Balancing safety and good care in the context of infectious disease outbreaks: learning health systems for infection prevention and control in Uganda

Learning from the responses and experiences of people and institutions that have undergone infectious disease (ID) outbreaks in the past is a critical yet neglected aspect of preparing for current and future epidemics. In resource poor and fragmented health systems experiencing ID outbreaks including Coronavirus disease, health care workers (HCW) respond to the demands of global standards for infection prevention control (IPC) within the locally specific contextual constraints and conditions. They must also balance the need to provide good care for patients alongside safety measures to protect patients and themselves from infection. Set in Uganda, a country that has experienced multiple ID outbreaks in recent decades, this project examines how IPC measures are implemented in the context of care relations in health facilities and communities. Our aim is to contribute to strengthening the health systems capacity to draw on past and existing information and experiences of preparing for, and responding to, epidemic outbreaks, both during and beyond the COVID-19 crisis. We draw on methods from policy research, anthropology and geography to examine the implementation of IPC measures within the broader context of historical, geographic, and social distances that characterise provision of care in two contrasting regions of Uganda. First, we employ documentary analysis methods alongside key informant interviews and life history methods to examine the influence of past ID outbreaks on current ideas and practices of IPC in health facilities and communities. Second, we use interviews, observations, and participatory mapping techniques to examine how physical barrier and distancing methods relate to social, professional, and geographic hierarchies of care provision. Through these methods, we will also elicit how formal and informal caregivers attend to care needs and mitigate risk and safety in the context of ID outbreaks including COVID-19. Third, we will summarise data in textual and visual forms to share it in a series of consultation workshops with stakeholders. These participatory exchanges aim to assess where and how health care workers and communities' experiences of providing care in the context of ID outbreaks can be usefully integrated into current IPC and health systems strengthening initiatives. Working with relevant stakeholders at national and regional level, our project aims to deliver insights that can inform health protection practices and protocols, optimise safe and compassionate care for vulnerable populations, and strengthen capacity of the health system for future epidemic preparedness both within and beyond Uganda's borders.

In resource-poor health systems experiencing infectious disease (ID) outbreaks including Coronavirus disease, health care workers (HCW) negotiate globalised standards for infection prevention control (IPC) under locally specific conditions and constraints and balance the need to care alongside that to protect. Set in Uganda, a country that has experienced multiple ID outbreaks in recent decades, this project applies a relational approach to the study of IPC measures in the context of care provision in health facilities and communities. Using methods drawn from policy research, anthropology and geography, our analysis of IPC measures is grounded in a broader mapping of temporal, geographic and social distances that characterise the material realities and practices of care in health facilities and communities of two contrasting regions (South-Central and West Nile). First, we employ documentary analysis methods, key informant interviews and life histories to elucidate path-dependent influences of past ID outbreaks on current discourse and practice of IPC. Second, interviews, observations, and participatory mapping techniques will examine how current implementation of IPC physical barrier and distancing measures relate to social, professional, and geographic hierarchies of care provision. We will further elicit how formal and informal caregivers attend to care needs and mitigate risk and safety in the context of ID outbreaks including COVID-19. Third, data will be synthesised and shared in consultation workshops to assess where and how health care workers and communities experiences of providing care in the context of ID outbreaks can be usefully integrated into current IPC and health systems strengthening initiatives. Our project aims to deliver findings that can inform health protection practices and protocols, optimise safe and compassionate care for vulnerable populations, and strengthen learning systems for epidemic preparedness within and beyond Ugandan borders.