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暴发的人和机构的反应和经验中学习，是为当前和未来的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病在内的ID暴发的资源匮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对全球感染预防控制标准(IPC)的要求做出反应。他们还必须在为患者提供良好护理的需要与保护患者和自己免受感染的安全措施之间取得平衡。这个项目以乌干达为背景，这个国家近几十年来经历了多次身份证暴发，该项目审查了在卫生设施和社区护理关系的背景下如何实施IPC措施。我们的目标是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，在准备和应对新冠肺炎危机期间和之后的流行病暴发方面。我们借鉴政策研究、人类学和地理学的方法，在乌干达两个不同地区提供护理的历史、地理和社会距离的更广泛背景下，检查IPC措施的实施情况。首先，我们使用文献分析方法，结合关键的信息者访谈和生活史方法来检查过去的ID暴发对当前卫生设施和社区中IPC的思想和实践的影响。其次，我们使用访谈、观察和参与性地图绘制技术来检查身体障碍和疏远方法与社会、专业和地理护理提供的等级之间的关系。通过这些方法，我们还将得出正式和非正式的照顾者如何照顾护理需求，并在包括新冠肺炎在内的ID暴发的背景下减少风险和安全。第三，我们将以文字和视觉形式总结数据，以便在一系列咨询研讨会上与利益攸关方分享。这些参与性交流旨在评估卫生保健工作者和社区在艾滋病暴发背景下提供护理的经验可以在哪里以及如何有效地纳入当前的IPC和加强卫生系统的倡议。我们的项目与国家和区域层面的相关利益攸关方合作，旨在提供见解，为健康保护做法和方案提供信息，优化对脆弱人口的安全和同情护理，并加强卫生系统在乌干达境内外应对未来疫情准备的能力。

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.