Building back better starts with equitable access to basic healthcare

Even before COVID-19 hit, the improvements achieved in access to basic healthcare in the world’s poorest nations were fragile and uneven. One year on, the situation has deteriorated alarmingly – especially for women, children, and adolescents.

As the world weighs how to rebuild societies and economies in the wake of the pandemic, there is an urgent need for policies and financial commitments to tackle head-on the inequities that are hitting vulnerable populations the hardest.

Without decisive action, the havoc wreaked by the pandemic will reverse years, if not decades, of progress in global health and leave behind a whole generation.

Advances in global health, driven by country leadership and underpinned by support from the global community, have been hard-won – yet they remain precarious.

Additionally, these gains have not been spread equally. The average under-five mortality rate in 36 countries defined as “fragile”, for example, is almost three times higher than in “non-fragile” states – and maternal mortality rates in the world’s many conflict zones are going up, not down.

The massive shock delivered by COVID-19 has destabilised already struggling healthcare systems and exacerbated pre-existing inequities. The economic downturn caused by the virus means that global poverty is expected to rise for the first time since 1998, with the number of pandemic-induced poor forecast by the World Bank to rise to between 143 million and 163 million in 2021.

Under-funded basic health services are not only a major barrier to bringing the pandemic under control. They also cause a cascade of secondary impacts that send deprivation rippling through societies, with women, children, and adolescents hit particularly hard.

Since the start of the pandemic, the Global Financing Facility (GFF) estimates that access to life-saving health interventions for women, children, and adolescents in 36 of the world’s poorest countries – 26 of which are in Africa – has slumped by up to 25 per cent. That is equivalent to four million women being unable to receive childbirth care, 17 million children missing vaccinations, and more than five million women and adolescents losing access to contraceptives.

Such problems stem not just from the virus, but also from the responses of governments and individuals, as resources for essential healthcare are diverted into the pandemic fight and many people fear attending clinics. The knock-on effects are clear: children will suffer life-long harm from not receiving childhood vaccines, young women will miss out on sexual and reproductive health support, childbirth will remain unnecessarily dangerous, and economic hardship will cause worsening nutritional and health problems.

Sadly, it is women who end up being disproportionately affected at all levels. Their employment is at greater risk than men’s, particularly given the impact of the downturn on the service sector, while draconian social restrictions and economic hardship also make them more susceptible to domestic violence.

This “feminisation” of deprivation is a stark example of how COVID-19 – far from being a leveler – is in reality  a great amplifier of inequality in a world where four billion people are estimated not to have access to any form of social protection.

It is clear that the world needs to embrace policies and financing actions that cushion the most at-risk populations and nurture the growth of fairer and more resilient health systems for the future.

That was already a prerequisite for achieving the United Nations’ Sustainable Development Goals. The need to focus this endeavour on women and young people has become more apparent than ever in the wake of COVID-19.

In light of the this, the Partnership for Maternal, Newborn and Child Health, on behalf of its 1000 partners, issued a COVID-19 Call to Action = outlining a seven-point agenda to protect the health and rights of vulnerable women, children and adolescents.  The Call and associated commitment mobilization efforts aim to stimulate political commitments in the form of policies and financing that can address the causes of this feminized deprivation.  

Countries, now more than ever, need to prioritize sexual, reproductive, maternal, newborn, child, and adolescent health and nutrition services. They can do this successfully by using well-tested tools such as the GFF’s partnership approach which aligns and harnesses resources of different partners to respond to country needs. 

The GFF aims to raise $1.2 billion this year, out of a total funding need of $2.5 billion by 2025, to underpin basic health services. By 2030, this investment is expected to reduce deaths of new-borns and children under age five by more than a third, saving approximately 13.5 million lives; prevent at least 3.5 million stillbirths; and cut maternal mortality by almost one-third, saving more than 1 million lives.

The next five years will be critical in countering the effects of the pandemic. Countries will need to cater for the basic health needs of women, children, and adolescents, not only as the right thing to do but also because it is the smart thing to do. Restoring human capital as the backbone of a resilient recovery  promises to yield substantial social and economic benefits. We call on countries to increase and strengthen domestic and international financing to protect women, children, and adolescents.  The world cannot afford to witness silently the suffering of the most vulnerable. 

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This op-ed was originally published on Jeune Afrique.