Ensuring the Continuity of Reproductive Health Services during COVID-19

By John Kutna and Gilbert Wangalwa

In the wake of the ongoing COVID-19 pandemic, the provision of many health services has been nearly paralysed nationally, especially in the arid and semi-arid areas due to the limited availability of human resources for health. This has had a direct effect on the uptake of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) and nutrition services. In this challenging season, adjusting to the ‘new normal’ has become critical.

It all started with a ban on public gatherings, advice to minimise movements and social distancing by the government which have greatly affected the provision of family planning services especially in areas where sensitisation on the various methods of family planning was ongoing. Counties have suspended the provision of maternal, newborn and child health (MNCH) services where family planning is hosted. The COVID-19 pandemic has resulted in limited engagement with community health volunteers and community-based distributors (CHVs/CBDs) to support RMNCAH services, awareness and referrals. The supply chain for health commodities has been interrupted, and the limited movement has affected mentorship and capacity building initiatives. Mothers no longer feel safe going to antenatal and well-baby clinic visits for fear of getting infected with the coronavirus disease.

However, not all is lost. Amref Health Africa, through its various projects in Kenya, has been fulfilling its mission to increase sustainable health access to communities through solutions in human resources for health, health services delivery and investments in health. Through its programmes and interventions, Amref continues to improve access to health services for women, men, adolescents and the youth during the COVID-19 pandemic. Working with other partners, we have ensured that some components of maternal health care are availed for free by facilitating hospital referrals for obstetric emergencies (both labour and miscarriage) during curfew hours.

Our partnership with various county governments has seen an increase in the availability and provision of family planning (FP), reproductive, maternal, newborn, child and adolescent health services in the counties. We have facilitated the employment of contracted health workers in Turkana County to help bridge the gap in human resources at health facilities in hard-to-reach areas. These health workers are in the frontline, ensuring continuity of health services in the face of the COVID-19 pandemic while sensitising the communities living around the health facilities on prevention of infections.

We are also supporting frontline health workers to line list and follow up on clients who miss services such as antenatal care, family planning, immunisation, collection of TB drugs, and anti-retroviral therapy. For FP services, we have deployed a Book-in-Client (BIC) approach to avoid overcrowding the health facilities and to facilitate continuity of other services without disruption. The pandemic and measures to curb the spread of the disease interfered with FP commodity supply chain leading to scarcity of FP commodities in counties such as Marsabit, Turkana, Wajir, Garissa, Samburu, Kwale and Homabay counties.

As we engaged in finding solutions to this challenge with the national and county governments, we ensured availability of commodities by supporting rapid stocktaking of health facilities and using that information to inform redistribution of commodities within and across neighbouring counties to ensure continuity of FP services. For instance, we did a stock take in Turkana County and supported redistribution of commodities to other health facilities that lacked, while distributing the surplus to the neighbouring Marsabit County.

Amref is leading a campaign to educate health workers on COVID-19 using its mobile learning platform LEAP to enable the transfer of critical information to the communities. To date, we have reached over 56,000 community health workers across 31 counties, reaching over 2.5 million people. We continue to use dialogue with the community leadership and engage CHVs and local youth champions to promote RMNCAH and COVID-19 messages. To ensure continuity of FP/RMNCAH services, riding on COVID-19 activities has become key to continued community education on FP service delivery points. Media engagement, primarily through radio programmes, has become critical in shaping conversations on various health services.

In line with World Health Organisation (WHO) guidelines to maintain essential health services during the COVID-19 pandemic, community-based care has continued to play a critical part in ensuring the sustainability of essential health services in the community. We are working with the youth in sensitising community members on COVID-19 at the community level using WhatsApp. Use of virtual platforms to conduct meetings and online dissemination of sexual and reproductive health and COVID-19 messages has ensured the continuity of these services.

Moving forward, we can ensure the continuity of these services in the target communities by adhering to the COVID-19 government guidelines and establishing new and innovative ways of reaching target populations with health services. The Ministry of Health has provided guidance on the continuity of critical and essential services at the household and community level using the existing community health workforce. Phone-based contact has been identified as one of the methods to ensure the safe continuity of these services.

Since it is still unclear when the COVID-19 situation will end, we will continue to support the national COVID-19 emergency response and work closely with the counties to ensure continuity of essential services such as maternal and child health, water and sanitation, prevention of gender-based violence and more to reduce social harm as a result of COVID-19. Both the public and private sector must provide technical and financial support and continue to find new ways to ensure the continuity of these services to bridge the demand gap.