COVID-19 threatens decades of progress in health outcomes and life chances for women and girls
Panelists call for country-led action with greater involvement by civil society and communities in fighting the next stage of the pandemic
On 26 October 2021, a high-level panel chaired by Dr Melinda Crane, Chief Political Correspondent of Deutsche Welle, discussed the impacts of the COVID-19 pandemic on the lives of young women and girls, particularly their access to health services. Data show a dramatic 25% drop in the coverage of lifesaving health interventions during 2020 compared with pre-pandemic levels. Senior representatives from the World Bank, Global Financing Facility (GFF) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the governments of Germany and Senegal, civil society and the private sector considered potential solutions for recouping these losses and building more resilient health systems. And for such a diverse group of panellists, there was a promising consensus on what needs to be done.
Paradoxically, women and girls dying as a result of the pandemic response
Mari Pangestu, Managing Director of Development Policy and Partnerships at the World Bank pointed to preliminary but quite shocking analysis showing that in low and lower-middle income countries (LMIC), for every covid-related death, two women or girls are dying from the secondary effects of the pandemic. These effects result from both huge disruptions to service provision and also restricted access to services brought about by measures introduced to manage the pandemic, including lock-downs and restrictions on travel, resources being diverted away from essential services and fear of infection among citizens.
In Senegal, these secondary impacts were starkly illustrated in numbers, with 100,000 fewer deliveries in health facilities and as many as a quarter of a million women without access to the family planning services they need. Her Excellency, Dr Awa Marie Coll-Seck, Minister of State to the President of the Republic of Senegal, also eloquently described the socio-economic impacts on women and adolescents through the closure of schools and the loss of informal sector jobs. The pandemic confined large numbers of women and girls to their homes – shutting off important avenues to services, such as youth-responsive sexual and reproductive health information and services, and safe spaces for girls.
While many countries did a good job in maintaining and even increasing ARV services in 2020, there was a dangerous reduction in HIV testing (11 percent) and prevention services (22 percent) and fewer mothers received the treatment necessary to prevent HIV transmission to their babies. Peter Sands, Director of the GFATM pointed to the dangerous combination of gender-based violence, disruptions to comprehensive sexuality education (CSE) and health services as one that will inevitably lead to higher HIV infection rates and ultimately more deaths among young women. Speaking of the recent progress in reducing infection rates among this group, he said ‘to lose that hard-won ground – particularly because this will have such long-term consequences – is a real tragedy and one we must work really hard to get back on track.’
Deepening existing inequalities and health system challenges
Dr Rosemary Mburu, Executive Director of WACI Health spoke about how the pandemic has entrenched existing inequalities, saying ‘when the pandemic came it found deep and long-standing inequalities that already disadvantaged women and girls’. Dr Mburu went on to remind us that the pandemic pushed millions of people into poverty, with often dire consequences for the livelihoods of women and in particular for girls, as evidenced by the rise in early and forced marriages.
The effect of the pandemic to worsen existing problems was also raised by Dr Julia Spencer, Vice President, Global Vaccines Public Policy & Partnerships, and Government Affairs at MSD Sharp & Dohme Corp., a global biopharmaceutical company in medicine and vaccine development. She pointed to the fact that pre-pandemic challenges with supply chains across LMICs (e.g., with storage and cold chains) have only worsened during COVID-19, and gave the example of HPV vaccinations which reduced by more than 20 percent due to schools closures and other so-called ‘down-stream’ supply-chain challenges. According to MSD’s own modelling, it could take two to 10 years to recover to pre-pandemic HPV vaccination rates.
The chair then played ‘devil’s advocate’, asking Dr Coll-Seck why we should not wait out the pandemic – why it is necessary to act now? The response was clear. We still do not know when the pandemic will end, these serious impacts on the lives of women and girls will only get worse if we wait. So the discussion turned to potential solutions.
The only solution: champion and support country-led processes and strong leadership
Dr Coll-Seck paid tribute to the role of GFF in championing country-led processes, while emphasising the importance of strong leadership at the highest level. In Senegal, the President is overseeing a planning process, clearly setting out actions to strengthen health system and addressing not only the negative health impacts of Covid-19 on women and adolescents but also the socio-economic impacts in terms of employment, education and protection. Dr Coll-Seck called on other countries to do more for themselves ‘because we should not only wait for people to come from abroad or for countries such as Germany which will support us. We ourselves need to do something.’
Country-led and owned processes and systems strengthening, including governance and leadership, are key components of Germany’s approach and something which the German government is rightly proud of. As Parliamentary State Secretary Dr Maria Flachsbarth said, ‘in order to strengthen crisis-resilient health systems we have shifted and reprogrammed. We have increased funding for ongoing bilateral health projects, increased core contributions to UNFPA and the GFF and others’.
A consensus on the need for stronger involvement by civil society and communities in the next phase of the response
Country-led processes go hand in hand with the urgent need to identify and scale-up successful mechanisms for enabling more effective involvement and leadership of civil society and communities in all stages of the response. This was reiterated all panellists and is essential to better understand the needs of different groups, particularly young women and girls, as well as how available funds can best be invested to address these needs.
Focus on building and strengthening integrated community health services
Which bring us to another highlight of the discussion – the consensus among the panelists around the need to strengthen integrated community health systems, and to champion as well as to strengthen and protect the critical role of community health workers. These workers, who are nearly always women, are at the forefront of the pandemic response, and yet are under-paid (or not paid at all), over-worked and often have little or no protection from infection. This is ‘one of the most powerful levers we can pull in terms of improving the performance of health systems and therefore health outcomes’ said Peter Sands.
Continue the successful partnerships developed as part of the COVID response
And finally, the importance of collaboration and partnerships was highlighted by Rosemary Mburu who pointed out that the world has not seen this level of joint action since the early days of HIV and AIDS response, and Dr Julia Spencer, who cited the 10-year partnership of Merck for Mothers with governments around the world which can then be leveraged in times of crisis. Peter Sands summed up the feelings of many when he said ‘I hope that one thing we do take from this crisis is the habit- should one say the pattern – of working together as closely as we have had to over the last 20 months or so, because this has been critical to our success.’
GFF Director Dr Juan Pablo Uribe concluded the discussion by emphasising that there is a way forward if we listen, feel and act properly. We know what the issues are – we need both to maintain a focus on the services which matter most for the most vulnerable, while making the best use of the instruments and institutions at our disposal, and to be cognisant of the paradox whereby in trying to manage the pandemic and mitigate its impacts, there have been far-reaching, unintended consequences for women and girls ‘in trying to vaccinate, we have stopped vaccinating, in trying to serve we have stopped serving, and in trying to care generously, we have stopped caring’. By understanding this paradox better, we can hopefully prevent it from happening again.
Corinne Grainger, October 2021