Healthworker Preparedness for COVID-19 Management and Implementation Experiences: A Mixed Methods Study in Uganda’s Refugee-Hosting Districts

Abstract

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 HCWs safety. The work environment has immensely changed with increased demands on the amount of work, skills and variation in nature of work. HCWs also reported moderate control over their work environment, 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.

Understanding the barriers and facilitators of COVID-19 risk mitigation strategy adoption and COVID-19 vaccination in refugee settlements in Uganda: a qualitative study

“…Other investigators have also found that refugees in Ugandan refugee settlements generally have confidence in the ability of prevention strategies like hand-washing, facemask wearing, staying at home, and physical distancing to prevent COVID-19 transmission [31]. Investigators in the REFLECT study, a mixed-methods study conducted in thirteen Ugandan refugee settlements between May 2020 and June 2021, similarly found that refugees were generally knowledgeable about COVID-19, but that knowledge gaps existed in specific areas and myths and negative perceptions prevailed among a minority of refugees [32]. Similar to our findings, an inter-agency effort to track rumors among affected communities in Uganda found that rumours about serious health risks resulting from COVID-19 vaccination and conspiracy theories were circulating among refugee populations [33].…”