This action brief describes the interventions carried out by Rays of Hope Hospice Jinja (RHHJ) to mitigate some of the common challenges imposed by the COVID-19 pandemic and resulting lockdown, which affected palliative care service delivery in Busoga Region and Buikwe District. These were informed by a survey conducted during the period of the total lockdown (31 March–26 May 2020) and findings from post-lockdown surveys that examined the impact of the interventions.
Key learning points
• The COVID-19 pandemic and resulting control measures such as lockdown created a lot of worry for patients in need of palliative care. It became clear that failure to secure continuity of care exacerbates the psychological distress of patients, resulting in a negative impact on health outcomes and quality of life. For the very vulnerable patients, food represented a critical necessity needing to be provided, alongside their medical care.
• To strengthen integration and continuity of care, palliative care services should strengthen collaboration with other service providers. In our case aligning care and support plans to those developed by the Uganda Cancer Institute made it feasible to support cancer patients in care to continue with their treatment.
• Health workers were also affected by the negative consequences of the COVID-19 pandemic. It is clear from our experience that caring for health workers and showing appreciation is vitally important, boosting morale and reducing absenteeism. Support to health care staff has proved to be an important aspect of responding to a pandemic, if continued access to care is to be ensured.
Impact of COVID-19 on delivery of essential health services
The COVID-19 pandemic impacted access to essential health services in Uganda and palliative care and rehabilitation were not spared. The COVID-19 control measures in Uganda included physical distancing, restrictions of public movement and curfews, which affected access to palliative care services. Many health institutions suspended screening services, rehabilitation and community outreach programmes, and reduced patient appointments to be able to maintain adherence to physical distancing guidelines. This led to delays in patients seeking care, as well as in the provision of timely care, but also interruptions in treatment adherence, which negatively impacted outcomes of care.
In particular, travel restrictions caused reductions in home-based care visits and access to treatment at the Uganda Cancer Institute (UCI). During lockdown, out of 12 (20%) patients who had an appointment at UCI, seven (58%) managed to go, while five (42%) were unable to get there.
Additionally, loss of work and school closures due to lockdown caused a number of socio-economic challenges, such as shortages in food supplies for some.
How did this intervention/activity contribute to the maintenance of EHS?
1. Maintaining supplies of consumables and medicines
A total of 234 patients were reached during the week prior to lockdown. Forty-seven (77%) of the patients surveyed received extra stocks of medicine from RHHJ before lockdown began.
Of the 47 who got medication before lockdown, 22% ran out of medicines. Of these, 63% were re-supplied by RHHJ, 17% got the refills from pharmacies and 4% from health centres. This helped to mitigate treatment interruptions. However, 17% did not get the medication needed until the next scheduled visit from RHHJ.
2. Maintaining access to health services
HIV/AIDS patients got their drug refills.
3. Mitigating treatment interruption for cancer patients in care
In March 2020, RHHJ supported 64 patients to get treatment from UCI. Transportation was provided for 5 out of 12 patients surveyed who had an appointment with UCI, to ensure continuity of treatment.
4. Social support and supply of basic foodstuffs
In the first quarter of 2020, RHHJ supported 119 patients with rice, beans and sugar, while 73 patients received additional nutritious porridge.
Because of the effects of the pandemic on livelihoods, RHHJ increased the number of families benefiting from social support during this time. Between April and June 2020, the numbers receiving support needed to be expanded to 145, 250 and 220 patients’ families respectively, over those three months. The provision of basic food helped prevent critical cases of malnutrition among patients and their families. Additionally, patients’ fear of being neglected or forgotten was mitigated, hence improving their psycho-social well-being.
5. Support to staff
Social support provided to hospice staff helped with the relief of distress associated with social support demands and allowed for continued service delivery without duress.
Margrethe Juncker, Volunteer Doctor and Programme Advisor, RHHJ and Dr. Eve Namisango, Programmes and Research Manager, African Palliative Care Association
This action brief was published on the WHO’s Health Services Learning Hub. For full article or to download it in PDF, follow this link