Sexual and Reproductive Health and Rights in the context of COVID-19 in the African Region: rapid assessment of continuity of services
As part of the fight against COVID-19 and its adverse effects on WHO African region countries' health systems, regular assessments of the provision of sexual and reproductive health and rights services are conducted. They aims to identify gaps in the availability of essential SRHR services to populations. They serve as a decision-making and resource mobilization tool to ensure that people in the WHO African Region have access to sexual and reproductive health and rights services at all times.
First Round (February to May 2020)
The COVID-19 pandemic has rapidly become a significant global public health crisis by causing disruptions in the supply and use of health services with a potential risk of adverse impact on maternal and child health.
The WHO Regional Office for Africa conducted a rapid assessment on the continuity of essential Sexual and Reproductive Health and Rights (SRHR) services in the African Region in the context of COVID-19. The evaluation aimed to assess the inclusion of SRHR in the Essential Health Services (EHS) package of the COVID-19 response in the countries of the African Region. The survey was conducted from June to July 2020. Purposive sampling technique was used. The questionnaire was sent to African countries that were already part of or being targeted to be focus countries of WHO SRHR projects, and countries that had reported a high number of COVID-19 cases.
Seventeen countries participated in the rapid assessment. Of these countries, only 2 (12%) countries , reported no integration of Sexual and Reproductive Health Services in the Essential Health Services package. All SRH components (Family planning/contraception and Comprehensive abortion care, including post-abortion care) are included in the EHS package in 12 (80%) of the 15 countries with SRH integrated. Fourteen (82%) countries , reported ongoing awareness-raising campaigns/communication messages about these services during the COVID-19 pandemic.
In terms of disruption of services, nine (53%) countries reported a reduction in the use of family planning since the beginning of the pandemic, in comparison to the same time in 2019. Twelve (71%) countries reported a reduction in uptake of family planning commodities since the beginning of the health crisis. Eight (47%) countries reported stock out of family planning commodities. The most-reported stocked out items were injectables, pills, and implants.
Three countries reported a decrease in comprehensive abortion care services (safe abortion where legal and post-abortion care) since the beginning of the COVID-19 pandemic.
The key challenges identified in most countries (71%) with regards to the provision of Family Planning/contraception and Comprehensive abortion care (CAC), including post-abortion care (PAC) services during the COVID-19 pandemic, were the fear of patients/clients to go to health facilities and the lack of information of the population regarding the continuity of these services. The funding of Family Planning/contraception and CAC/PAC services was also identified as a challenge.
Thirteen countries (76%) reported implementation of self-care interventions for Family Planning/contraception or safe abortion. The most common ones implemented during the COVID pandemic are self-provision of pills and self-administered sub-cutaneous Depomedroxyprogesterone acetate (DMPA).
Some suggestions to improve continuity of these essential services include training and supervision of Health care providers, improving service provision at community level, offering alternative approaches to service delivery, promoting self-care interventions for SRH, and ensuring availability of Family Planning products.
Second Round (June to September 2020)
Fifteen (15) countries participated in the second round of the rapid assessment of continuity of essential SRHR services in the African region in the context of COVID-19. The goal of the assessment was to evaluate the continuity of essential SRHR services with focus on safe abortion, post-abortion care and Family Planning (FP).
Findings
- SRH is integrated into the the package of the national continuity of Essential Health Services (EHS) in 14 out of the 15 participating countries
- Comprehensive abortion care, which was missing in the 1st round, is now included in the package of the national continuity of EHS in Mali
- Improvements in family planning were observed in contrast to the previous assessment:
- only four countries reported a reduction in Family Planning services compared to 9 countries in the first round - Cameroon, Guinea, and Madagascar showed improvements in Family Planning services
- Five countries reported a reduction in uptake of Family Planning commodities compared to 12 countries in the first round - Benin, Cameroon, United Republic of Tanzania (mainland), DRC, Madagascar, SA, and Zimbabwe showed improvements in uptake of Family Planning commodities
- Stockout of Family Planning commodities remains an issue in eight countries
- Cameroon, Senegal, South Africa, and Tanzania showed improvements in this area in comparison to the first round
- Burkina Faso, Burundi, South Sudan, and Zimbabwe reported stockout in the second round
Safe abortion services decreased in three (43%) of the seven participating countries that answered this question. Post-abortion care services decreased in six (40%) and increased in two (13%) of the 15 participating countries. Improvements in self-care interventions were noted in the second round which were not reported in the first round: Cameroon, Guinea, Mali, and South Sudan reported self-provision of pills; Benin, Cameroon, and Senegal reported DMPA sub-cutaneous self-administered; DRC reported Self-management of Abortion (Mifepristone/Misoprostol); and Zimbabwe reported HPV self-testing.
*CAR, Ghana, Nigeria, and Rwanda did not participate in round 2. Cote d’Ivoire and Ethiopia participated only in round 2.
Related Documents
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Rapid assessment of continuity of SRHR services in the context of COVID-19 in the African Region: Article: English [pdf]
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Rapid assessment of continuity of SRHR services in the context of COVID-19 in the African Region: Infographics: English [pdf]
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Guidelines for the management of pregnant and breastfeeding women in the context of Ebola virus disease English [pdf]
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Maintaining essential health services: operational guidance for the COVID-19 context English [pdf]
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WHO online consultation in response to the COVID-19 pandemic: Planning for rapid dissemination and implementation of the WHO Consolidated Guideline on Self-Care Interventions to strengthen sexual and reproductive health and rights in the African Region English [pdf] French [pdf]