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. 2022 Jun 6;19(1):135.
doi: 10.1186/s12978-022-01443-5.

Health system resilience during COVID-19 understanding SRH service adaptation in North Kivu

Lara S Ho  1 , Maria Paola Bertone  2 , Wesam Mansour  3 , Cyprien Masaka  4 , Jessica Kakesa  4
Affiliations

Health system resilience during COVID-19 understanding SRH service adaptation in North Kivu

Lara S Ho et al. Reprod Health. .

Abstract

Background: There is often collateral damage to health systems during epidemics, affecting women and girls the most, with reduced access to non-outbreak related services, particularly in humanitarian settings. This rapid case study examines sexual and reproductive health (SRH) services in the Democratic Republic of the Congo when the COVID-19 hit, towards the end of an Ebola Virus Disease (EVD) outbreak, and in a context of protracted insecurity.

Methods: This study draws on quantitative analysis of routine data from four health zones, a document review of policies and protocols, and 13 key-informant interviews with staff from the Ministry of Public Health, United Nations agencies, international and national non-governmental organizations, and civil society organizations.

Results: Utilization of SRH services decreased initially but recovered by August 2020. Significant fluctuations remained across areas, due to the end of free care once Ebola funding ceased, insecurity, number of COVID-19 cases, and funding levels. The response to COVID-19 was top-down, focused on infection and prevention control measures, with a lack of funding, technical expertise and overall momentum that characterized the EVD response. Communities and civil society did not play an active role for the planning of the COVID-19 response. While health zone and facility staff showed resilience, developing adaptations to maintain SRH provision, these adaptations were short-lived and inconsistent without external support and funding.

Conclusion: The EVD outbreak was an opportunity for health system strengthening that was not sustained during COVID-19. This had consequences for access to SRH services, with limited-resources available and deprioritization of SRH.

Keywords: Adaptation; COVID-19; Democratic Republic of the Congo; Sexual and reproductive health.

Plain language summary

Women and girls often face increased challenges to accessing healthcare during epidemics on top of pre-existing health disparities. There is emerging evidence that COVID-19 has had negative impacts on the health of women and girls in sub-Saharan Africa due to diverted funding, reduced services, negative socioeconomic impacts, and increased or new barriers to access. In the DRC, COVID-19 hit shortly after the end of an Ebola epidemic within a context of protracted insecurity. This study used mixed methods and drew upon 13 interviews to examine the effects of COVID-19 on SRH services in North Kivu and how the health system did or did not adapt to ensure continued access and utilization of SRH services. There was limited prioritization of SRH during COVID-19. Although the government issued policies on how to adapt SRH services, these were developed centrally, without much guidance on how to operationalize these policies in different contexts. Consequently, healthcare providers and civil society actors developed their own ways to continue activities at local levels, not necessarily in a systematic way. There was limited longer-term strengthening of the health system that could adapt to the subsequent COVID-19 pandemic aside from increased capacity of healthcare providers to manage infection prevention and control measures. However, this was hampered by the lack of personal protective equipment that received no external support. Therefore, donors need to consider how resources can be leveraged to support sustained strengthening of the health system to be able to adapt to shocks even when resources are limited.

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Conflict of interest statement

The authors declare that they have no competing priorities, and that the funders take no responsibility for the views expressed in this article.

Figures

Fig. 1
Fig. 1
ANC1 Visits in selected North Kivu Health Zones
Fig. 2
Fig. 2
Birth with skilled attendance in North Kivu Health Zones
Fig. 3
Fig. 3
New Family Planning Users in selected North Health Zones
See this image and copyright information in PMC

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References

    1. Desrosiers A, Betancourt T, Kergoat Y, et al. A systematic review of sexual and reproductive health interventions for young people in humanitarian and lower-and-middle-income country settings. BMC Public Health. 2020 doi: 10.1186/s12889-020-08818-y. - DOI - PMC - PubMed
    1. Health Action International (HAI). COVID-19 and SRH. c2021. https://haiweb.org/covid-19-and-srh/. Accessed 26 Feb 2021.
    1. Heidari S, Onyango MA, Chynoweth S. Sexual and reproductive health and rights in humanitarian crises at ICPD25+ and beyond: consolidating gains to ensure access to services for all. Sex Reprod Health Matters. 2019;27(1):1676513. doi: 10.1080/26410397.2019.1676513. - DOI - PMC - PubMed
    1. Hall KS, Samari G, Garbers S, et al. Centering sexual and reproductive health and justice in the global COVID-19 response. Lancet. 2020;395:1175–1177. doi: 10.1016/S0140-6736(20)30801-1. - DOI - PMC - PubMed
    1. Iyengar P, Kerber K, Howe CJ, Dahn B. Services for mothers and newborns during the Ebola outbreak in Liberia: the need for improvement in emergencies. PLoS Curr. 2015;16:7. doi: 10.1371/currents.outbreaks.4ba318308719ac86fbef91f8e56cb66f. - DOI - PMC - PubMed