On Monday, Leader of Opposition in Parliament, Mathias Mpuuga addressed the media at Parliament in light of the current lockdown and the government’s management of the Covid-19 pandemic, and outlined a number of alternative measures directed at containing the spread of the deadly disease.
We reproduce his statement in full.
The country is now battling a second COVID-19 wave. It is more devastating than the first wave. More infections and deaths are being registered countrywide. This has been fronted by the President as a basis for the current lockdown.
When compared to the lockdown in 2020, the citizens are now in a more vulnerable condition characterised by collapsing businesses, lost employment and subsequently struggling households. They have had their incomes and savings eroded in a bid to reinstate their livelihoods after the past lockdown.
Over the last couple of days when the lockdown was announced, we have been consulting specialists in the field of medicinde and health, economists and staticians, and we are here to give our view and response to the situation.
We are alive to the fact that most families can no longer afford a meal, parents struggled to return their children to school before they were again sent back home, paying rent for both homes and businesses is deplorable and of course the prohibitive cost of medical care. Additionally, the health sector is struggling to contain the pandemic. It is characterised by constraints of hospital beds, intensive care units, ambulances, motivated medical personnel and as you know it now; the severe lack of oxygen supply.
Lockdowns without development of befitting response system worsens the devasting impact of the pandemic as is the case now in Uganda. It is most felt in urban areas than rural areas although the trends now show that we could not reverse the trajectory, the rural areas too are going to bite even harder, given the nature of the systems in the areas. Elsewhere closure of businesses is reducing ability of lockdown subjects to earn and survive amidst inadequate social protection.
The situation is not helped by escalating food, fuel, electricity and water prices that are bound to even rise further in the new financial year due to the recently announced tax measures which were unmindful of the deplorable state of economic conditions of our people. It is akin to milking an unfed cow locked up in a kraal.
Ideally the initial lockdown should have been a stop gap measure to help the country buy time to develop a robust response system and mobilise resources. Unfortunately, the mobilised COVID-19 funds amounting to over UGX 11 trillion appropriated by Parliament in FY2019/20 and FY2020/21 were grossly mismanaged. The Auditor General noted that there are ghost recipients, funds were diverted, spent on poor quality supplies, expended without supporting receipts and unjustifiably appropriated to individual leaders not institutions.
Furthermore, most of the funds were geared towards resuscitating the economy rather than boosting preparedness of the health sector which was outstretched by the pandemic.
To the contrary the unfunded gaps in health sector remained glaring. Given the intensity of the pandemic as envisaged in other countries such as India, USA, Brazil and Italy among others, more effort ought to have been geared towards funding of purchase of vaccines, ICUs, oxygen plants, ambulances, drugs among others including personal protective equipment (PPEs) for health workers.
The citizens are now facing the consequences of government’s failure to prioritise their health. The President is increasingly relegating government’s obligations to being a regulator and fronting the private sector as the service provider. We believe that this is part of the problem.
The deplorable state of government facilities and services has created massive demand for COVID-19 treatment in private health facilities. Consequently, the cost of COVID-19 treatment has soared to a range of Shs 2–5 million per week spent in hospital.
The situation is not helped by the low vaccination rates. Aggressive vaccination would have slowed down the spread of the virus as has been noticed in countries such as United Kingdom and USA. However out of our target population of 21.9 million, close to 870,000 have so far been vaccinated. This translates to a performance of 4%.
At this pace, it would take us 12 years to meet the target. During this time, thousands of people would have passed on due to COVID-19 if we are to go by the 4% performance. The sluggish performance is largely attributed to government’s reliance on COVAX facility other than direct purchase of vaccine from manufacturers. While block purchases are economical, access to vaccines is slower and hampers pandemic response. This is evident in many African countries and the European Union.
The purpose of lockdown is to slow the transmission of Covid-19; and the purpose of slowing the transmission of Covid-19 is not for the disease to disappear, but for government to buy time and prepare for adequate healthcare delivery as well as access. So, to say;
• Increasing hospital beds;
• Streamlining oxygen supply channels, to the extent of acquiring sufficient oxygen cylinders, Oxygen generation systems in regional referral hospitals, Oxygen delivery devices, ventilators and medical staff recruitments and their safety;
• Transforming hospital spaces into High Dependence Units (HDU) and Intensive Care Units (ICU)
• Converting public amenities into treatment supporting facilities.
• Increasing ambulance services in the hard-to-reach areas like the islands, and the highly disease burdened areas.
This sluggish pandemic response has also been derailed by the seemingly static messaging that focuses on prevention through washing hands, social distancing and avoiding touching of the face. It is not in tandem with the community infections and deaths.
Therefore, the latest lockdown pronouncement by the President fell short of adequately addressing the above issues and lacks deliverables that should be expected after 42 days. It is on this account that the following ought to be implemented:
- Given that the new budget is yet to be executed, through a Motion of Parliament, it should be adjusted to allocate more funds towards state vaccine procurement, ambulances, testing kits, drugs, oxygen, personal protective equipment and renumeration of medical personnel;
- Amend the tax measures such as rental income and excise duty that are to take effect on 1st July 2021 to temporarily reduce taxes on rent, fuel, and data. We all know the impact of taxes, and how fuel prices eventually impact food prices and consequently reduce the size of the basic basket available to the suffering masses. We believe that the tax measures announced by the Minister of Finance need to be revisited, and now, before they take effect to address the constraints of a suffering public.
- We expect the President, in the circumstances, to assent to the NSSF bill to enable savers access midterm payments as a means of sustaining them during and after the pandemic.
- Engage with private facilities with the intention of agreeing on minimal cost range of COVID-19 treatment and offering incentives such as tax waives to these facilities. As long as government continues to look at these facilities as private, and therefore fail to rethink their approach to doing business, the cost of treatment will remain high, yet we know that the spread of government facilities is very limited and therefore cannot deal with the speed and current spread of the pandemic.
- Recruitment of more health workers on permanent and contract basis to close the human resource gap that has been known to exist for several years to help cope with the pressure in the government health facilities. Government should also second health workers to private facilities to help and deal with the pressure and critical manpower needs in handling the pandemic.
We applaud the approach announced by the Prime Minister yesterday but we caution that this should be properly done because we are coming out of food abuse. Cash, as we know it, is very tempting and we have very weak systems. We have heard that they intend to use Mobile Money to deliver to individual citizens but we don’t have adequate data. If we consider phones available per capita and available to the poor, we see a problem. We invite the government to explain how money is going to be transferred to the citizens so that there is a democratic conversation about its feasibility.
CLOSURE OF SCHOOLS AND FREE MOVEMENT OF PEOPLE
That Covid-19 originated from outside Uganda. Had there been a sustained mechanism of restricting people entering our country at the boarder points, the population would be reasonably protected from the depression and financial loss associated with lockdown.
The failure to sustain the mechanism of restriction at the point of entry, like the mandatory 14 day quarantine and testing; prompted the decline into Phase three; community transmission.
Even then, had there been COVID-19 surveillance by way of massive testing to identify hot spots throughout the country, a cluster containment strategy would be employed to avoid large local outbreaks and a National Lockdown.
It is very regrettable that a large number of students in schools tested Covid-19 Positive Whereas, this age group is observed to be very resilient to Covid-19, with the least recorded deaths, and that many Covid-19 positive students were asymptomatic and others with very mild symptoms and are largely being managed from their homes; we also know of the few cases that needed High Dependence Unit care and ICU care.
We are aware that there are isolated cases of students who have passed on and we grieve with the families.
However, we believe that the decision to close schools was hurriedly thought. In the school environment isolation would be possible by way of converting a dormitory(s) into an Isolation Treatment Centre and government would easily identify and manage the extreme cases with a preferential and specialized care, especially where parents are financially challenged.
Otherwise, the COVID-19 positive students have returned to the different destinations of the country and are in lockdown together with their families. In some families, members are more vulnerable due to compromising and underlying health issues.
This is very defeating because transmission is within households.
We worry about a decline into the phase of uncontrolled transmission.
We therefore advise that we need to invest more money in testing and vaccination.
We need to profiling the underlying health issues with patients succumbing to COVID-19.We have been informed by health workers that there are a number of deaths that are avoidable but once patients are admitted, they are detached from their families and therefore care is not adequate. We invite government to adopt a new care system that involves families of the patients once they are admitted. In some of these facilities, families should be allowed to attend to their loved ones and given the same protection as given to a health worker. Families are reporting that their loved ones are dying in isolation and without information.
We are demanding for transparent treatment system; a more transparent protocol of treating the COVID-19 patients because there is also evidence that the lack of transparency accounts for some of the deaths.
• A phased Lockdown;
We believe that the issue of a Lockdown would have been phased and therefore, it is not late to be revisited. This is our proposal;
Every 2 weeks of a lockdown, the country should also have a 5-days lull to test the veracity of the government’s intervention because simply locking down without action is like running away from the epidemic.
1 week lockdown followed with 5 days break; when we do this, it will facilitate the government to understand whether what they are doing is working without necessarily breaking down the economy.
Massive Testing informs the policy of Lockdown on whether it’s achieving its purpose or not. Without massive testing the country can be condemned to an abnormally longer lockdown than necessary.
The practice with Covid-19 positive patients is self-isolation of 14 days along with treatment, before subsequent testing. What informs the need of a 42 day lockdown? All the parameters that show progress against the disease, like the time taken for the positive cases to double, the daily recorded positives; are informed by results from a sustained massive testing.
There are 2 types of tests;
Antigen Test: where a Covid-19 Positive patient is identified, and medically managed.
Antibody Test: This identifies people who have developed immunity against COVID-19. The antibody test is very cheap and simple to perform. It’s as simple as doing a pregnancy test only that the sample used is a drop of blood.
The test strips are as cheap as $4, approximately UgxShs 15,000 as opposed to the antigen test which costs UgxShs 180,000.
The massive Antibody test will inform us whether Uganda has reached the Herd Immunity. But most importantly, it will inform the policy on Vaccine procurement and Vaccination.
We recognize that vaccines are not readily available on the world market; especially to countries that are waiting for them as donations. We have already observed and noted that funds should be voted to procure vaccines from the most reliable private suppliers, if we are to meet the target earlier envisaged by the Ministry of Health.