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Women, children, and adolescents bear the brunt of a “shadow pandemic”, threatening decades of progress in improving health and rights. Focused action is needed urgently say a growing number of low- and middle-income countries whose pro-equity investments, policies and programmes are leading efforts for change
At today’s Lives in the Balance: Equity in COVID-19 Response and Recovery meeting, more than 1,000 participants from around the world met to highlight the need for targeted investments in pro-equity programmes and policies to combat the devastating social and economic effects of COVID-19.
Government leaders from Nigeria, South Africa, Liberia, Kenya, Panama and Malawi spoke out at the two-day event about the devastation of the COVID-19 pandemic on women’s, children’s, and adolescents’ health, and unveiled targeted, time-bound commitments for focused action.
“COVID-19 has devastated economies and affected social and community life”, said Dr Zweli Lawrence Mkhize, Minister of Health, South Africa. “Women, children, and adolescents have been significantly affected.” At the summit, the Government of South Africa announced its commitment to review national COVID-19 policies to improve sexual and reproductive health and rights, and to allocate resources to raise youth awareness of these issues, accompanied by investments in youth economic participation, including to improve gender equality.
The two-day Lives in the Balance meeting was organized by PMNCH, together with the CORE Group, the Global Financing Facility for Women, Children, and Adolescents, and Gavi, the Vaccine Alliance. Meeting participants including those from civil society, the UN, academia, the private sector and governments, discussed solutions to mitigate the direct and indirect impacts of the pandemic, including concrete and measurable commitments to investment and policy change.
These commitments respond to rising need. Given that progress toward the UN Sustainable Development Goals (SDGs) related to women’s, children’s, and adolescents’ health was already off track by some 20 per cent before the crisis, the COVID-19 crisis has highlighted the need for dedicated action for the most vulnerable.
In addition to the ongoing and catastrophic direct impact of COVID-19 in many parts of the world, women, children, and adolescents are affected indirectly because of widespread disruptions to essential health, nutrition, and social services under lockdown conditions. This increases the risk of mortality and morbidity, including from treatable and preventable causes, denying the right to protection and care.
For example, UNFPA estimates that, in 2020, twelve million women experienced disruptions in family planning services due to the pandemic, with an estimated 1.4 million unintended pregnancies across 115 low- and middle-income countries. Additionally, a recent Global Financing Facility review of 36 partner countries showed there has been up to a 25 percent drop in coverage of essential health interventions, hitting women and children the hardest. One-third of countries report interruptions to routine immunization services due to lockdown conditions. The redeployment of primary health workers to COVID-19 duties; community reluctance to visit health clinics for fear of infection; and income losses have compounded the problem of reduced access.
Yet the needs of women and children are too often invisible in policy responses to COVID-19. Global Health 50/50 reports that more than 80 per cent of all COVID-19 health-related activities implemented by assessed global health institutions have failed to take gender into account in programme design. Women, who according to WHO make up 70 per cent of the global health and social workforce and bear the largest share of COVID-19 infections among health workers, hold only 25 per cent of senior positions in national COVID-19 response leadership teams.
“Taken together, the direct and indirect effects of COVID-19 have rolled back decades of global effort, and threaten to disrupt the future trajectory for progress and development massively”, said Helen Clark, Board Chair of PMNCH and former Prime Minister of New Zealand. “COVID-19 is deepening and magnifying social inequalities compounded by ethnicity, gender, income, geography, and other factors. We must act now, not just to protect progress previously made, but also to work towards a world that is far more equitable than the one that existed before the pandemic.”
A seven-point Call to Action on COVID-19, backed by PMNCH’s 1,000-member platform, seeks to protect and prioritize the rights and health of women, children, and adolescents during the COVID-19 response and recovery. The Call seeks to strengthen investment, policies, and services for the recovery of health services, as well as protection of rights and future socio-economic resilience.
“COVID-19 has exacerbated underlying inequities, with vulnerable populations that are already living on the margins and are so often bereft of basic health services being hardest hit. The knock-on impact of the pandemic on childhood vaccination in lower income countries has been devastating, with millions of children missing out on timely, life-saving immunizations. As a co-host of the Third Lives in the Balance Summit, we look forward to highlighting the imperative of keeping equity at the center of the COVID response, and in particular addressing the urgent needs of women, children and adolescents,” said Anuradha Gupta, Deputy Chief Executive Officer of Gavi, the Vaccine Alliance.
In December 2020, at a previous “Lives in the Balance” meeting, ten national governments and the Bill & Melinda Gates Foundation issued statements describing their national and ODA commitments to prioritizing women’s, children’s and adolescents’ health in COVID-19 response plans, which when taken together, totaled some US$20 billion in investments. The statements, aligning with the PMNCH Call to Action, outlined a significant array of efforts to improve SRHR, gender equality, service quality, and adolescent health and well-being, among other priorities.
This week, at the Lives in the Balance meeting, these statements were revisited by senior country leaders from Nigeria, Kenya and Liberia, who updated participants on progress since December 2020.
Nigeria, which had announced a commitment of US$2.3 billion at the December 2020 meeting for strategic interventions across the health sector during 2020-2028, updated participants on the Government’s efforts to protect and support health workers across the country, 70 per cent of which are women. “We are making sure salaries are paid on time and setting up infection control measures, made compulsory,” said Minister of Health Dr. Osagie Ehanire. “Capacity building continues – people continue to have more training. We ensure that when it is time for leave, that people go on leave, and that connectivity between the states and the federal government with respect to task-shifting and task-sharing among health workers is being properly managed.”
In a show of growing momentum and commitment, such efforts were echoed in an increasing number of country statements, including from South Africa, Malawi and Panama, announced today. These countries have committed to strengthening the health workforce and addressing gender disparities, including their effect on sexual and reproductive health and rights and gender-based violence.
Expressing solidarity to the PMNCH Call to Action, Dr Luis Francisco Sucre, Minister of Health of Panama notes: “In the context of COVID-19, we have fulfilled our commitment to ensure that within the first 100 days of 2021, the vaccination of health workers, the elderly, and pregnant women is underway, as part of the declaration of equity of vaccines and a symbol of hope to overcome this pandemic and its inequalities.”
Malawi highlighted a presidential initiative to expand the health workforce during COVID-19; staffing budgets this year have increased by nearly 50 per cent, improving quality of care for women, children and adolescents. “The pandemic has put so much stress on our workforce, especially those working in hospitals,” said Khumbize Kandodo Chiponda, Minister of Health of Malawi. “Our President, His Excellency Dr Lazarus Chakwera, has made a directive that we should employ 1,380 additional health care workers to support the response. This was an opportunity to increase our numbers, so that we offer quality health care service to our people, especially the women, children and adolescents. In our national budget, we have set aside $US58.3 million (47 billion Kwachas) for personnel, which is a 45 per cent increase from last year.”
The next round of national and ODA commitments, aligned with the PMNCH Call to Action on COVID-19, will be announced in September 2021.
Commitments to date, aligning with the PMNCH Call to Action on COVID-19
Announced at Lives in the Balance, May 2021
MALAWI
Malawi commits to strengthening sexual and reproductive health and rights by finalizing its relevant national strategies and incorporating responses to emergencies, including COVID-19. It commits to expanding its health workforce, ensuring that nurses and midwives have the knowledge, skills and equipment necessary to deliver quality, respectful and dignified care by 2023. Malawi commits to recruiting an additional 1,380 health workers to provide primary care to women, children and adolescents by the end of 2021. It will also conduct assessments to determine staff recruitment needs in district health facilities by 2023.
PANAMA
Panama is focusing on equity and primary care approaches to protect and improve the health of women, children and adolescents. In March 2021, the government also signed into law new legislation that criminalizes political violence and harassment against women, including actions that limit women's access to elected positions. The government commits to work collectively with civil society, the UN, health professionals, adolescents and youth, donor organizations, and the private sector to provide quality, respectful and dignified care, and mechanisms for community engagement and redress.
SOUTH AFRICA
South Africa commits to reviewing national COVID-19 policies for adolescents and youth sexual and reproductive health to ensure adequacy and responsiveness of programmes. South Africa has allocated US$6.99 million to raising the awareness of young people on SRHR and to enabling their productive economic participation towards achieving gender equality. Additionally, South Africa is dedicating US$11.5 million to address violence against women. These resources will be allocated towards the management of circumstances that perpetuate gender-based violence, such as poverty and lack of education. Recognizing the importance of the health workforce to slowing the spread of COVID-19 and its impact, the government has committed to accelerate the COVID-19 vaccination program by reaching 1.2 million health workers by June 2021.
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Announced at Lives in the Balance, December 2020
https://pmnch.who.int/news-and-events/campaigns/pmnch-call-to-action-on-covid-19/country-commitments
AFGHANISTAN
US$176.6 million during 2020-2023 to combat the challenges of COVID-19 and to improve the health and well-being of women, children and adolescents and ringfencing US$695 million for continued access to reproductive health services.
INDIA
US$2 billion during 2020-2021 to strengthen all levels of care in response to the pandemic and to ensure essential public health functions with an enhanced focus on women, children and adolescents and the most vulnerable.
KENYA
US$2.2 billion during 2021-2022 for the provision of universal health coverage to guarantee quality and affordable healthcare, with additional funding committed under the post COVID-19 Economic Recovery Strategy for inequality, social cohesion and social protection.
LIBERIA
US$10.65 million in 2021 to improve the health and well-being of women, children and adolescents, by supporting and building the capacity of health services providers, providing safe and accessible drinking water, sanitation and hygiene as part of the COVID-19 incidence management system, and guaranteeing availability of critical life-saving equipment and medicines to ensure access to quality health care to women, children and adolescents.
NIGERIA
US$2.3 billion during 2020-2028 for strategic interventions that protect the reproductive, maternal, newborn, child, adolescent and elderly health and nutrition through access to family planning services; immunization; and nutrition programmes.
GERMANY
US$5.3 billion bi- and multilateral contributions to meet the challenges of the COVID-19 pandemic during 2020-2022; including US$120 million to ensure globally fair, equitable and transparent access to COVID-19 vaccines; and US$210 million to protect the health and rights of women, children and adolescents, by sustaining health systems with a focus on the needs of women and girls in the context of sexual and reproductive health through multi-lateral agencies and Global Financing Facility (GFF).
SIDA (SWEDEN)
US$165.67 million additional funds to the COVID-19 crises and allowing for flexibility in existing funding in 2020-21, US$53 million dedicated for protecting Sexual and Reproductive Health and Rights services and promoting gender-responsiveness in the COVID-19 crisis through integrated efforts in health, health system strengthening, and ensuring access to maternity care, contraception and safe abortion care during and after the pandemic.
UNITED KINGDOM
Up to £1.3 billion (USD$1.7 billion) of new funding to tackle the health, humanitarian, and socio-economic impacts of COVID-19, including up to £500 million (US$665 million) for COVAX, in support of equitable access to COVID-19 vaccines during 2020-2021.
USAID
US$1.3 billion for the global fight against COVID-19 to improve public health education; protect healthcare facilities; and increase lab, surveillance, and rapid-response capacities in more than 100 countries in 2020. This includes delivery of diagnostics and treatment tailored to countries’ needs, and measures to ensure safe delivery of essential maternal and child health and nutrition through improved WASH and infection prevention control in healthcare facilities.
THE BILL AND MELINDA GATES FOUNDATION
US$1.75 billion during 2020-2021 to support the global COVID-19 response efforts to accelerate the search for effective coronavirus vaccines and treatments to ensure that once available, they can be delivered quickly and affordably. In addition to new response efforts, the foundation will continue its support to protect the health and well-being of women and children, including by strengthening primary healthcare systems and improving the quality of care provided through essential health service.