care capacity through clinical training, leadership and research will ensure that patients will benefit not just from access to critical care, but from the wider benefits to healthcare that result, in Uganda as well as in the UK through the development of clinical, leadership and teaching skills volunteers will experience.Lessons learntUndertaking such an ambitious programme requires a large time commitment from senior leaders on both sides of the partnership at a time when healthcare resources are stretched. Whilst much time is volunteered, the support of the hospitals and governments has been critical to the success and sustainability of the project.Measurement of improvementOutput measurement will include increase in critical care workforce numbers in Uganda, with a plan 6-10 MTI doctors to be hosted by Cambridge University Hospitals.We collect feedback from the grand rounds and seek to improve content and delivery accordingly.Publication of novel research from Uganda will be a lo ger term measurement once the research strand of the partnership is developed.Strategy for improvementThe first MTI doctor is due to arrive in the UK late in 2022;there will be ongoing training â€' both clinical intensive care medicine, but also in other critical areas such as leadership and management training. The doctors who undergo the MTI training will return to Uganda to be the future leaders and drivers of intensive care medicine training.The SCALE Critical Care project is truly collaborative. Training of doctors alone will not lead to meaningful or sustainable development â€' training of the multidisciplinary team including nurses and physiotherapists is a critical part of the project.
ABSTRACT
BACKGROUND: Despite research on large urban areas in the context of COVID-19, evidence on how these settings impact migrants is still limited. OBJECTIVE: To explore exacerbating and mitigating factors of large urban areas on migrants' vulnerabilities during the COVID-19 pandemic. METHODS: We conducted a systematic review of peer-reviewed studies published between 2020 and 2022, focused on migrants (foreign-born individuals who have not been naturalized in the host country, regardless of legal immigration status) in urban areas with a population >500â000. After screening 880 studies, 29 studies were included and categorized within the following thematic framework: (i) pre-existing inequities, (ii) governance strategies, (iii) urban design and (iv) engagement of civil society organizations (CSOs). RESULTS: Exacerbating factors include pre-existing inequities (e.g. unemployment, financial instability and barriers to healthcare access), exclusionary government responses (e.g. ineligibility for relief funds or unemployment benefits) and residential segregation. Mitigating community-level factors include the engagement of CSOs to fill institutional and governmental gaps through service provision and use of technology. CONCLUSIONS: We recommend increased attention to pre-existing structural inequities faced by migrants, more inclusive governance strategies and partnerships between government and CSOs to improve the design and delivery of services to migrants in large urban areas. More research is needed on how urban design can be utilized to mitigate COVID-19 impacts on migrant communities. The factors identified in this systematic review should be considered as part of migrant-inclusive emergency preparedness strategies to address the disproportionate impact of health crises on migrant communities.
ABSTRACT
The devastating impact of COVID-19 on individuals and communities has accelerated the development of vaccines and the deployment of ambitious vaccination programmes to reduce the risks of infection, infection transmission and symptom severity. However, many people delay or refuse to get vaccinated against COVID-19, for many complex reasons. Vaccination programmes that are tailored to address individual and communities' COVID-19 concerns can improve vaccine uptake rates and help achieve the required herd-immunity threshold. The Maximising Uptake Programme has led to the vaccination of 7979 people from February-August 2021 in the South West of England, UK, who are at high risk of severe illness from COVID-19 and/or may not access the COVID-19 vaccines through mass vaccination centres and general practices. These include: people experiencing homelessness; non-English-speaking people; people from minority ethnic groups; refugees and asylum seekers; Gypsy, Roma, Travelers and boat people; and those who are less able to access vaccination centres, such as people with learning difficulties, serious mental illness, drug and alcohol dependence, people with physical and sensory impairment, and people with dementia. Outreach work coupled with a targeted communication and engagement campaign, co-designed with community leaders and influencers, have led to significant engagement and COVID-19 vaccine uptake among the target populations.