Keeping essential reproductive, maternal and child health services available during COVID-19 in Kenya, Mozambique, Uganda and Zimbabwe: analysis of early-pandemic policy guidelines

Abstract

Background The COVID-19 pandemic has disrupted the provision of essential reproductive, maternal, newborn, and child health (RMNCH) services in sub-Saharan Africa to varying degrees. Original models estimated as many as 1,157,000 additional child and 56,700 maternal deaths globally due to health service interruptions. To reduce potential impacts to populations related to RMNCH service delivery, national governments in Kenya, Mozambique, Uganda, and Zimbabwe swiftly issued policy guidelines related to essential RMNCH services during COVID-19. The World Health Organization (WHO) issued recommendations to guide countries in preserving essential health services by June of 2020. Methods We reviewed and extracted content related to family planning (FP), antenatal care (ANC), intrapartum and postpartum care and immunization in national policies from Kenya, Uganda, Mozambique, and Zimbabwe from March 2020 to February 2021, related to continuation of essential RMNCH services during the COVID-19 pandemic. Using a standardized tool, two to three analysts independently extracted content, and in-country experts reviewed outputs to verify observations. Findings were entered into NVivo software and categorized using pre-defined themes and codes. The content of each national policy guideline was compared to WHO guidance related to RMNCH essential services during COVID-19. Results All four country policy guidelines considered ANC, intrapartum care, FP, and immunization to be essential services and issued policy guidance for continuation of these services. Guidelines were issued in April 2020 by Mozambique, Kenya, and Uganda, and in June 2020 by Zimbabwe. Many elements of WHO’s 2020 recommendations were included in country policies, with some notable exceptions. Each policy guideline was more detailed in some aspects than others — for example, Kenya’s guidelines were particularly detailed regarding FP service provision, while Uganda’s guidelines were explicit about immediate breastfeeding. All policy guidance documents contained a balance of measures to preserve essential RMNCH services while reducing COVID-19 transmission risk within these services. Conclusions The national policy guidelines to preserve essential RMNCH services in these four countries reflected WHO recommendations, with some notable exceptions for ANC and birth companionship. Ongoing revision of country policy guidelines to adapt to changing pandemic conditions is recommended, as is further analysis of subnational-level policies.

The effects of COVID-19 lockdown measures on health and healthcare services in Uganda

“…The suspension of both private and public transport in Uganda greatly hindered access to essential maternal health services including health facility deliveries, yet no alternative measures were instituted to ensure continuity of care. A study conducted in four sub-Saharan African countries showed that Kenya instituted measures such as multi-month dispensing of antenatal care related supplements and medications as well as telephone antenatal care sessions [17], strategies that were not considered in Uganda. Although the Ugandan government promised that pregnant women would get access to ambulances to transport them to health facilities if they contacted their local leaders, anecdotal evidence suggests that such ambulances were not readily available, forcing many women to resort to traditional birth attendants [16].…”

“…Our study also revealed that routine paediatric services such as immunisation and treatment of childhood illnesses were negatively affected. Immunisation services offered at both health facilities and in the community were significantly slowed during the lockdown [17]. It is believed that low rates of immunisation across the country during the pandemic may have resulted in the recent polio outbreak in Uganda [29,30].…”

Effects of the COVID-19 pandemic on maternal and perinatal health service utilisation and outcomes in Mozambique: an interrupted time series analysis

“…Through concerted efforts, the level of facility deliveries was able to catch up to expected levels and even surpass them. While the factors related to this increase remain unstudied, anecdotal evidence suggests strong political will, collaboration and coordination of partners, and effective health communication 29–32. The study that included DRC, Somalia and Cameroon, previously described, examined five pandemic months and similarly noted increases in facility deliveries in these countries 3.…”

“…While the factors related to this increase remain unstudied, anecdotal evidence suggests strong political will, collaboration and coordination of partners, and effective health communication. [29][30][31][32] The study that included DRC, Somalia and Cameroon, previously described, examined five pandemic months and similarly noted increases in facility deliveries in these countries. 3 These countries, along with Mozambique, may offer important insights about how to effectively recover from shocks to health systems.…”

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders

“…Efforts taken to maintain continuity of service delivery in Ethiopia mirror those taken in various low- and middle-income country contexts [ 42 ]. Other countries in the region, such as Kenya, Uganda, Mozambique and Zimbabwe similarly developed SRH guidelines for navigating the pandemic while preserving SRH service delivery [ 43 ]. However, participants in our study spoke to variable implementation of SRH guidelines during the pandemic, suggesting a need for more monitoring and supervision to guide the implementation process.…”