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Feb 14, 2024   |   Blog Post

Battling Polio in Uganda: A Conversation with Uganda Virus Research Institute’s James Eliku

A rider arrives at the Uganda Virus Research Institute laboratory in Entebbe to deliver samples from the environmental surveillance team in Kampala. Photo credit: Denis Onyodi

By Dr. Bannet Ndyanabangi

Vice President Global Programs

Polio, a crippling and potentially fatal infectious disease, has seen a significant global decline thanks to concerted efforts like the Global Polio Eradication Initiative (GPEI). However, vaccine-derived polio outbreaks remain a threat in several African countries, including Uganda.

In October 2023, I had the privilege of meeting with James Eliku, Program Coordinator at the Uganda Virus Research Institute (UVRI), to discuss the ongoing challenges and advancements in polio eradication in Uganda. We also explored how VillageReach’s partnership with Uganda’s Ministry of Health (MoH) has impacted this crucial effort.

Picture of James Eliku, Program Coordinator, Uganda Virus Research Institute (UVRI)

James Eliku, Program Coordinator, Uganda Virus Research Institute (UVRI)

Can you shed light on the challenges of polio eradication in Uganda and how VillageReach’s collaboration has made a difference?

The transport of polio samples in Uganda has faced numerous hurdles. This includes samples delivered with incomplete data, late arrival of specimens, lack of training, inadequate polio sample transportation equipment and supplies, challenges in the chain of custody and reporting of fake cases. These challenges resulted in delays in testing, diagnosis, and response.

VillageReach partnered with the Uganda MoH to improve the speed and reliability of polio sample transportation – for both acute flaccid paralysis (AFP) and environmental surveillance (ES) specimens – from health facilities to the national laboratory. This partnership is part of accelerated efforts to eradicate polio worldwide and strengthen lab specimen referral systems.

In addition, the collaboration aimed at ensuring the quality of the samples during transportation, so the lab can produce a quality result and improve data visibility at all levels of the health system.

Uganda has a proven track record of excellence in timely deliveries for AFP surveillance, consistently meeting the 3-day target between sample collection from patients and arrival at the national lab.  To further enhance this success, we joined forces with VillageReach to implement a more integrated approach to sample transport, replacing the existing parallel system for polio samples.

Collaboration with partners including VillageReach has led to the success of the National Hub System, which was formed by the MoH to address long turnaround times and high costs of transportation for all types of lab samples. The National Hub System, officially known as the Uganda National Sample and Results Transport Network (NSRTN) uses government drivers to efficiently move samples across different disease programs and laboratories[1]. Our collaboration with VillageReach and GPEI has integrated polio samples into this transport system in 30 participating districts (out of 135 in the country) and increased the frequency of sample pick-ups from health facilities, leading to non-participating districts wanting to join in.

Specifically, through our partnership, we have implemented several improvements:

  • Training of health workers: We provided training in polio sample transportation to health facility surveillance focal persons, hub coordinators, and the government drivers transporting the samples.
  • Increased collaboration: We extended our collaboration to include measles and rubella samples, entering them into the national transport system. We also set up WhatsApp groups to coordinate transport, allowing for swift identification and transportation of samples.
  • Additional equipment and supplies: We procured 150 lab sample carriers and provided triple packaging materials to all health facilities; having sufficient transport supplies becomes very important when a disease outbreak occurs and sample volumes suddenly increase.
  • Enhancements in the chain of custody: We improved sample tracking through the MoH app called Restrack Uganda. We trained hub coordinators and drivers on the use of the app before its roll-out across the 30 districts. We also added 11 environmental surveillance sites for polio to the tracking system.

A driver delivers samples to the Central Public Health Laboratories (CPHL) in Butabika, Kampala. Photo credit: Denis Onyodi

In what ways have the digital enhancements improved the polio sample transport process?

Through our partnership, we procured equipment that increased the speed and quality of polio samples. This included the procurement of two barcode readers and a desktop computer for environmental surveillance, enabling digital tracking from the field to UVRI labs. We also transitioned from a paper-based sample reception to a digital system, enhancing efficiency.

How crucial has the role of partners been in improving polio sample transport?

The partners have done a great job, starting with the World Health Organization, which helps fund the transport of polio samples countrywide.  With VillageReach, we have been able to strengthen the National Hub System in 30 targeted districts, where even polio samples are transported through the government hubs, instead of being hand-carried by health workers to the capital. We also partnered with Gavi and the Core Group who supported transportation in some districts. These partners came in to enhance the hub transport system that ensures all types of lab samples move as fast as possible to the national laboratory.

What are some of the key achievements and insights from this initiative?

Our partnership has achieved several notable milestones:

  1. Extended polio sample transportation through the hub system to all 30 implementing districts, without sacrificing sample timeliness or quality:
    • AFP sample quality remained consistent, with about 100% of the samples reaching the UVRI polio lab in good condition. In comparison, ES sample condition improved during the project from a baseline of 64% to 92%.
    • The timeliness of sample transport is captured in the graph below. Transporting AFP samples via the government hub system, rather than via health workers, takes a similar amount of time (and the project team is working to improve this), while for environmental surveillance samples, the government hubs appear to be much faster than when health staff do the transport.

Polio Lab Transport via National Hub System (30 Districts)

  1. Improved the tracking of not only polio samples but also other vaccine-preventable disease (VPD) samples, such as measles and rubella.
  2. Provided end-user training to those coordinating the hub system (drivers and motorbike riders).
  3. Deployed barcode readers in collaboration with the Central Public Health Laboratories to track samples being transported.
  4. Increased the number of measles samples being transported.
  5. Enhanced collaboration among key stakeholders involved in polio case identification, transportation, and coordination, and improved coordination from the national level to all sites.

Samples are received at the Uganda Virus Research Institute laboratory in Entebbe. Photo credit: Denis Onyodi

What lies ahead for the program? Are there ambitions to extend or repurpose this approach to other sectors?

The future of this program involves transporting all lab samples in Uganda through the national hub system. We aim to establish a working system that will be more affordable and accessible for partners supporting sample transportation (regardless of the disease for which samples need to be tested). Continuous stakeholder advocacy is crucial to ensure awareness of the national hub system and the importance of maintaining the chain of custody for samples.

From Right- Dr Bannet Ndyanabangi, VillageReach Vice President, Global Programs; Dr. Ampaire, Surveillance Officer, MOH; Peter Eliku, Program Coordinator, UVRI and Dauda Majanbu, VillageReach Senior Manager, Supply Chain at a workshop on the transition of project activities to government

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Polio eradication is not just a goal; it’s a necessity. Conversations with experts like James Eliku underscore the significance of collective effort, persistence, and innovation. We extend our gratitude to James for sharing his invaluable insights.

For more information about the Polio Lab Sample Transport program in Uganda, contact Mr. James Eliku, Uganda Virus Research Institute (elikujampe@yahoo.com) or Mr. Dauda Majanbu, Senior Manager (Dauda.Majanbu@villagereach.org)

[1] Hub Guidlines.pdf (cphl.go.ug)

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