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Why COVID-19 Testing is the Way to Go: A View From Civil Society

COVID-19 testing is one of the key prevention strategies in the pandemic response. It is a tool for gathering information on who is infected or not and this is important for evidence-based public health decision-making.

The World Health Organisation (WHO) recommends that all individuals suspected of being infected with COVID-19 be tested to effectively stop the spread of the virus. It is necessary to rapidly detect all positive cases of COVID-19 for isolation, treatment and implementation of public health control measures based on the national protocols.

Testing for COVID-19 in Uganda is by antigen Rapid Diagnostic Tests (Ag RDTs) and Polymerase Chain Reaction (PCR) tests. Ministry of Health (MoH) recommends the use of PCR for diagnosis of COVID-19 and the RDT for its surveillance in the communities.

MoH and partners have carried out accelerated mass vaccination campaigns nationwide, in order to increase the uptake of Covid-19 vaccination. However, uptake of COVID-19 vaccination services in some areas and sub-populations has remained low in Uganda.

Though important, testing remains low in Uganda and this is a concern. Low income and lower-middle income countries are still far from the UN General Assembly’s global target of 100 tests per 100,000 population per day. Since 2020, less than 3.5 million Ugandans (as at October 30, 2022) have tested for Covid-19, according to Ministry of health statistics, a figure that is too low.

Since the Covid-19 outbreak in Uganda, Civil Society Organisations (CSOs) like HEPS- Uganda, a health and socioeconomic promotion NGO has been part of the pandemic response efforts. The organisation work has enriched their understanding of global health security and the best ways to respond to health emergencies.

With support from FIND and Unitaid, HEPS-Uganda carried out a rapid assessment to assess availability and uptake of Covid-19 testing. This was part of the advocacy for COVID- 19 test-and-treat approaches project.

Findings from the assessment indicate that only 41 percent of the people sampled had ever taken a COVID-19 test, confirming the low uptake of testing services even among respondents who had experienced COVID-19 signs and symptoms. Only one in four of the respondents believed that an individual should take a COVID-19 test if they are travelling from a high-risk area, while 64 percent of the respondents believed that testing is only necessary if one has been exposed to an individual who had previously tested positive for Covid-19.

The assessment further discovered that community testing hesitancy is driven by a number of factors including high cost of testing, fear of being found positive, low risk perception, belief that COVID-19 is no longer a big threat, fear of the discomfort associated with the sample collection process, doubts about reliability of testing methods and results, among others.
During the assessment, it was found out that the cost of Covid-19 testing ranges between UGX 120,000 to UGX 200,000 in private health facilities, an amount the community perceives as too high and is one of the main hinderances towards access to Covid19 testing.

From the perspective of health consumers, non-availability of services was the biggest hindrance to access COVID-19 testing.
The assessment observed capacity gaps on the supply side, including skills and logistical gaps. As far as human resource gaps are concerned, about 18% of the health workers reported that they did not know how to interpret the COVID-19 test results and guide clients on the next steps.

CSO’s Call to Action

“Although Uganda has done well in Covid-19 response, the government should invest in evidence generation on operational challenges, supply constraints and uptake scale-up strategies for COVID-19 testing, even for future pandemics,” Kenneth Mwehonge – the Executive Director HEPS-Uganda says, adding that, the government should also partner with community health workers who typically are trusted sources of information to tackle rampant misinformation on COVID-19 testing and treatment.

The government should as well conduct price monitoring studies to inform the process of regulating testing costs in private health facilities.

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