Balancing safety and good care in the context of infectious disease outbreaks: learning health systems for infection prevention and control in Uganda

从过去经历过传染病（ID）爆发的人和机构的反应和经验中学习是为当前和未来流行病做准备的一个关键但被忽视的方面。在经历包括冠状病毒疾病在内的ID爆发的资源贫乏和分散的卫生系统中，卫生保健工作者（HCW）在当地特定的背景限制和条件下响应感染预防控制（IPC）全球标准的要求。他们还必须在为病人提供良好护理的需要与保护病人和他们自己免受感染的安全措施之间取得平衡。该项目以乌干达为背景，近几十年来该国经历了多次ID爆发，该项目研究了IPC措施如何在卫生设施和社区的护理关系中实施。我们的目标是在COVID-19危机期间和之后，帮助加强卫生系统的能力，以利用过去和现有的信息和经验来准备和应对疫情爆发。我们借鉴政策研究，人类学和地理学的方法，在更广泛的历史，地理和社会距离的背景下，审查IPC措施的实施情况，这些措施在乌干达两个对比鲜明的地区提供医疗服务。首先，我们采用文献分析方法，以及关键的线人访谈和生活史的方法来研究过去的ID爆发对当前的想法和IPC在卫生设施和社区的做法的影响。其次，我们使用访谈，观察和参与性绘图技术，以研究如何物理障碍和距离的方法与社会，专业和地理层次的护理提供。通过这些方法，我们还将了解正式和非正式护理人员如何在包括COVID-19在内的ID爆发的背景下满足护理需求并降低风险和安全性。第三，我们将以文字和视觉形式总结数据，并在一系列咨询工作坊中与利益相关者分享。这些参与式交流旨在评估卫生保健工作者和社区在ID爆发背景下提供护理的经验在何处以及如何有效地融入当前IPC和卫生系统加强举措。我们的项目与国家和区域层面的相关利益攸关方合作，旨在提供能够为健康保护实践和协议提供信息的见解，优化对弱势群体的安全和富有同情心的护理，并加强乌干达境内和境外卫生系统未来流行病准备的能力。

Learning from the responses and experiences of people and institutions that have undergone infectious disease (ID) outbreaks in the past is a critical yet neglected aspect of preparing for current and future epidemics. In resource poor and fragmented health systems experiencing ID outbreaks including Coronavirus disease, health care workers (HCW) respond to the demands of global standards for infection prevention control (IPC) within the locally specific contextual constraints and conditions. They must also balance the need to provide good care for patients alongside safety measures to protect patients and themselves from infection. Set in Uganda, a country that has experienced multiple ID outbreaks in recent decades, this project examines how IPC measures are implemented in the context of care relations in health facilities and communities. Our aim is to contribute to strengthening the health systems capacity to draw on past and existing information and experiences of preparing for, and responding to, epidemic outbreaks, both during and beyond the COVID-19 crisis. We draw on methods from policy research, anthropology and geography to examine the implementation of IPC measures within the broader context of historical, geographic, and social distances that characterise provision of care in two contrasting regions of Uganda. First, we employ documentary analysis methods alongside key informant interviews and life history methods to examine the influence of past ID outbreaks on current ideas and practices of IPC in health facilities and communities. Second, we use interviews, observations, and participatory mapping techniques to examine how physical barrier and distancing methods relate to social, professional, and geographic hierarchies of care provision. Through these methods, we will also elicit how formal and informal caregivers attend to care needs and mitigate risk and safety in the context of ID outbreaks including COVID-19. Third, we will summarise data in textual and visual forms to share it in a series of consultation workshops with stakeholders. These participatory exchanges aim to assess where and how health care workers and communities' experiences of providing care in the context of ID outbreaks can be usefully integrated into current IPC and health systems strengthening initiatives. Working with relevant stakeholders at national and regional level, our project aims to deliver insights that can inform health protection practices and protocols, optimise safe and compassionate care for vulnerable populations, and strengthen capacity of the health system for future epidemic preparedness both within and beyond Uganda's borders.