To stay up to date on African news, subscribe to the “Monde Afrique” newsletter from this link. Every Saturday at 6 am, find a week of current events and debates treated by the editorial staff of “Monde Afrique”.
It’s a warning that has gone almost unnoticed. In September 2020, the United Nations warned that thirty years of “Remarkable progress” in terms of maternal and child health risked being “Reduced to nothing” by the health crisis of the new coronavirus. The fear of being contaminated at the place of consultation, the decline in family income, the limits on travel, but also the problems of supplying drugs, vaccines, contraceptives and medical equipment have seriously disrupted access to care.
Investigations by the United Nations Children’s Fund (Unicef) and the World Health Organization (WHO) revealed significant disruptions to essential health services in more than two-thirds of the world’s countries in 2020: up to 63% decrease in pre and postnatal follow-up, care for sick and malnourished children reduced by half, an explosion of violence against women and girls, which the South African Phumzile Mlambo-Ngcuka, director of UN Women, did not hesitate to qualify as “Shadow pandemic”.
In thirty years, maternal and child health has nonetheless made considerable progress in the world: the number of deaths of mothers and children under the age of 5 has thus increased from 12.5 million in 1990 to 5.2 million in 2019, its lowest level. Africa, which alone still accounts for more than half of this mortality, has also played its part in this progress, reducing it on average by 43%, according to figures from Unicef. But the continent, although less affected than the countries of the North by the Covid-19 with 100,000 deaths officially recorded in mid-February, has also seen its entire health chain disrupted.
“The pandemic has posed problems of continuity for maternal and child health, in particular because the workforce has been reduced to be protected: up to 50% of the staff have been absent in basic health centers, which has resulted in to close certain services for a while, such as family planning or prenatal consultation ”, confirmed Véronique Rakotondrainibe, medical manager in sexual and reproductive health for Médecins du monde, based in Antananarivo, Madagascar. Added to this is the reallocation of part of the centers to the response against Covid-19, to the detriment of traditional consultations. On the African continent, in addition to Madagascar, Cameroon, the Central African Republic (CAR), Libya and Sudan have been particularly affected by the disorganization, according to Unicef.
The pandemic, revealing the fragility of systems, has also brutally recalled the obvious: no country can claim sustainable development if it does not invest in the health of its population, and first of all in that of its women and their children. “One of the great lessons of Covid is that we cannot build an effective response to any disease without a minimum health system”, sums up the Beninese Roch Christian Johnson, doctor specializing in public health and advisor to the Raoul-Follereau Foundation based in Togo.
“Measles, yellow fever, cholera, Ebola episodes, all of this already absorbs a lot of funds and personnel, testifies the Burundian Deogratias Manirakiza, doctor for Unicef based in Kinshasa, in the Democratic Republic of Congo (DRC). The arrival of the coronavirus epidemic has made the situation even more difficult, including disrupting the system for vaccine-preventable diseases. This crisis must absolutely be an opportunity to strengthen systems. ” The doctor, who has also been stationed in CAR and Mali, continues: “We must not only secure financial and personnel resources, but invest more in the systems that have proven their resilience thanks to Covid-19. “
At the center of attention for those working in the field: strengthening local systems, from the health center to mobile teams, including community workers. Neither doctor, nurse, nor midwife, the community worker is able to take care of a case of malaria, acute childhood diarrhea, create a basic pharmacy and deliver essential drugs.
Respected by the inhabitants, the “neighborhood godmother” or the “educator father” roam the streets and paths to advise, explain, identify isolated women or children forgotten from the vaccination record. Also defusing fears, disinformation and social constraints that keep them away from the post or the health hut which is sometimes only a few kilometers from home.
“The community worker is at the end of the chain of the health system, but he is a key part of it. It creates trust between the population and caregivers. He is often the only one who can lead the doctor or nurse through the maze of neighborhoods for which there is no plan ”, highlighted Véronique Rakotondrainibe.
Finally, the agent in turn trains resource people in the villages, enabling them to collectively determine health priorities during “talks”. This educational work deepens the link with the customary authorities. Because the success of a vaccination campaign or a family planning program depends as much on the support of the village chief or the imam as on access to the drugs themselves.
The crisis due to Covid-19 has further confirmed its importance: it is on it that the health authorities of many African countries have been able to rely to inform, explain the barrier gestures and what to do in the event of symptoms. “The successive episodes of Ebola had already demonstrated the resilience of community organization”, recalls Doctor Manirakiza.
The associations in the field as well as the large UN agencies are now pleading to strengthen this essential role. “The health worker must be even better trained and well paid”, specifies Mr. Manirakiza who concludes: “The coronavirus will be part of our lives like other epidemics before it. We must integrate it into our health systems as we did with cholera or yellow fever. We must not forget that in the DRC, for example, 6,000 children died of measles in 2020 alone, while the Covid-19 has not even killed 1,000 people. “
Summary of our series “Health in Africa: Women and Children First! “
It’s a warning that has gone almost unnoticed. In September 2020, the United Nations warned that thirty years of “Remarkable progress” in terms of maternal and child health risked being “Reduced to nothing” by the health crisis due to Covid-19. The fear of being contaminated at the place of consultation, the decline in family income, travel restrictions, but also the problems of supplying drugs, vaccines, contraceptives and medical materials have greatly disrupted access to care. Putting the continuity of essential health services back at the center of the challenges.
The World Africa offers a series of reports from Senegal, Togo and Mali to tell the story of the resilience of the continent’s health systems.
This article is part of a series produced as part of a partnership with Cartier Philanthropy.