COVID-19 heavily impacts health systems, calling for concerted response

Around the world, COVID-19 has radically affected public health delivery, placing unprecedented stress on health systems that in many countries are under-resourced and ill-equipped.

c-section delivery Viet Nam COVID-19
A C-section delivery of twins in Viet Nam for a mother suspected of having COVID-19. A&T assisted hospitals to implement measures to reduce the risks of COVID-19 spread.

As the pandemic has upended daily life, Alive & Thrive has worked with government and other partners to design effective responses, providing technical assistance regarding breastfeeding and the maintenance of essential MIYCN services.

Breastfeeding

As the pandemic unfolded, guidance evolved regarding breastfeeding. The first guidance, issued in February, came from the China Consensus and called for separating mothers and their infants due to the risk of infection.

But by mid-March, experts agreed that breastfeeding did not pose a significant risk of transmission. The fast-evolving situation called for concerted efforts to ensure governments and their partners were providing consistent, accurate information.

An A&T review of guidance documents from around the world confirmed that guidance varied. Results were shared with stakeholders, including during a global webinar.

A&T’s participation in bodies that advise governments in the countries where it works facilitated the rapid sharing of the latest WHO guidance. And in one case – that of human milk banking – A&T supported the forming of a global online network of HMB stakeholders that is now leading efforts to promote the use of human milk banks, including issuing a call to action.

“The strengthening of human milk bank systems is required to ensure that safe provision of donor milk remains an essential component of early and essential newborn care during routine care or emergency scenarios, such as natural disasters and pandemics” – From the Call to Action of the Virtual Communication Network of milk bank leaders

In Niger, the Technical Group on Nutrition, an advisory body comprising nutrition partners including A&T, supported the development of IYCF guidance documents that emphasized the importance of early initiation of breastfeeding, exclusive breastfeeding, appropriate foods for complementary feeding and breastfeeding to the age of 2 years.

India poster COVID guidance
A&T assisted public health officials in India to produce materials like this poster to raise awareness of the latest guidance on breastfeeding and COVID-19.

The group also supported a joint statement on child nutrition with UNICEF and the Directorate of Nutrition, calling for concerted efforts across the health system and the private and public sectors to share the latest COVID-19-related breastfeeding guidance. It also included alerts regarding the marketing of breastmilk substitutes which, anecdotally, appears to have increased during the pandemic across A&T’s program countries.

At the same time, the A&T Southeast Asia office provided supportive evidence and updated references for breastfeeding to the National Nutrition Cluster in the Philippines, the Scaling-Up Nutrition Civil Society Alliance in Viet Nam and to partner hospitals. And in Nigeria, A&T supported the National Agency for Food and Drug Administration and Control (NAFDAC) to raise awareness via the media of the WHO guidance and the BMS Code.

In Madagascar, A&T also provided guidance regarding BMS Code enforcement and assisted in the planning of activities to enforce the Code. In India, A&T supported national professional associations to disseminate information on breastfeeding through a three-day webinar that reached over 700 medical professionals on breastfeeding and COVID-19, focusing similarly on BMS Code violations, referred to in the country as the Infant Milk Substitutes (IMS) Act.

Health system response and MIYCN program maintenance

Technical assistance also helped health systems respond and supported governments to maintain MIYCN services, a critical need in light of an expected spike in malnutrition globally, particularly in West Africa.

After it became clear that COVID-19 led to significant declines in people seeking services at health facilities, the Government of Ethiopia established a national task force. As members, A&T’s experts devised and then supported the government to conduct rapid assessment checklists to assess MIYCN service delivery status and provide guidance for frontline workers to continue non-COVID-19 services.

“Most health facilities’ services were significantly disrupted,” said Dr. Abdulaziz Oumer, A&T Country Director. “Some facilities had closed due to lack of personal protective equipment and mothers stopped coming for services due to the panic.”

The assessments provided insights on the scope of the problem and led to a concerted media campaign and delivery of personal protective equipment. The effort also led to the development of a focused action plan to strengthen antenatal care, post-natal care, delivery, and child health and nutrition services.

maternity ward Ethiopia
Across Ethiopia, fear of coronavirus led to significant declines in visits to health facilities, as evidenced by empty beds at this normally bustling maternity ward during recent assessment visits. Fearful of contracting coronavirus, expectant mothers may have delivered at home, which poses risks.

Swift response in Southeast Asia helped hospitals maintain early and essential newborn care despite the surge in COVID-19 cases, which initially filled hospitals to capacity. In a presentation during a WHO webinar, A&T Southeast Asia’s team discussed the technical assistance it provided to the hospitals to set up separate areas to treat suspected COVID-19 cases, implement measures to manage admissions, and adopt social distancing, among other strategies.

In India and Bangladesh technical support to  government and partners on MIYCN during COVID-19, in close collaboration with  UNICEF, USAID, the World Health Organization and the World Bank included, disseminating materials on breastfeeding; information on  safely initiating complementary feeding, and and guidance on continuing nutrition services during COVID-19.

In Burkina Faso, A&T worked directly with the Ministry of Health to develop materials and radio advertisements on IYCF and COVID-19 and collaborated with community radios to discuss COVID-19 and IYCF in six health regions, sharing knowledge and information and answering listeners’ questions during live call-in shows.