Community health structures and the Covid-19 response in low-resource settings: The that case of village health teams

Uganda's health service delivery structure includes village health teams (VHTs), grass root structures that comprise volunteers that deliver basic health services and education. VHTs do COVID-19 surveillance and rural environments are likely to be more affected by COVID-19 than the urban environments. Standard operating procedures for prevention of COVID-19 necessitate use of basic necessities, such as water, soap or masks which are not easily affordable. The VHTs as first responders in the rural areas are at times poorly facilitated and this puts their lives at risk of infection. This study applied a qualitative approach where data were collected using in-depth interviews with VHT members, community members and local leaders. Twenty-two study participants were conveniently sampled from 12 villages. The interviewees were conducted by telephone as a precaution of observing and adhering to Uganda's COVID-19 pandemic response that included a total lockdown. Data were analysed using Nvivo and categorised in themes and patterns. Findings indicate that VHTs do health monitoring and provide reliable information regarding COVID-19 to the community members. VHTs work despite being amidst material and financial constraints. Hence, they are very helpful in resource-and health care-constrained rural communities. The rural environments were associated with lack of awareness on the pandemic, poverty, low levels of education, reluctance in complying with the presidential directives with regard to responding and preventing COVID-19, inadequate protective gears, among others. © 2023 Kemi Ogunyemi and Adaora I. Onaga. All rights reserved.

Mediating antiretroviral treatment for HIV during COVID-19: lessons from implementation in Gomba District, Uganda.

Initial and subsequent waves of COVID-19 in Uganda disrupted the delivery of HIV care. In rural areas, village health teams and organisations on the ground had to develop strategies to ensure that people living with HIV could continue their treatment. It was necessary to take evolving circumstances into account, including dealing with movement restrictions, constrained access to food and stigma due to anonymity being lost as a result of a shift from health facility-based services to community-level support. Uganda has a long history of community-driven response to HIV, although health systems and response programming have become more centralised through government and donors to address political commitments to HIV treatment and other targets. The delivery system for antiretroviral therapy was vulnerable to the impacts of COVID-19 restrictions and related circumstances. To understand the continuum of challenges, and to inform ongoing and future support of treatment for people living with HIV, interviews were conducted with HIV organisation implementers, health workers, village health team members and people living with HIV. It was found that stigma was a central challenge, which led to nuanced adaptations for delivering antiretroviral treatment. There is a need to strengthen support to households of people living with HIV through improving community capacity to manage crises through improving household food gardens and savings, as well as capacity to organise and interact with support systems such as the village health teams. In communities, there is a need to evoke dialogue on stigma and to support community leadership on pressing issues that affect communities as a whole and their vulnerable groups. There are opportunities to reawaken the grassroots civic response systems that were evident in Uganda's early response to HIV yet were lacking in the COVID-19 context.

Uganda Mountain Community Health System-Perspectives and Capacities towards Emerging Infectious Disease Surveillance.

In mountain communities like Sebei, Uganda, which are highly vulnerable to emerging and re-emerging infectious diseases, community-based surveillance plays an important role in the monitoring of public health hazards. In this survey, we explored capacities of village health teams (VHTs) in Sebei communities of Mount Elgon in undertaking surveillance tasks for emerging and re-emerging infectious diseases in the context of a changing climate. We used participatory epidemiology techniques to elucidate VHTs' perceptions on climate change and public health and assessed their capacities to conduct surveillance for emerging and re-emerging infectious diseases. Overall, VHTs perceived climate change to be occurring with wider impacts on public health. However, they had inadequate capacities in collecting surveillance data. The VHTs lacked transport to navigate through their communities and had insufficient capacities in using mobile phones for sending alerts. They did not engage in reporting other hazards related to the environment, wildlife, and domestic livestock that would accelerate infectious disease outbreaks. Records were not maintained for disease surveillance activities and the abilities of VHTs to analyze data were also limited. However, VHTs had access to platforms that could enable them to disseminate public health information. The VHTs thus need to be retooled to conduct their work effectively and efficiently through equipping them with adequate logistics and knowledge on collecting, storing, analyzing, and relaying data, which will improve infectious disease response and mitigation efforts.