COVID-19 and Health Sector Development Plans in Africa: The Impact on Maternal and Child Health Outcomes in Uganda

Abstract

Introduction Health Sector Development Plans (HSDPs) aim to accelerate movement towards achieving sustainable development goals for health, reducing inequalities, and ending poverty. Reproductive, maternal, newborn and child health (RMNCH) services are vulnerable to economic imbalances, including health insecurity, unmet need for healthcare, and low health expenditure. The same vulnerability influences the potential of a country to combat global outbreaks such as the COVID-19. We aimed to provide some important insights into the impacts of COVID-19 on RMNCH indicators and outcomes of the HSDP in Uganda. Methods We conducted a descriptive study of secondary data obtained from the Ugandan government-led portals, supplemented by analyses of relevant articles published up to 06 May 2021 and deposited in PubMed. Results Through synthesizing actionable and relevant evidence, we realized that RMNCH in Uganda is highly affected by the COVID-19 pandemic and the lockdown measures. The impact was across immunization, antenatal, sexual and reproductive health, emergency and obstetric, and postnatal care services. There was a decline sharply by 9.6% for under-five vitamin A coverage, 9% for DPT 3 HibHeb 3 coverage, 6.8% for measles vaccination coverage, 6% for isoniazid preventive therapy coverage, and 3% for facility-based deliveries. Maternal and under-five deaths increased by 7.6% and 4%, respectively. Outreaches were rarely conducted in the lockdown period. Conclusion The COVID-19 pandemic has created a multitude of questions regarding the optimal policies to mitigate the disease while minimizing the unintended detrimental consequences of RMNCH. The lockdown restrictions threatened to reverse the progress made on the national HSDP for RMNCH. In Uganda, where young women are vulnerable to early marriage, unintended pregnancies, and unsafe abortion, access to RMNCH services should continue regardless of the COVID-19 status in the country. We urge that Uganda and other African countries should build resilient and sustainable health systems that can withstand emerging diseases like the COVID-19.

The direct and indirect impact of COVID-19 pandemic on maternal and child health services in Africa: a scoping review

“…Authors illuminated the undeniable need to ensure women’s access to maternal and child health services during pandemics and lockdowns to protect the health of their babies and themselves [ 42 , 48 , 50 ]. In areas where early marriage, unexpected pregnancies and unsafe abortions are prevalent, it becomes crucial to continually provide MNCH services [ 42 , 48 ] and provide proper transportation to these services during crises [ 48 ].…”

“…Authors illuminated the undeniable need to ensure women’s access to maternal and child health services during pandemics and lockdowns to protect the health of their babies and themselves [ 42 , 48 , 50 ]. In areas where early marriage, unexpected pregnancies and unsafe abortions are prevalent, it becomes crucial to continually provide MNCH services [ 42 , 48 ] and provide proper transportation to these services during crises [ 48 ]. Both government and non-governmental agencies are needed to strengthen the delivery of and access to these services, and regulate the costs of health care procedures and personal protective equipment during current and future pandemics [ 41 , 51 ].…”

“…There is a need to investigate the short-term and long-term impacts of the pandemic on maternal and child health outcomes [ 28 , 42 , 50 ] and for research to identify approaches to reduce the ongoing disruptions on maternal and child health in this region [ 39 ].…”

“…Lastly, it was suggested that African should continually build a resilient and sustainable health system as a strategy for providing uninterrupted MNCH services during future emerging diseases [ 39 , 42 ].…”

“…In Kenya, there was a report of increased preference for home-based births [ 29 ], which calls into question what strategies were most suited to safeguard the continued delivery of routine health programs while preventing the adverse effect of the pandemic on maternal and child health. Effective healthcare policies should be based on evidence-based guidelines and should focus on mitigating ongoing maternal and child health challenges, and providing continuous access to MNCH services, especially during global crises [ 42 , 48 , 50 ]. To improve the disproportionate access to health services, strategies should include education and training of the workforce and communities [ 45 , 53 ], especially those working with the low- income areas, to enhance knowledge about emergency preparation, maternity and child health services, and strategies to alleviate the challenges posed by pandemics.…”