LONDON — The COVID-19 pandemic has dealt a blow to reproductive, maternal, newborn, child, and adolescent services in many low- and middle-income countries, not only in terms of women’s access to care but in the ability of health workers to deliver services safely and effectively, according to Monique Vledder, head of secretariat and practice manager at the Global Financing Facility for Women, Children and Adolescents, or GFF.
“Travel restrictions during lockdowns, difficulties obtaining personal protective equipment, severe shortages of essential medicines, high infection rates, and increased caring responsibilities at home have created obstacles for health workers, making it difficult — and potentially dangerous — for many to attend work and to provide the high-quality, affordable health services women and children in their communities need,” she said.
Founded in 2015 to help governments in LMICs transform how they prioritize and finance maternal and child health programs, the GFF partnership is playing a key role in protecting and promoting lifesaving services for women, children, and adolescents.
For example, amid the pandemic, GFF has tapped private sector expertise in a string of related initiatives, including tackling supply chain bottlenecks in personal protective equipment and other crucial commodities, as well as supporting the training and deployment of community health workers in rural areas.
Vledder sat down with Devex to discuss the current crisis facing health systems, as well as the work GFF is doing to help protect and empower health workers and the women and children they serve.
This conversation has been edited for length and clarity.
What impact has COVID-19 had on health workers and the services they provide?
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COVID-19 has triggered a secondary crisis in the health of women, children and adolescents, with significant disruptions in a broad range of services, particularly related to outpatient care but also in childhood vaccinations and, in some cases, family planning, antenatal care, and post-natal care — so really those core services that we know have a very big and positive impact on the health and well-being of women and children.
To help understand the reasons for these disruptions, early on in the pandemic we teamed up with ministries of health in our partner countries to examine real data from their health systems, which we continue to supplement with phone and household surveys.
We found that the lack of availability of protective equipment was initially a very big problem in terms of ensuring front-line health facilities were properly resourced with enough health workers. In governments’ procurement of PPE, initial estimations and allocations did not always consider community health workers or private providers of primary care, which are big employers of health workers in many countries.
As a result, low levels of trust among health workers that they and their families were being kept safe impacted their ability to provide services. Absenteeism has been a big challenge, with lockdowns also affecting transportation.
As telemedicine becomes a prominent method for undertaking first interaction with clients, low availability of and underinvestment in the necessary technology is another bottleneck that has hindered health workers’ ability to offer care safely. Three-quarters of our LMIC member countries have also experienced severe disruptions in the availability of health commodities and medicines, such as oxytocin and chlorhexidine, that health workers need to do their job.
What is GFF doing to tackle these problems, and how is the private sector supporting that work?
Soon after the COVID-19 outbreak, we launched a Service Delivery Learning Program, which allows partner countries to quickly share best practices and lessons learned as they respond to COVID-19, through a mix of webinars, workshops, and online discussion forums. As a direct result, some countries have adopted measures that enable health workers to deliver services while maintaining social distancing. Others have learned new ways of integrating community health workers to improve service continuity.
We are currently working with the World Bank and its private sector arm, the International Finance Corporation, to provide partner countries with grant financing and technical assistance to help them improve the availability of PPE and lifesaving medicines.
“For the GFF, the private sector is a key player to help reach the goal of universal access to quality, affordable health care.”— Monique Vledder, head of secretariat and practice manager, GFF
A surge in global competition for these products — exacerbated by lockdowns in India, where many of them are produced — has severely impacted availability in many African health facilities. This has highlighted the continent’s dependency on global supply chains and the need to invest in local manufacturing, which is something we will take forward. Improving the sustainability of supply in this way will improve the protection of health workers, as well as the quality of care they are able to provide.
The GFF is also now building on a private sector partnership it launched in 2018 with The UPS Foundation, the Bill & Melinda Gates Foundation, and MSD for Mothers. This focuses on translating best practices in transport, warehousing, and distribution from private sector firms such as global shipping and logistics provider UPS to health care supply chains in order to improve the speed, scale, and cost-efficiency of public sector pharmaceuticals procurement programs.
For the GFF, the private sector is a key player to help reach the goal of universal access to quality, affordable health care. We have private sector representation on our board, as well as on our country platforms, which helps define the priorities of the GFF finance investment cases on a country level.
What’s next for GFF, and how will your upcoming strategy refresh support your response to the pandemic?
Our latest annual report demonstrates very promising progress across partner countries during the GFF’s first five years of activity.
Until the COVID-19 pandemic hit, an increasing number of GFF countries were seeing improvements in access to quality, affordable health services; progress toward reducing maternal and child mortality and adolescent pregnancy; and improvements in the way health systems function and are financed.
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For example, Tanzania almost doubled its coverage of four antenatal care visits between 2016 and 2019 to 80%. In Afghanistan, between 2015 and 2018, deaths among children under 5 years old and newborns dropped sharply by 35% and 34% respectively.
Immunization coverage was also better, as was child nutrition, with eight of the 10 partner countries that report on this measure showing an improvement. Almost two-thirds of partner countries are implementing budget and financial reforms to boost front-line health care resources and lift health expenditure efficiency.
COVID-19 has, of course, represented a major setback in many of the same areas, and we need to make a big push in order to help countries get back on track. Our new strategy refresh, for which public consultation just closed, will help us achieve this through our commitment to focus relentlessly on results and to build more resilient, equitable, and sustainable health financing systems.
The GFF’s reason for being — to ensure that all women, children, and adolescents in the world’s poorest countries can survive and thrive — is now more critical than ever.
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