While a large part of the world’s population had already been placed under lockdown, 2019’s novel Coronavirus had a late arrival on the African continent.

Since the first confirmed case on the continent in February 2020, South Africa and Egypt have been hotspots for the disease. At least 55 African countries across all regions on the continent have reported either or all cases, recoveries and deaths.

The latest records, updated on August 9, 2020, reveal a total of 1,037,728 confirmed cases; 38,091 cases of Health Care Workers (HCW) including those who developed COVID-19 from presumed occupational exposure; 22,975 deaths and 721,750 recoveries[1].

These statistics have contributed approximately 5% to the confirmed Coronavirus cases worldwide.

Uganda’s COVID-19 Numbers

Uganda reported her first case of COVID-19 on March 21, 2020.

From the onset, the President, in early March, declared the crisis as “a war” and encouraged Ugandans to stay where they were and follow the Ministry of Health Standard Operating Procedures.

Schools were closed and public gatherings of all manner were also suspended.

Kampala City, through its governing Authority, Kampala Capital City Authority (KCCA) released a report defining their next steps according to the Presidential Directives on March 18, 2020 and instituted the Kampala City Task Force that consisted of the following stakeholders; Hon. Minister-Kampala City and Metropolitan Affairs, Resident City Commissioner, Lord Mayor and Division Mayors, Executive Director and Directors, Town clerks and District Medical Officers, and Kampala Metropolitan Police[2].

Later, in the same month, the President closed the country’s borders and tightened control measures against COVID-19.

In a press release, following the Presidential address to the nation, KCCA introduced new measures to control the spread of the virus in Kampala City.

According to the Ministry of Health, throughout March, the majority of confirmed cases were travellers returning from other countries.

The two main measures against COVID-19 have been mitigation to slow down the spread and suppression through lockdown.

In an update of the COVID-19 response in Uganda in April, 2020, the Minister of Health reported that they registered confirmed cases in some districts of the country and it was not clear then if they were secondary to already on-going active transmissions[3]. Three (3) of these confirmed cases from two districts were admitted at Mulago National Specialized Hospital in Kampala.

In April, the newly reported cases were from truck drivers at various regional border points of entry. The Ministry of Health had to shift some of its focus from its centralized approach that involved movement of samples from the rest of the country to either Kampala or Entebbe for screening, testing and treatment. Results from Entebbe Uganda Virus Research Institute were previously returning to districts within 48 hours depending on proximity to Kampala.

More proactive measures, which were designed to prevent importation of the virus into the country, were put in effect at Entebbe International Airport and at the country’s inland border points of entry. Uganda’s borders are largely porous with fifty three (53) known border points and of these, eight (8) major border points receive the most traffic consisting of both people and trucks.

Some of these measures included disease surveillance at border points and institutional quarantine.

The challenge was technical failure of testing equipment at Elegu, Uganda’s border point of entry with South Sudan and a hotspot of Coronavirus in Uganda. Most of the tested victims at the borders were foreigners so the Ministry of Health resorted to reporting national cases while separating non-national cases[4]. This was questionable because the main objective was to contain the disease.

The capacity of the Ministry of Health was boosted by specialist doctors from Uganda’s army, Uganda People’s Defence Force (UPDF); 82 UPDF medical personnel to handle case management, surveillance and logistics management; and recruitment of 220 health workers to support response at the main center (serving Kampala and Entebbe) and in the districts.

A total of 310 ambulances were deployed at central (Kampala & Entebbe) and district level to support the COVID-19 response and evacuate confirmed positive Coronavirus cases.

The Ministry of Health COVID-19 budget in May 2020 stood at USD 400 billion  to approximately USD 1 trillion.

This was meant to buy testing kits (each goes for USD 65). USD 20 million had already been spent on testing kit purchases with a daily expense of USD 100,000. In comparison, if mass testing were to be considered at least USD 800,000 would have gone in daily expenses.

Other essentials that were budgeted for included Personal Protection Equipment (PPE) Kits and hospital infrastructure to complement every Regional Referral Hospital to have ICU beds[5].

Investment in ICU units was not yet high at this point in time because the disease burden was still low. The reality is that about 150 beds are available in ICU units across the country. And according to these statistics, one (1) bed can serve a million people of the 41.6 million persons in Uganda.

Noteworthy areas where Kampala has been central in the fight against COVID-19 in collaboration with the Ministry of Health’s multisectoral response are not limited to the following health related functions[6];

  • Management of Coronavirus cases at district level. Three (3) of the ICU facilities selected for critical cases are located in Kampala, at Mulago Hospital, with 36 adult and 27 paediatric beds, Women Hospital with 35 adult and 30 paediatric beds and Regional Referral Hospitals with 10 beds on average.
  • Call centers. The KCCA COVID-19 response call center was set up before the Ministry of Health call centers that have increased capacity to handle more calls concurrently.
  • Movement of health workers. The President declared that health workers are in the ‘Essential Service Providers’ category. For those that used public transport, KCCA following Standard Operating Procedures stationed buses in defined locations to board and report to work and return home.
  • Management of other health emergencies during the pandemic. Patients including those with HIV and TB were free to access medical services as well as pregnant women. KCCA provided clearance for personal vehicles and for public transport, they did home pickups and deliveries as well as community surveillance.
  • Psychosocial support. A team with 23 providers were deployed to quarantine facilities located in the central region (Kampala).

By July 2020, as the ease of lockdown in the country happened, at least twelve (12) people were reported to have been allegedly killed by security personnel enforcing the presidential directives to mitigate COVID-19.

There has been public outrage about the purpose of quarantine as it has caused more loss, suffering and death than the virus it is intended to mitigate and suppress.

The first death from the novel Coronavirus was reported in the same month.

Source: Ministry of Health, 07th August 2020

Epidemiological memories

Several African countries have had to deal with much more than just the Coronavirus; from Presidential elections to extreme weather and natural disasters.

Belatedly, African governments are waking up to the rising effects caused by the pandemic. A noteworthy fact is that most African countries had rapid mobilization to limit the risk of the Coronavirus spreading and their leaders responded with precautionary measures.

Some African governments previously affected by deadly epidemics such as Cholera and Ebola, have used lessons learnt from managing these health crises and put their political, administrative, health and epidemiological experience towards the management of the COVID-19 crisis.

In Uganda, a country that was previously affected by the Ebola virus the most recent being in 2018, certain anticipated measures have been taken against COVID-19 from the start of January, 2020. Currently the number of confirmed cases remains low in comparison to global statistics including at least 25 confirmed cases on admission and 387 discharges in Kampala city[7].

The COVID-19 pandemic response plan deployed by Kampala Capital City Authority (KCCA) is comprehensive and multidimensional.

Source: La réponse des gouvernements locaux africains à la pandémie du Covid-19: Quelques exemples de mobilisations locales  observés en Afrique, 2020

Kampala’s administrative capacity to manage the COVID-19 crisis

Source: JG, 2019

Kampala, Uganda’s capital city has a total area of approximately 195 square kilometers with 33 kilometers of shoreline on Lake Victoria. It has an estimated population of 1,680,600 persons with a projected 5 million day population.

This is at least 4% of Uganda’s total population of 41.6 million people in mid-2020 according to the latest projections by Uganda Bureau of Statistics (UBOS). Kampala is the 2nd most populated Higher Local Government after Wakiso district in Greater Kampala Metropolitan Area that has a projected population of 2,915,200 million people.[8]

Before defining the governance structure of the city and its administrative capacity, it is important to highlight Kampala’s rising population that is contributing to growth of informal settlements, uncoordinated housing, traffic congestion, unemployment and adversely overwhelming health facilities.

The Authority

In 2009, Kampala district underwent a legal process that transformed it from a Local Government into a Corporate entity. The Kampala Capital City Act 2010 enacted Kampala Capital City Authority (KCCA) as the governing body of the Capital city and therefore it administers the Capital city on behalf of the central government[9]. KCCA replaced Kampala City Council through this act of parliament and introduced the positions of Executive Director (appointed by the president), Lord Mayor (the head of the political wing) and a Cabinet and State Minister for Kampala Capital City and Metropolitan Affairs.

(Source; KCCA. Retrieved from a presentation, 2019) ]

Exposition of Kampala’s response to COVID-19

At Kampala Capital City Authority (KCCA), each directorate has response teams on standby. The COVID-19 pandemic was more of a public health concern so the initial response to the crisis was largely under the jurisdiction of the Directorate of Public Health and Environment. The directorate’s emergency response teams have previously handled cases of cholera outbreaks in different areas of the city, the Ebola epidemic beyond the city’s administrative boundary as well as victims of the 2010 terrorist bombings in Kampala.

Given the magnitude of the Coronavirus global pandemic, it necessitated that a bigger multi sectoral task force be put together. Hence the Kampala City Task Force was set up. The technical team lead was Director Public Health and Environment due to the health related nature of COVID-19. Through a call to action by the Director Human Resources and Administration, teams from other directorates joined the task force.

Some of their specific roles include; sensitization and dissemination of relevant information to citizens, management of people and their livelihoods, ensuring a clean and safe city so as not to combine the pandemic with other diseases, development control in the city and providing support to the Ministry of Health.

According to an advisor to the task force on Occupational health and safety issues who also Coordinated Ambulances response services, the Kampala City Task Force is multisectoral and multidimensional, susceptible of management of all manner of emergencies that may arise not only within the city but also in the Greater Kampala Metropolitan Area.

With the ban on movement of private and public vehicles, the central government commandeered all vehicles from ministries in Kampala to be dispatched to KCCA to complement its 5 divisional ambulances in conducting effective community surveillance and response to emergencies received through the call center (90%  of  KCCA’s Call Center services  have been dedicated to Covid-19 related  emergencies)[10].

KCCA has  set  up  Division  Rapid  Response  Surveillance  Teams  including health care workers and their major  responsibility  during the crisis is  to  respond  to  alerts  from  the  communities  and  carry  out  patient assessments. The  Institution has also engaged  Village  Health  Teams  (VHTs)  and  prepared them  for  identification of suspects and  health education of the  community. Working  with  the  Ministry  of  Health,  KCCA  has  deployed  film  vans  across the  5  City  Divisions  to  sensitize  the  communities  on  the CoronaVirus. 

The Authority has provided access to essential tools such as handwashing  and  hygiene  facilities, and no  touch  infrared thermos  cans  or  thermometers  to  help  in  the  screening process in  many  public  places like parks,  markets, public buildings, arcades. 

Only  gazetted  markets have been allowed  to  operate  in  the  city  having been  issued with  Standard  Operating  Procedures  (SOPs)  developed  by the Ministry of Health.  All  other  markets  including  open  street  markets,  weekly  markets and roadside  markets among  others were closed. The markets  management  team from KCCA is promoting online shopping in all city markets.

The activities at City Hall, KCCA  have been scaled  down including all community  outreach  activities  except  those  in  public  health. Online services have been encouraged even for high level external meetings. public engagement and decision making can be done virtually[11].

The task force at KCCA also collaborated with the National Task Force in the Prime Minister’s office to distribute food aid to the 5 urban divisions of Kampala.

Implications of the COVID-19 crisis in Kampala

A ‘seamless’ working relationship between the Authority and central government has developed in dealing with the pandemic. Hopefully this seamless relationship of working together and sharing resources can be leveraged post-COVID. In turn, this will break bureaucratic log jams in the effectiveness of response to other urban development plans and decisions. This challenge is a result of the pre-existing power play which exists in the city administration because of political tension amongst the leaders at the helm of KCCA.

There are several infrastructure projects that KCCA had commenced and the institution of the lockdown presented an opportunity to finally implement them. The Old Taxi Park – a public transportation park – renovation took off as part of the Mass Public Transport system project that has been on-going for 7 years. The closure of Kalerwe market managed by KCCA, which is located at a busy intersection with the Northern bypass (a 23km urban highway under construction) allowed road works to progress.

The pandemic has exponentially magnified the poverty and inequality gaps in the city and there will be a slow recovery post-COVID. The self employed that account for 60% of the city population have to work to sustain themselves. The lockdown spread anxiety among these people who are now grappling with its effects on their finances and livelihood. Vulnerable groups including people with disabilities also suffered during this period because the nature of care they deserve was negatively impacted by the strict measures against COVID-19.

Movement to work has been hampered by high transportation costs as the lockdown eased to new measures, where public transport vehicles have to carry half their capacity.

1 out of 5 citizens in urban areas like Kampala have no work to go back to after the lockdown[12]. This is due to their workplaces being shut down because of the financial effects of COVID-19 and in some cases their positions being declared redundant.

Government has been a firm steward through at least 14 presidential addresses to the nation with strict measures to curb COVID-19. They facilitated countrywide food aid and face mask distribution.

However, growing mistrust is the outcome of the response to COVID-19. The citizens were still starving and had to survive by all means even under lockdown.

A lack of trust in the authorities who have not been exemplary in adhering to the COVID-19 guidelines and presidential directives will hinder the recovery process post-COVID.

Some media reports also indicated that Uganda had other strains of the virus.

Serious discourse on the reality of universal health care for Ugandans has also ensued in various media and amongst different stakeholders. This is timely especially during this global pandemic when the public health system has shown that it works. It is imperative that the government should strengthen its priorities in the health sector during and post-COVID.

Currently, the country has confirmed deaths from the Coronavirus and these sentiments are starting to change.

Environmentally, the city is cleaner and has registered better solid waste management during COVID-19. This is attributed to fewer people in the city center and limited mobility especially during lockdown.

Following the government’s suspension on movements to counter the spread of COVID-19, Kampala’s air quality has improved by up to 40% according to a recent study by Makerere University’s AirQo project. One of the key drivers of air pollution in Kampala is motorized traffic, largely filled by aging Taxis and Boda-Bodas which clog the streets along with a wide range of private and commercial vehicle[13].

It is prudent that KCCA successfully implements its proposal to decongest and create order in the city with modern terminals for public transport through its mass public transport system plan post-COVID. According to public opinion, the proposal in creating car free zones should not exclude forms of business such as Boda Boda cyclists and Taxi operators (both private players) from operating alongside the proposed high carrying capacity bus system.

The city should also consider other functions like light rail to complement the existing transit system.

On the flip side, progress of infrastructure projects that had for years been hindered by citizens refusal to be evacuated has shown that it takes minimal public engagement to take off. So this begs to question who the city is planning for. The role of public participation in project implementation has weakened during COVID.

Is Kampala ready?

Is Kampala ready for a localized lockdown and potential future crisis? With its current capacity, KCCA has served not only the city population but also the Greater Kampala Metropolitan Area during the pandemic. Should there be a lockdown of the city in light of the increasing numbers of confirmed community cases, will Kampala absorb the shock and challenge of meeting the essential needs of its citizens?

The Authority does not provide food to its people, food supply into the city is from other regions in the country and is distributed through city markets.

KCCA manages several health facilities but does not provide free medical care to citizens. There would be a great need to step up funding of city health facilities to meet the needs of each citizen under total lockdown.

In case of future crises KCCA has a dedicated risk team that is in operation at all times. The public health emergency response teams are engaged on a daily basis with or without COVID-19, it is only a matter of the magnitude of the crisis for a multi sectoral approach[14]. A good lesson learnt from the current global pandemic is that managing a crisis is not a political issue but a governance one.

The short term solution for recovery of Kampala’s urbanites is to allow them to go back to work. The government should look into providing long term safety nets to the glaring inequality and poverty gaps in the city and the rest of the country.

There should be urban resilience strategies that feed into a national resilience strategy.

As citizens, COVID-19 has disintegrated the edges to our work, education and businesses as we had previously conceived them pre-COVID. This has presented opportunities for us to think differently, change our ways of earning and consider alternative livelihoods (like urban agriculture, cycling and working/studying remotely modern communication technologies).

Considerations in the post-COVID era should be made to multiply options that support citizens to have a smooth transition to recovery. All stakeholders including ministries and development agencies, financial institutions and investors, need to develop intentional strategies at greater scale of impact that focus specifically on this transition from economic resilience to encouraging alternative livelihoods and transport means; like the previously unsupported pedestrian/cyclist infrastructure. The next steps will involve formalizing the informal and then structuring these systems.

References

Africa Coronavirus statistics, (9th August 2020). http://covid-19-africa.sen.ovh/index.php?map=hcw

KCCA, (19th March 2020). Presidential Directives On COVID-19 – Next Steps For KCCA. Media release; Media Center, Kampala.

https://www.mediacentre.go.ug/sites/default/files/media/KCCA%27s%20Action%20on%20Presidential%20directives%20on%20Covid%20-%2019%281%29%20%281%29.pdf

Ministry of Health, MOH, (2nd April 2020). Update On The COVID-19 Response In Uganda. Media Center, Kampala

https://www.mediacentre.go.ug/sites/default/files/media/Corona%20Virus%20Update%202nd%20April%202020.pdf

NTV – On The Spot, (29th May 2020). Interview with the Permanent Secretary, Ministry of Health titled – What are the health implications of easing the lockdown?, . Nation Media, Kampala. https://www.youtube.com/watch?v=GFRoEtXubf8&authuser=0

Ministry of Health, MOH, (2020). COVID-19 Situation report 07th August 2020, 22:00. #171 https://www.health.go.ug/

Convent of Mayors in Sub-Saharan Africa-GIZ, (2020). La réponse des gouvernements locaux africains à la pandémie du Covid-19: Quelques exemples de mobilisations locales  observés en Afrique. Infographic on page 18.

Uganda Bureau of Statistics, UBOS, (2020)

https://www.ubos.org/wp-content/uploads/publications/07_2020WORLD-POPULATION-DAY-BROCHURE-2020.pdf

KCCA Website. About the Authority. https://www.kcca.go.ug/about-the-authority

Sajjabi, JP, (July 2020). Interview with Manager Fleet and Transport Logistics, Ag. Manager Health and Safety at KCCA and an advisor on the COVID-19 Kampala City Task Force. City Hall, Kampala. Retrieved from interview notes.

KCCA, (26th March 2020). Measures to combat the spread of COVID19 and price hikes in Kampala City. Press Release https://www.kcca.go.ug/index.php?jsp=news&req=393&cat=measures-to-combat-the-spread-of-covid19-price-hikes-in-kampala-city#.XpUIR5mxU2w

Sauti za Wananchi, (May-June, 2020). Livelihoods under COVID-19: Ugandans views and experiences on livelihoods and inequality. Fact sheet; https://twaweza.org/uploads/files/LivelihoodsUnderCorona_factsheet1%20_FINAL.pdf

Makerere University-AirQo, (2020). Kampala  Air  Quality  Improves  by  Up  to 40%  During  the  Covid-19  Lockdown. Retrieved from a Draft Report, Makerere University/KCCA.

https://www.pmldaily.com/investigations/special-reports/2020/07/78-ugandans-no-longer-fear-covid-19-survey.html

https://www.independent.co.ug/museveni-maintain-your-discipline-were-working-on-a-covid-19-vaccine/

Footnotes

[1] Africa Coronavirus statistics, 9th August 2020

[2] KCCA, March 2020

[3] MOH Update at media center, April 2020

[4] NTV on the spot interview, Permanent Secretary MOH, May 2020

[5] NTV on the spot interview, Permanent Secretary MOH, May 2020

[6] MOH Update at media center, April 2020

[7] MOH COVID-19 Situation report, 07 August 2020

[8] UBOS Report, 2020

[9] KCCA

[10] Interview notes, Sajjabi, JP, July 2020

[11] KCCA Press Release, March 2020

[12]Sauti za Wananchi – Livelihoods under COVID-19 fact sheet, May-June, 2020

[13] Makerere University-airqo, 2020

[14] Interview notes, Sajjabi, JP, July 2020

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