The recently concluded national elections in Uganda presented one fundamental public health challenge that will be live in the annals of history: How to prevent the spread of a highly infectious disease in a low-resourced setting during an event that by its very nature is meant to congregate thousands of people.

This is an issue on which public health specialists spent agonising days and nights figuring out the right advice to give. The World Health Organization (WHO) was consulted for advice but unfortunately, there were no precedents in Uganda. A national election during a raging epidemic was something new. Yet, the national authorities had no option because elections are sacred and sanctified constitutional issues that must be respected.

Fortunately, the scientifically proven COVID-19 prevention and control measures were well known and could be easily implemented or observed by most people at minimal or no cost. It is these measures that WHO emphasised to all people who sought the organization’s advice on the matter.  

“Our advice is simple and clear. All people should always wear masks, they should regularly wash hands with soap and water, they should physically distance by at least two meters and those with signs and symptoms should stay at home and seek immediate medical attention,” Dr Yonas Tegegn Woldemariam, the WHO Representative to Uganda succinctly put it.

Indeed, the message was as clear and direct as it could ever be, the only remaining hurdle being how to communicate it deeply and widely throughout the country and for the people to comply.

Time was of the essence; the resources were limited and yet the campaigns were reaching a crescendo. For public health workers, the heightened political activities were the perfect recipe for a COVID-19 time-bomb. The country was already in phase four of the epidemic characterised by sustained community transmission. Anxiety abounded.

The United Nations Country Team in Uganda urgently raised funding for a mass media and community engagement campaign. WHO was tasked to quickly plan and execute a min campaign targeting safety during the electoral period using the raised funds.  

After consultations and inputs from the Ministry of Health, the National Electoral Commission, and several stakeholders, the min campaign was up and running by mid-January 2021, just a few weeks to the polling date. 

A variety of Information, Communication and Education materials were produced and distributed to over 86 districts while others were covered by other partners working with the Ministry of Health. Public service announcements were airing at regular intervals on various FM radio and television stations throughout the country. Other interventions included direct interaction with the Electoral Commission field workers, aspiring politicians, and some members of the public.  

In the West Nile sub-region for instance, the WHO field team ensured that COVID-19 Standard Operating Procedures (SOPs) reached whoever mattered in the planning and conducting of the elections. Indeed, the team, working with the District Health Teams managed to engage and orient the different electoral commission sub-county supervisors, returning officers and polling assistants to ensure adherence to the COVID-19 SoPs.

“My constructive engagement with the WHO team in Arua started way back in September 2020 when they visited the electoral commission offices and put emphasis on measures to curb the spread of COVID-19 before undertaking major electoral activities like nomination of candidates, campaigns and polling days,” says Mr Shesa Juma Adam the returning officer for Arua city.

The engagements also enabled the Electoral Commission officials to acquire more knowledge about COVID-19, and how to mitigate the risks of transmission of the virus during the election period. Little wonder, therefore, at most of the polling stations in the country, there were handwashing facilities, most voters wore masks and there were attempts at physical distancing.  

“WHO provided the Electoral Commission offices with an assortment of vital supplies for use on polling day. These included hand sanitizers, disposable face masks, informative leaflets and banners which helped us at least control COVID-19 during the elections,” says Mr Shesa Juma Adam.

According to Mr Idringi Dieudonne the District Health Educator for Koboko, all the electoral commission staff and observers adhered to the COVID-19 SoPs of the polling centres he visited.

One notable aspect arising out of the engagement was the impressive integration of COVID-19 messages into the campaign speeches by many aspiring politician leaders across the political divide. This was not accidental as WHO and the Ministry of Health had specially developed talking points on COVID-19 which they distributed to all politicians through the Electoral Commission field offices and the district administrators.

Overall, WHO teams worked with Electoral Commission staff, the Ministry of health, districts health authorities, and politicians throughout the country to safeguard the health and mitigate transmission of COVID-19 during the elections period. Several weeks after the elections, COVID-19 infections have not surged as had been feared partly due to these interventions.