PHOTO: Hon. Dr. Charles Ayume (chairperson Parliamentary Health Committee) leading Members of Parliament on a tour at the Covid-19 testing centre -Entebbe. Extreme right is Mr. Andrew Nsawotebba, site operations manager


THE Parliament of Uganda has saluted the partnership between Ministry of Health (MoH) and the private sector for a wonderful operation to secure the country from the Covid-19 variants carried by travellers entering Uganda especially through Entebbe International Airport. MPs have bought the idea of mandatory testing and vowed to support it.
Six modern laboratory facilities are stationed at Peniel Hotel, a site which was identified by the joint team of Ministry of Health and World Health Organization (WHO) as a testing site, located just a few meters from Entebbe Airport. 
The six laboratories are from; Medipal Hospital, Case Hospital, Test and Fly, City Medicals, Same Day Laboratories and Safari Laboratories.
Travellers are tested first to know their status and those found negative, are cleared to join their families and friends.
Addressing media yesterday on a parliamentary Health Committee tour of the Covid-19 testing centre in Entebbe, Committee chairperson Dr. Charles Ayume who with other committee members interfaced with the six modern facilitities stationed, appreciated that the site is a private sector led intervention with supervision of The Ministry of Health.
The MPs were received by among others; Mr. Fred Byamukama (Administration and also in charge of Test & Fly), Mr. Andrew Nsawotebba the site operations manager, Ms. Naturinda (Test & Fly) and other Ministry of Health officials.

On behalf of other members sitting on the Health Parliamentary Committee, Hon. Dr. Charles Ayume said, “We have seen the statistics of this facility showing that 54% of the Delta variants were from tourists. Now the question is, if the Ministry of Tourism allows tourists to go through un tested, wont the country  be in great trouble?” 
“Good the facility has capacity for about 25,000 travellers and modern testing lab machines, we must go for mandatory testing to secure the lives of 45M Ugandans from Covid-19. We only request to lower the turn around time from four hours to atmost two hours.” Said Parliamentary Health Committee Chairman Dr. Charles Ayume.
This comes at a time when some voices from the Ministry of tourism were protesting mandatory testing saying it takes a lot of tourists’ time and may kill tourism industry hence financially crippling the economy. Parliament does not however share this school of thought. 
Dr. Ayume, son to late Francis Joash Ayume former Speaker Parliament of Uganda clarified that, “As Health committee of Parliament, we shall support the position of the ministry of Health to ensure that all travellers are tested regardless of vaccination status or when you last did your PCR because we are backed by science.”
Other committee members present included; Hon. Margaret Makokha (Woman MP Namayingo district), Hon. Nekesa, Hon. Isaac Otimgiw Ismail (Mp Padyeri county Nebbi district), Nebanda Andiru Florence (Woman MP Butaleja), Hon. Hope Grania Nakazibwe (Woman MP Mubende district), Hon. Dr. Opio Samuel Acuti (MP Kore North), Hon. Josephine Babungi Bebona (Woman MP Bundibujo district) and Hon. Yusuf Nsibambi (Mawokota South).
Dr. Ayume revealed that, “The objective of this visit was fact finding. It is within our scope to oversee. We came here to ascertain whether this facility is necessary. The answer is yes, it is very necessary in the sense that we anticipate the third wave in the country and monitoring of boarder entry points, is one of the pillars of World Health Organization (WHO) management of the epidermic.”
The Koboko Municipality Member of Parliament noted that by testing travellers entering the country for covid-19, the ministry of Health is exercising it’s mandate in terms of management of the epidermic. 
So what the ministry of Health does is quality assurance, supervision, data management and so forth. 
The six hospitals named to carry out tests are under the watch of Uganda Virus Research Institute, the Central public Health laboratory.
About the public concern in regard with whether the people who were immunised from their respective countries and those who have PCR test in the last 72 hours need to be subjected to a test, the Parliamentary Health Committee agreed with the Ministry of Health that these travellers should be subjected to Covid-19 testing before allowing them to proceed with their journey. 
Hon. Dr. Ayume said, “Science has shown that even when you are vaccinated, you can still be a transmitter of some of these variants like the Delta.
About compliants that the test cost of UGX 235,000 ($65) is high, the committee tasked Ministry of Health and the private partners to explain how they reached that figure, something which they perfectly did. They however agreed to sit and see how to get a subsidised figure.
Dr. Ayume however reminded public that, “The cost of treating a patient in ICU is UGX 3M per a day. Let’s have that at the back of our heads before we look at the financial and social inconvenience. If you had a patient in ICU for 20 days, that is UGX 60M. Yet you would have paid just 65 dollars and walked through.”

Dr. Richard Mugahi who works with the Ministry of Health and also is the Assistant Commissioner in charge of health operations at the Entebbe Covid-19 testing site revealed to Members of Parliament on a visitation tour how they have put in place a special package for tourists. 
Taking MPs through what goes on at the facility regarding the testing of travellers for Covid-19 who are coming into the country, Dr. Mugahi said their major objective for this operation is to ensure that they do minimise importation of variants of Covid 19.

“The country knows that variants are responsible for causing the epidermic within the country and we think by minimising the entry of these variants through screening at the points of entry and specifically Entebbe International Airport, is very important. We have a number of laboratories that are engaged in this process. It’s not true that we have one lab. There are six laboratories that have been engaged to do this work, good you have seen all them with your naked eyes.” Dr. Mugahi told MPs who visited the site.
He added, “We are happy that you have noted how the service at the facility between the Ministry of health and private sector laboratories partnership has greatly improved. We believe that in the coming week when we move on to mandatory testing we shall be able to give them results within two hours or even in one and half hours.”
He said, some of the travellers testing postive are tourists although they are not a big number.
“So testing for tourists is also mandatory as they come in but we have put in place mechanisms that make sure that tourists are not inconvinienced and do not take a lot of time at the testing ground. When they come in, they are immediately tested, samples taken, they go to their hotels and do not get out of their hotels until they get their results in a period of about one and half hours.” Said Dr. Mugahi about the tourists’ package.
The ministry said they have enough man power at the facility and if they go for mandatory testing, they will be able to test between 800 – 1000 travellers. 
“We are trying to get all our stakeholders engaged. As a country, we are not ready to have these waves of Covid-19. They disrupt the economy and everything. That is the sole purpose why we are doing all this.” Dr. Muhiga told MPs.

Dr. Muhiga revealed that the ministry has been not been testing vaccinated people but the new proposal is testing everyone coming into the country through the international Airport
“Because we know that vaccination does not protect an individual from carrying the infection and spreading it but protects the individual from getting a severe form of the infection. We therefore have to test even vaccinated people.” Said Ministry of Health official. 
He reffered to Science that it has shown how vaccinated people can easily carry the infection and infect others with them not getting severely affected.
About the testing cost, Dr. Mugahi said, “The true cost is $ 45. Then, $20 is operational costs. We need to test to protect our population, we need also to make sure that the cost is not high for any traveller. I think the discussion is going to continue. I don’t know how low it can go because this test is a partnership between  the Government and the private sector.”

As of 30th Aug, 2021 the Cumulative No. of targeted travellers tested for COVID-19 at Peniel beach- testing ground was 18,907 (Nationals 7,590 and Foreigners 11,317).  A total of 697 cumulative positive travellers were identified out of 18,907 (3.7 %). All the (697) positives have been linked to Isolation facilities under the case management pillar (360 Public, Private 302, HBC 35).The above positive cases are from a total of (15) countries and (05) high contributors are; Kenya 186 (26.7%), UAE 148 (21.2%), South Sudan 99 (14.2%), Tanzania 70 (10 %), South Africa 37 (5.3%) and Others. 
Of these positive cases, 495 were Ugandans and 202 were Foreigners. 97 of the positive samples were taken for genomic Sequencing (looking at which variant are these people coming with) and the results show predominantly the delta variant.

Lessons and proposed reforms from previous testing Interventions at the EIA.
The engagement with CAA revealed there was no adequate space at the airport to carry out testing activities. The testing of travellers started on 11th May 2021 and on average 120 tests are done daily from travellers in category 2 countries, but for mandatory testing of all incoming travellers, we expect to test between 800-900 tests daily. The testing at the Airport started on 10th May 2021.

Issues of escaping travellers and selective testing criteria 
This has been an area of concern as some travellers from category 2 countries felt it segregated them. This will be addressed by the “test all” principle and regular coordination meetings with stakeholders to address the gaps.

Increasing No. of travellers unable to pay for PCR test
Clearly authorised and documented waiver options for tests will be done by any of the private labs. GOU will refund test kits. (As of 30th August 653 travellers had been exempted from testing fees and GOU will cater for the testing Kits) .Criteria; Deportees, Students (Armed forces), returning palliative patients.

Delays at the testing area due to long TAT by some labs
Failure of the Laboratories to install at the testing site. Initially only three private laboratories were engaged to screen travellers and only one laboratory was able to install equipment at the testing site. The new direction is all private laboratories MUST install equipment at the testing site by the 3rd of September.

(06) Laboratories with modern equipment capable of producing PCR results within 90 minutes have fully installed equipment at the site;

Rationale for Mandatory Testing of all Incoming Travellers at POEs?
Availability of COVID-19 variants of concern among travellers with potential to rapidly spread and overwhelm our health system. There are many deadly variants that are circulating around the globe and this will come in country through travellers if we do not strengthen screening. Available evidence shows that, vaccinated persons are protected from severe forms of the disease but can carry and spread the Virus. Category testing at the airport had challenges of screening and can potentially allow variants of concern to enter the country.

Areas of emphasis for effective implementation of the mandatory testing
▪Results processing and dispatch guidelines are available
▪Management of positive cases protocols are available
▪Stakeholder communication strategy.

Passenger Transportation and coordination
All arrivals shall be escorted to the VIP Parking Lot by a joint Avipol, MoH & Operations team. At the parking lot, they shall present their baggage to the baggage handling team. Passengers shall then be directed to waiting buses (10 stationed buses with 30 seat capacity with social distancing). Hand sanitization shall be done before boarding the buses, a free mask shall be given to those without, social distancing will be observed while in transit to the testing site. The travelers will; be escorted to the testing site by security personnel. It takes about 10 minutes for travelers to embark and move to the testing site.

Baggage handling
All travellers will present their baggage to the Baggage Handling Team at the airport VIP parking lot. The team shall pick Bingo stickers from Tags on baggage and append them on Bingo reconciliation forms/cards (a Bingo is a card with a Tag number; Flight number; and Barcode identical to the information on a Baggage Claim Sticker and unique for each traveller). The Baggage shall then be loaded onto trucks (box bodies) with secured locks and transported to the Baggage store at the testing site. There has not been any reported loss of baggage for the last 4 months of operation.

Waiting area travellers
A well paved waiting area for travellers with capacity to hold 300 passengers is in place with, free wireless internet and 16 charging spots, and six electronic bug zappers for trapping and killing lake flies and mosquitoes at night have been installed.A process to erect 3 more tents (@ with capacity of handling an additional 300 passengers with social distancing has started.External service providers have been engaged to provide food and drinks to the travelers at their own cost.60 Charging points & Bug Zappers have already been drawn and contractors identified.The waiting area, is fitted with a public address system that will help during results dispatch to the clients.

Waiting area for family and friends
Family members and friends will wait outside the gazette testing area with ample packing for about 200 vehicles at an affordable cost charged according to time spent.The crowd will be managed by our security personnel that are deployed at the testing ground.
Upon receiving the results and Baggage the security team will authorize the traveler to leave the testing ground and link up with family.

Progress so far
Stakeholder coordination meetings have been conducted at operational and strategic levels. Meetings with security team (Aviation Police, UPDF)Private laboratory teams, Immigration, CAA, UTB. Health committee of ParliamentInter – Ministerial coordination meeting.

Identification and engagement of private Laboratories to support Testing
Formal invitation was sent out to all the (25) COVID-19 accredited laboratories to express interest and attend a meeting at the Ministry of Health. 10 Laboratories attended the meeting and expressed interest but only 06 were able to set up at testing venue.

Testing Facilities:
The testing capacity at the penial beach has been increased from (02) to (06) private laboratories with modern equipment set up at the site. The total testing capacity for the (06) private laboratories is 1048/run or per every 90 Mins.All the (06) six laboratories have capacity to produce PCR results within 90 Mins. (1.5 hrs.) and this has been verified by the Ministry of Health Laboratory supervision team. The (06) laboratories will be able to serve the anticipated increase in the daily load of tests from the average of 120 travelers/Day to the average of 800 travelers/day.The participating Laboratories will conduct weekly coordination meetings under the leadership of the Ministry of Health.

Management and linkage of all positives cases
All the identified positive cases are linked to Isolation facilities. The public Isolation facility will be Namboole Isolation facility.
Two (02) other Non-Traditional Isolation facilities have been identified for positive travelers who are not comfortable in Public isolation facilities one in Entebbe (Mowcribs Hotel) to Isolate Tourists and other travelers and the second is in Kampala (Kerona Dam Hotel). The cost of the private facilities range from $60 to $80 full board. The positive cases will be managed by the case management pillar as per the National Protocols. Stand by transport is available for timely referral and linkage of positives cases to isolation facilities. Positive samples are segregated and those with low CT value are forwarded to UVRI for Genomic sequencing. A team of (10) psychosocial counsellors are available at the testing site and airport to deliver results and also explain the importance of the intervention.

Data Management facilities
We intend to reduce the pre-analytical time from 15 Minutes to 5 Minutes by introducing an electronic data capture and payment system. This will save travellers time as they will only present for sample collection at the testing ground.

Special Considerations.
Testing Government VVIP:

Samples will be collected from the VIP lounge and will be allowed to wait for their results that will be ready within 90 minutes.

Test for Ambassadors and Immediate families:
Clearance was provided to the EU and USA Ambassadors to have their tests from their approved laboratories (eg. the IOM laboratories) and provide MOH with test result within 90 Minutes.

Testing of Tourists:
Samples will be collected from the testing grounds where a special desk has been set up to handle tourists. The tourists will be allowed to move to (05) Hotels in Entebbe gazetted with the support of the Uganda Tourism Board (UTB). The Hotels are; Hotel Number 5, Papyrus Guest House, Boma Guest House, Karibu Guest House and Airport guest House hotel. The cost of staying at the guest house will be settled by the tourists.The results for Tourists will be processed within 2 hrs. The negative Tourists will proceed to their destinations and positive ones will be Isolated at gazetted NTIF.

● Support the mandatory PCR testing for all incoming travellers
● MOFA to communicate to all Embassies about the new directive.
● OPM to coordinate the inter-ministerial meetings and communications 
● CAA to communicate to airlines about the new directives

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