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. 2025 Mar;15(1):565-570.
doi: 10.1016/j.afjem.2025.01.001. Epub 2025 Feb 1.

Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda

Sulaiman Bugosera Wasukira  1   2 , Carl Trevor Kambugu  1   2 , Judith Nanyondo S  1 , Emmanuel Candia  1   2 , Stephen Emmanuel Aporu  1   2 , Patricia Ikwaru  1   2 , Racheal Kwagala  1   2 , Andrew Kwiringira  1 , Peter Mukiibi  1 , Costance Murungi  1 , Marek Ma  2 , Celine Jacobs  3 , Cliff Asher Aliga  4   5   6 , Afizi Kibuuka  7 , Dathan M Byonanebye  1   8 , Sylvia Natukunda  9 , Kenneth Bagonza  5   10   9 , Rose Muhindo  10   9 , Prisca Kizito  10   9 , Benard Toliva Opar  6 , Nathan Kenya-Mugisha  6 , Wilson Etolu  11 , Paska Apiyo  12 , Mohammed Larmode  1 , Joseph Oumo  2 , Rony Bahatungire  2 , John Baptist Waniaye  2 , Annet Alenyo-Ngabirano  1   2   3
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Implementation of a cascade training model to enhance emergency care capacity of healthcare workers during the COVID-19 outbreak in Uganda

Sulaiman Bugosera Wasukira et al. Afr J Emerg Med. 2025 Mar.

Abstract

Introduction: The COVID-19 pandemic highlighted the gaps and the need to strengthen the emergency care system in Uganda. The Ugandan Ministry of Health implemented an emergency care capacity-building program during the COVID-19 pandemic response to improve COVID-19 case management in Uganda. We describe the curriculum development and rollout using a cascade model.

Methods: In June 2021, the World Health Organisation (WHO) Hospital Emergency Unit Assessment Tool (HEAT) was used to assess emergency units and document existing capacity gaps in regional referral hospitals and general hospitals. The WHO Basic Emergency Care curriculum was modified to a training curriculum for emergency care principles for COVID-19 management. Training of trainers was conducted across 14 health regions in July and August 2021. The trainers trained cascaded the training through facility-based training during continuous professional development sessions.

Results: Using the HEAT, 115 health facilities (14 regional and 101 general hospitals) were assessed. Only 31.3% (36/115) of the health facilities had a formal triage system. 53.5% (54/101) of general hospitals lacked non-rotating staff in the emergency unit. Some 511 healthcare workers from 205 facilities were trained as trainers, of whom 51.8% were nurses. The trainers trained cascaded the training to 3,550 healthcare workers. There was a significant difference between the overall median pre-test (71%) and median post-test (86.8%) scores of trainers trained (p<0.001).

Conclusion: There was a general lack of emergency unit protocols and a shortage of fixed staff at the emergency units. The cascade model facilitated the dissemination of emergency care knowledge to seven times more healthcare workers than the trainers trained. This demonstrates the efficiency of this approach in knowledge dissemination and its ability to be replicated in other low resource settings.

Keywords: COVID-19; Capacity building; Cascade; Emergency care; Emergency medical services.

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Conflict of interest statement

All the authors declare no conflict of interest.

Figures

Fig 1
Fig. 1
Distribution of health facilities assessed using the WHO HEAT in 2021, Uganda.
Fig 2
Fig. 2
A summary of the steps undertaken to conduct the countrywide cascade training in emergency care.
See this image and copyright information in PMC

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