Enhancing Equitable Access of COVID-19 Vaccines

Aim

The delivery of COVID-19 vaccines is conducted in an equitable and transparent manner, ensuring that the right people are vaccinated, and there is no corruption in the delivery of the vaccine.

Landscape

With the devastating economic and social impact of the COVID-19 restrictions, the demand for vaccines in order to restore a return to normal life is high. As such, it is crucial that the distribution adheres to the principle of equity, and that health workers, and those clinically vulnerable, remain prioritised. Such high levels of demand, combined with varied (and often poor) mechanisms for managing and monitoring responses to pandemics, open the door to corruption, which if left unchecked, will seriously reduce the impact that a COVID-19 vaccine is intended to have on protecting those most at risk. As a result, efforts to counter COVID-19 may be harmed, prolonging its negative impact and leaving the already fragile health system further weakened.

Corruption may stop those entitled to vaccines from accessing them. This sets out in many forms including favouritism, the diversion of supplies to private hospitals and the informal market, the distribution of fake vaccines, as well as demands for bribes and informal payments.

Activities

1. Inception meeting at national and sub-national level. TIU held inception meetings with the district level task force committees and with the Ministry of Health. The meeting with the MoH was aimed at enabling TIU to share project details and also to seek further guidance on how best to collaborate with the Ministry during the project implementation. With the district task forces, the meetings aimed to ensure that the key stakeholders have a clear understanding of the project and its activities.
   ConsultationStrategic working groups & Collaboration
2. Conducting a survey on the effectiveness of vaccine supply chains and delivery mechanisms. TIU is in the process of conducting this survey. So far, TIU has identified and oriented selected Village Health Team members that are administering this survey to different households in their communities. TIU plans to collect data from 15,000 households by the end of November 2021. This data will be analysed and documented into a report for sharing with different duty bearers.
3. Running and publishing a toll-free call centre to document any corruption-related incident while accessing the vaccine. TIU continues to advertise its pre-existing toll-free line among the communities to report any corruption-related issues in the process of acquiring the vaccine. These issues are synthesized on a weekly basis, analysed and referred to the relevant stakeholders for further actions. TIU follows up these issues to ensure that they are dealt with.
   System development
4. Publishing quarterly reports on the progress of the vaccination programme. As a means of disseminating the works that TIU is doing, we publish progress reports on the organisation’s website and social media accounts.
   Media campaignMonitoring & evaluationPublication of report & guidance

Achievements

1. Enhanced responsiveness of duty-bearers on corruption-related cases in the process of obtaining the vaccine. TIU analyses cases received through the call centre and the different engagements, develops a report and disseminates it to various duty-bearers. Responses from some of them have been positive and cases could be resolved. For example, in Kiwangala Health centre 1V, Lwengo district, people who were receiving their first dose were asked to pay UGX 1,000 and those receiving their second dose were asked to pay UGX 2,000. This bribe was being asked for when picking up the vaccination card two days after the vaccination. Recipients are told that this money is necessary to either buy airtime or hire public address systems to call other people to turn up for the vaccination. TIU sent this report to the Assistant District Health Officer (ADHO) who held a meeting at the facility, the health worker who was extracting money from people apologized and promised not to repeat this action. Since then, the ADHO has been closely monitoring the proceedings at all health facilities within the district and no report of this crime has been documented since.
2. The Village Health team members that are located in the villages have become more confident in reporting corruption-related cases. This is a result of various engagements that TIU has been including them in.

Future Plans

1. Conduct community awareness meetings on the accessibility and uptake of the vaccine. These will be aimed at creating a platform to spread information on COVID-19 vaccination, as well as to give citizens the opportunity to interact with their duty-bearers. These forums are aimed at increasing the uptake of the vaccine.

2. Feedback meetings with duty-bearers at sub-national level: TIU shall synthesize and analyse the findings from the survey with the feedback from the community awareness meetings and call centre reports. A report shall be developed and shared with the district leaders and Ministry of Health. These meetings will be aimed at discussing the findings and generating action points to address the existing gaps and commit duty-bearers in the districts to including community's perspectives in the strategies.

Lessons Learnt

• Guidelines for the response to COVID-19 pandemic are dynamic in nature. Therefore, the project needs to be very flexible to incorporate changes as they come.