Background The negative impact of COVID-19 on population health outcomes raises critical questions on health system preparedness and resilience, especially in resource-limited settings. This study examined healthworker preparedness for COVID-19 management and implementation experiences in Uganda’s refugee-hosting districts. Methods A cross sectional, mixed-method descriptive study in 17 health facilities in 7 districts from 4 major regions. Total sample size was 485 including > 370 health care workers (HCWs). HCW knowledge, attitude and practices (KAP) was assessed by using a pre-validated questionnaire. The quantitative data was processed and analysed using SPSS 26, and statistical significance assumed at p < 0.05 for all statistical tests. Bloom's cutoff of 80% was used to determine threshold for sufficient knowledge level and practices with scores classified as high (80.0–100.0%), average (60.0–79.0%) and low (≤ 59.0%). HCW implementation experiences and key stakeholder opinions were further explored qualitatively using interviews which were audio-recorded, coded and thematically analysed. Results On average 71% of HCWs were knowledgeable on the various aspects of COVID-19, although there is a wide variation in knowledge. Awareness of symptoms ranked highest among 95% (p value < 0.0001) of HCWs while awareness of the criteria for intubation for COVID-19 patients ranked lowest with only 35% (p value < 0.0001). Variations were noted on falsehoods about COVID-19 causes, prevention and treatment across Central (p value < 0.0356) and West Nile (p value < 0.0161) regions. Protective practices include adequate ventilation, virtual meetings and HCW training. Deficient practices were around psychosocial and lifestyle support, remote working and contingency plans for HCW safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs reported moderate control over their work environment but with a high level of support from supervisors (88%) and colleagues (93%). Conclusions HCWs preparedness is inadequate in some aspects. Implementation of healthcare interventions is constrained by the complexity of Uganda’s health system design, top-down approach of the national response to COVID-19 and longstanding health system bottlenecks. We recommend continuous information sharing on COVID-19, a design review with capacity strengthening at all health facility levels and investing in community-facing strategies.

Better policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper, we examine the functionality of QCN in different contexts. We focus on implementation circumstances and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019–2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter-linked. Systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical for policy-making including addressing financing issues—to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported this, for example, shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks.

Better policies, investments, and programs are needed to improve the integration and quality of maternal, newborn, and child health services. Previously, partnerships and collaborations that involved multiple countries with a unified aim have been observed to yield positive results. Since 2017, the WHO and partners have hosted the Quality of Care Network [QCN], a multi-country implementation network focused on improving maternal, neonatal, and child health care. In this paper we examine the functionality of QCN in different contexts. We focus on implementation capacities and contexts in four network countries: Bangladesh, Ethiopia, Malawi, and Uganda. In each country, the study was conducted over several consecutive rounds between 2019-2022, employing 227 key informant interviews with major stakeholders and members of the network countries, and 42 facility observations. The collected data were coded using Nvivo-12 software and categorized thematically. The study showed that individual, organizational and system-level capacities, and circumstances all played an important role in shaping implementation success in network countries, but that these levels were inter linked. Across all levels, systems that enabled leadership, motivated and trained staff, and created a positive culture of data use were critical from the policy making arena including addressing financing issues - to the day-to-day practice improvement at the front line. Some characteristics of QCN actively supported these levels, for example shared learning forums for continuous learning, a focus on data and tracking progress, and emphasising the importance of coordinated efforts towards a common goal. However, inadequate system financing and capacity also hampered network functioning, especially in the face of external shocks. Key words: capacities, multi-county network, quality of care, maternal and newborn health, Bangladesh, Ethiopia, Malawi, Uganda

No abstract

Background: Worldwide, behavioral change interventions are at the core of prevention efforts to contain the novel Corona Virus (COVID-19). While the evidence base to inform such interventions in the general population is growing, equivocal research in humanitarian populations is lacking. The current study describes the nature, extent and predictors of COVID-19 risk behaviors among conflict refugees in Uganda in a bid to inform prevention strategies for humanitarian settings.Methods: Cross-sectional survey data on COVID-19 risk-behaviors, demographic, socio-economic, behavioral and clinical variables was gathered from 1014 adult refugees drawn from 3 refugee settlements in Uganda, using two-staged cluster sampling. Data was analyzed using t-test, Analysis of Variance (ANOVA) and Multivariable Linear Regression.Results: Many refugees (25-70%) were involved in hygiene, congestion and nutritional/physical activity related risk behaviors likely to contribute to community transmission of COVID-19. Refugees living in rural settlements, of male sex, young age and low socio-economic status were at heightened risk of exposure to COVID-19 risk behaviors. Physical activity and healthy nutritional practices reduced the likelihood of COVID-19 risk behavior. Indulgence in COVID-19 risk behaviors increased the risk of developing COVID-19 symptoms. Conclusions: COVID-19 risk behaviors among conflict refugees in Uganda are multifaceted in nature, widespread in extent and associated with symptom development, signaling for high risk for COVID-19 transmission in humanitarian settings. The data on predictors of COVID-19 risk behaviors have unmasked underlying inequalities, holding promise for development of evidence-based interventions to meet the needs of most vulnerable clusters in the refugee community.