Enhancing MOH Support to Maintain Essential Services and Fight COVID-19

Living Goods Uganda Health Director Dr. Peter Kaddu joins the Minister of ICT and National Guidance, Hon. Judith Nabakooba at a nationally televized press briefing to remind the country to adhere to COVID-19 guidelines and the importance of wearing masks correctly.

Over the past 3 months, Living Goods has continued to proactively ramp up our support to governments, with a focus on supporting them at national and local levels to integrate community health into their COVID-19 responses and ensure service continuity for essential reproductive, maternal, newborn and child health services in the face of the pandemic. Key updates since Q1 include: 

 Advocacy and collaborative partnerships 

We’re focusing current advocacy efforts around influencing policy, budgeting and planning for personal protective equipment (PPE), and ensuring community health is included in COVID-19 legislative frameworksbudgets and reporting.  

 In Kenya, we are a part of the 8-member community health for UHC (CH4UHC) advocacy group that is pushing for passage of a community health bill, increased financing for community health, and allocation of PPEs for CHWs. Jointly, the CH4UHC team submitted memoranda on community health services and COVID-19 pandemic bills to Kenya’s Senate. In addition, we supported MOH to repurpose the country’s Global Fund budget, unlocking critical resources for CHW PPE and stipends.  

 In Uganda, advocacy efforts resulted in the institution of the community health acceleration tracker, finalization of the UHC roadmap, inclusion of community health in the finalized health sector development plan and Global Fund grant, and we embarked on budget assessment to support efforts to increase funding for primary health care. In her role as the UHC Co-Chair for Africa, our deputy country director Dr. Diana Nambatya Nsubuga worked to advocate and support the African Union and African CDC to finalize a strategy on the Partnership to Accelerate COVID-19 Testing initiative, which focuses on coordinating pooled procurement of diagnostics, support for testing 1 million Africans in 10 weeks, deploying 1 million CHWs to support contact tracing, standardizing and deploying common technology platforms to boost public trust in testing data, and more.   

 Policy development and MOH surge support  

Working through various MOH-led technical committees, Living Goods is lending technical expertise to the development, review and adoption of strategies, policies, guidelines and reporting tools in order to inform delivery of COVID-19 community health interventions as well as maintain essential community health services.  

Specifically, in Kenya we supported the development of the Kenya Community Health Policy 2020-2030 Kenya’s Community Health Guidelines for Continued Provision of Services in the Context of Corona Virus Pandemic​, andGuidelines for COVID-19 within iCCMPrograms. 

In Uganda, we supported the development of Operational Guidelines on COVID-19 for VHTsCOVID 19 VHTs Information SheetGuidance on Continuity of Essential Health Services During the COVID-19 Outbreak​, and the COVID-19 Community Health Guidelines. We are also finalizing the Uganda Integrated COVID-19 Strategy for a communitybased knowledge, attitudes and practices survey. Additionally, in Kenya and Uganda, Living Goods is co-leading a number of working groups aligned to national response pillars.   

 With the MOH technical teams busy providing frontline supportLiving Goods’ staff secondments and other staff time are serving as extra hands and feet at the MOH, supporting continuity of services at the national level. The 10+ seconded staff in Kenya have supported MOH to set up the M&E system, including harmonized reporting indicators and building data analysis and quality assurance capacity. In Uganda, our two MOH secondees are leading risk communication for the national COVID-19 response. They support the online dissemination of the guidelines and factsheets that Living Goods helps to create, coordinate partners, and support the development of all pillar documents, including plans, budgets and indicators. Proximity of our teams to the MOH is also enabling handson mentorship and progressive capacity transfer, setting up MOH to succeed during and post COVID-19.  

Operational support 

Living Goods is supporting MOH teams at the subnational level to contextualize national policies, guidelines and strategies, which enables their implementation at the grassroots level. Our teams are also working alongside government counterparts to support orientation and training of teams, hosting planning and coordination meetings, and data review and reporting sessions.  

In Kenya, we continue to support 7 counties to host online meetings for planning, data reviews and partner coordination meetings. Living Goods participates in 4 national-level technical working groups (TWGs) and is providing operational and budgeting support.  

Supporting Enhanced Protection for CHWs 

Living Goods believes that CHWs are essential frontline health workers who need to be equipped, trained, compensated, protected and supported as part of a well-functioning health system that can help keep the pandemic in check. When it comes to the CHWs we support, we are directly procuring and distributing the PPE they need to operate safely and effectively. But with all CHWs equipped with mobile phones, we are also in a unique position that we can move to no-touch protocols when needed by using technology. 

Living Goods is also a member of a new 30+ member coalition called the COVID-19 Action Fund for Africa (CAFA), which is working in partnership with Ministries of Health to meet the essential PPE needs (including surgical masks, gloves, eye protection and more) for up to 1 million CHWs serving more than 400 million people during the COVID-19 pandemic. This is the only known effort to date that pools resources for PPE for CHWs in Africa. In Kenya, Living Goods and Lwala Community Alliance are serving as the in-country focal partners representing this initiative, and we have supported the MOH in doing PPE quantification, while offering coordination and communication support between the donors and MOH. We may also support PPE distribution to CHWs beyond those we directly support in the counties where we operate. 

Outside of CAFA, in Uganda, Living Goods supported the MOH in thinking beyond the health facility to include CHWs in their PPE projections. Previously, the MOH used to procure PPE with support from the WHO system, but is now using the Africa CDC portal, which requires governments to set national priorities. Along with other partners, including UNFPA, we were able to influence MOH to ensure a line item for CHW PPE and provided technical support to assist with forecasting and procurement.   

Burkina Faso  

Our team in Burkina Faso has been assisting with the development and maintenance of DHIS2-based digital health tools that are supporting COVID-19 contact tracing and tracking border entry and disease call centers alerts. They are also helping to develop COVID-19 data management guidelines and training regional staff on appropriate data entry practices. They are currently in the process of building an interoperability layer between DHIS2 and UNICEF’s mHealth tools, which include case registrations and follow up, self-check tools for the populationand case identification and followup modules at community level. They are also supporting the development of Burkina Faso’s CHW response plan for COVID-19, including sharing guidelines Living Goods helped develop in Kenya and Uganda. Importantly, we have restarted work to support the MOH in reprogramming resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) to ensure CHWs have access to PPE and training to respond to COVID-19.  

Knowing COVID-19 would be our new reality for some time, and following a request from the MOH, we also made the decision to restart our work developing recommendations for a contextappropriate digital health solution and performance management framework in Burkina Faso, which we believe we can now do safely. The team will be conducting field visits throughout the first two weeks of August, with the goal of finalizing our recommendations by late August/early September in order to inform Global Fund negotiations for the 2021-23 funding cycle, which are taking place this SeptemberIn partnership with the MOH, Living Goods will assess whether we should explore more broadly supporting the government in digitally enabling and increasing the efficiency of its cadre of 17,000+ CHWs beyond 2020. 

Sierra Leone  

In Sierra Leone, Living Goods’ three seconded staff are providing critical M&E assistance that has led to the development of harmonized community health indicators.  We have supported the configuration of the country’s CHW and COVID-19 dashboardsbuilt off DHIS2to enable use of integrated, real-time data to drive decision-making. Simultaneously, we’re conducting a situational analysis of the country’s COVID-19 response and developing detailed user requirements so that Sierra Leone’s Emergency Operations Center can better harness data visualization and analytics in its response. 

In June, Living Goods and our tech partner Dimagi inked a partnership with Sierra Leone’s Ministry of Health and Sanitation (MoHS) and Directorate of Science, Technology and Innovation (DSTI) to support the government in developing mHealth tools that assist with the prevention, early detection, tracking and case management of COVID-19, particularly at the community level. These focus on developing and rolling out digital surveillance and case management applications that collate data from multiple sources, including quarantine centers, health facilities and labs, and integrating that with DHIS2.  

In August, in partnership with Praekelt.org, we’re helping to launch Health Alert, a dynamic new WhatsApp-based tool that will enable people across Sierra Leone to immediately access accurate information about COVID-19 and arm the government with data-driven insights that will improve monitoring of community spread and contact tracing. The tool will provide users with the latest infection numbers, enable access to accurate information about disease spread and prevention, have myths dispelled, read relevant news and more.  

We intend to upgrade it to include modules for users to conduct symptom checks, seek referrals, and engage in case management. It will also serve as a two-way messaging system to facilitate health alerts and information sharing during and beyond the pandemic. All data collected will be integrated with DHIS2, and the account will also be integrated with RapidproUNICEF’s common SMS platform for developing and sharing mobile data—as a fallback for areas with little or no internet connection. 

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