Funded by:
ENDORSE - ENhancing individual and institutional infectious Disease Outbreaks ResponSe capacities of healthcare professionals to mitigate infectious Emergencies in the Northern Uganda region

Project background

Since the first reported outbreaks of Ebola virus disease (EVD) in humans in 1976, infections acquired in health-care facilities have been identified as a major cause of morbidity and mortality, particularly in health workers. The latest EVD outbreak which affected Guinea, Liberia and Sierra Leone starting March 2014, has confirmed that, in case of outbreak, health workers die at a higher rate than any other population group, exacerbating skill shortages in countries that have very few trained health personnel to begin with. Even though identifying the precise risk factors and the situations in which health workers are exposed is very difficult, inappropriate use or lack of Personal Protective Equipment (PPE), defective IPC practice and behavior, and poor employment conditions are among the most frequently reported gaps in implementing Infection Prevention and Control (IPC) standards.
The largest Ebola outbreak before the last one took place in Norther Uganda between September 2000 and February 2001. The outbreak has been a testing ground of Ugandan healthcare system preparedness to respond to infectious diseases outbreaks. Indeed, one of the main problems that undermined the effectiveness of the response in Uganda during that outbreak was related to fear, which implicitly fostered negative outcomes such as stigmatization of the ill patient and subsequent deterioration of people’s relations. A very negative impact has been observed among healthcare workers that, “frightened and demoralised”, abandoned their duties. The appropriateness of the response was varied, including prompt and efficient response in S. Mary’s Lacor Hospital in Gulu, where control activities were organized around surveillance and epidemiology, clinical case management, social education and mobilization, and coordination and logistic support.
Beyond the possibility of a new EVD outbreak in general, in Uganda the burden of disease remains predominantly communicable diseases. Neglected tropical diseases remain a huge problem in the country affecting mainly rural poor communities. Gaps in human resources for health, in numbers, skill mix and distributions continue to pose a challenge for effective service delivery. Furthermore, there are wide disparities in health status across the Country, closely linked to underlying socio-economic, gender and geographical disparities. Capacity in planning, management and human resource development remains weak especially at the decentralized levels, exacerbated by the high number of districts. Service availability is highest in the referral hospitals and progressively decreases by level of care. The same holds true for the availability of training for healthcare workers all over the Country. On average, spending on administration and training accounted for no more than 8% across the Country, with about 6% among referral hospitals and the lowest percentage (2%) at the health center IIIs level.

Within the framework of this multifaceted context, ENDORSE will specifically address decentralized levels of care and train healthcare workers in biosafety and personal protection from infectious agents in both laboratory and patient-care settings.