Uganda is working hard to prevent COVID-19 by encouraging its citizens to get vaccinated. Today, the country’s cumulative positive cases are over 170,000, including 3,600+ deaths and over 100,000 recoveries. While Uganda has sustained a low COVID-19 transmission rate at 2%, not all of its eligible population is fully vaccinated, and the Ministry of Health is trying to change that.

Bududa District is situated in the Bukedi region of Uganda and has a population of 270,000. It’s considered a hard-to-reach area due to its poor terrain and multiple landslides that affect both lives and livelihoods. Because of this, the district struggles to provide easy access to health services. As a result, the district has a 26% teenage pregnancy rate, low uptake of modern contraceptives (14%), poor client attendance for antenatal care visits, and low male involvement in family planning decisions. Additionally, many expectant mothers prefer to deliver at home instead of in a health facility. The COVID-19 pandemic has further burdened the already struggling health system.

Like the rest of the country, the Bududa District embraced vaccination efforts and its health team was proactive on the district task force. And Bududa collaborated with IntraHealth’s Regional Health Integration to Enhance Services in Eastern Uganda (RHITES-E) project, which helped them conduct continuous reviews, correct course when needed, and design and implement several helpful strategies.

Demand creation

First, the district needed to inform the local population about the benefits of the COVID-19 vaccine. They did this through mass vaccination drives and radio talk shows spearheaded by health experts, and by deploying volunteer health teams to communities to talk about the importance of vaccination, which helped address myths and misconceptions about the vaccine.

Influential district leaders, including chief administrative officers, members of Parliament, the resident district commissioner, and religious leaders all received their vaccines publicly, which played a key role in allaying people’s fears.

Partnerships with health workers

Second, RHITES-E trained 180 health workers on COVID-19 risk communication and vaccine storage and management. The district created and worked with subcounty taskforces to help manage COVID-19 response. Continuous engagement with the subcounty, village, and lower-level stakeholders, such as community elders and leaders, improved service delivery in hard-to-reach areas, especially since the district chose to administer the Johnson and Johnson vaccine, which only required a single jab.

We had to quickly find solutions to avoid further COVID-19 spread.

“At first, it was really a problem,” says Dr. Ntegeka Sylvia Enid from the Bududa District Health Office. “Being a hard-to-reach district with many porous borders made the pandemic uncontainable. We had to quickly find solutions to avoid further COVID-19 spread.”

The district also established 96 vaccination teams with clear roles and responsibilities. Comprised of a nurse, health information assistant, community health workers, and health assistants, the teams ensured that vaccines were provided at all vaccination health centers and that data was adequately captured.

These teams identified any available opportunities to administer vaccines, including at busy trading centers, markets, schools, and religious and political gatherings. In the initial phase, the district prioritized the most at-risk community members, such as health workers, teachers, persons with underlying health conditions, and those above 50 years.

Goal-setting

Third, the district established targets for vaccination. With guidance from the Ministry of Health, the Bududa District set a goal of 136,924 vaccinations. To achieve this, vaccination service points were expanded up to health center IIIs in addition to hospitals and health center IVs. Vaccination teams conducted outreach services and reduced their team sizes from six to four members to increase coverage at the subcounty level. Health workers were asked to establish their clients’ COVID-19 vaccination status through routine care and to talk to those who hadn’t been vaccinated about getting their jab.

Regular review

Lastly, deliberate coordination mechanisms were built to allow for regular reviews and informed decision-making. At the lower level, health facility in-charges began providing daily updates on vaccinations through a WhatsApp group. This platform helped health facilities share information and address challenges together in real-time. For example, vaccines were redistributed from districts with low demand to the facilities in need.

At the national level, RHITES-E continues to engage in COVAX and partner catch-up meetings to share experiences and discuss challenges and plans to improve vaccination uptake in the region. RHITES-E is currently helping data assistants and biostatisticians in Bududa with monthly internet data bundles and entry fees to ensure prompt reporting and avoid vaccination data backlogs.

These vaccination strategies in the Bududa District vaccination have drastically changed the vaccination rate in the region, not only for key populations but for everyone. In November 2021, the rate for the first dose was at 9% and the rate for the full dose was 2%. By September the Summer 2022, that rate had improved to 78% and 63% respectively.

RHITES-E is funded by the US Agency for International Development.