Reflections from health and advocacy practitioners on responses to COVID-19: A COPASAH webinar

By Lynda Keeru

Communities are the most tested by the coronavirus pandemic (COVID-19). Those that are most feeling the consequences are the poorer communities where its implications will be massive and may unfortunately undo many of the strides and gains made especially in public health and health systems. Governments, health practitioners, NGOS/CSOs are hell bent on ensuring that development gains are not reversed.

In a webinar organized by Community of Practitioners for Accountability and Social Action in Health (COPASAH) stakeholders from different fields highlighted the challenges they are facing in responding to this pandemic and the effects it has had on communities. Five speakers from Uganda, Liberia, India and Macedonia meant there was representation of nearly all the continents. This blog highlights some of the challenges and some of the different ways stakeholders are working around the pandemic to provide essential health services to their communities and hold governments accountable.

Some challenges cut across the board while others are specific to individual countries. A common challenge is the fact that health workers don’t have permits to move around which restrains them from providing the very much needed services especially in the wake of lockdowns/curfews in most countries. Many countries are concerned with ensuring that governments do not forget their roles and obligations in ensuring that women do not die unnecessarily, especially during childbirth.

Maternal mortality and reproductive health

In Uganda for example, there has been a rise in maternal mortality because pregnant women are having to walk long distances when heavily pregnant to get permission to get to a facility. This has meant that women are dying by the roadside, delivering by the roadside and even being pronounced dead on arrival at the facilities.

Advocacy efforts are already underway with letters written to the President to report the rising cases of maternal mortality cases and the challenges being experienced by the women like the lack of public transport. The letter suggested solutions like the government allowing a few ‘bodabodas’ to be in operation in order to ferry these women to the health facilities.

Through concerted advocacy efforts, antenatal visits have now been restored in Uganda and the same for access to family planning which is essential.

Lack of COVID-19 preparedness

One of the issues that seemed to affect most of the countries was the fact that a lot of attention is being accorded to COVID-19 in health facilities which leads to sidelining of the rest of the services. This causes delays which again puts the women and all other patients at high risk of contracting the disease. The preparedness for handling of COVID-19 in many countries and health facilities is low. Facilities may not have separate wings/rooms to handle COVID-19 patients.

Human rights

In Uganda, efforts have been put in place to counter human rights violations and harassment especially from the police. Legal experts have been engaged to provide legal aid counsel which ensures that people especially at the community level have access to legal services. The advocacy efforts have been around the engagement of the police and government by lawyers to urge them to respect and uphold the rights of the people. The presenter also highlighted that there were reported cases of mothers being restricted from accessing cancer services, Maternal Newborn and Child Health (MNCH) as well as cases of young people experiencing challenges accessing family planning (FP).

The presenter from Uganda drew special attention to the fact that their President was active on social media and responds to issues raised on the various social media platforms resulting to social media becoming a key tool for advocacy. The lawyers and other legal practitioners in Uganda also got together and wrote to the World Bank (which like in many other countries has given money to Uganda to tackle the pandemic) to request that the World Bank helps them hold their government accountable by asking the Ugandan government to reveal to them how they plan to use this money.

Macedonia is also experienced challenges regarding police harassment toward the marginalised Roma community. However, this is being countered by the effort NGOs are making to ensure that the Roma community are exercising their right to health and also right to services.

In Mumbai people are being denied health care services until they test negative for COVID-19 yet according to the guidelines, health care providers should not deny people care. However, due to the lack of COVID 19 test kits, hospitals continue to do this. Some patients with chronic diseases are really suffering as they are being denied care from fear that they may have COVID-19. Private health care facilities in India account for the highest number of spread of the COVID-19 among health care workers and this has been due to the fact that infection control protocols have not been implemented properly and PPE is not distributed according to the protocols.  Harassment of patients and their support systems has also been witnessed like in the case of a wife who was told that she would be subjected to daily testing of COVID-19 if she were to be allowed to visit her husband who was admitted for a different illness.

Civil society and private sector involvement

Unlike many other countries around the world, Liberia has managed to have the civil society represented on the national committee for COVID-19 response which is an important measure as they are key players in this pandemic and many other fields and their voice at the table cannot and should not be overlooked.  Their representation at the national committee helps to push the various advocacy agendas and countries represented on the webinar were urged to borrow this from Liberia to help them enhance their advocacy efforts.

Medical support groups have played a central role in India. This is very commendable as it supports health workers especially nurses to be at the table as their voices are often not represented most of the time. In India, a diverse private sector plays a role as opinion leaders and give direction on how they think the response should be handled. However, the general challenge observed in these private institutions is that they are trying to still make profits even in the wake of this crisis and make up for the losses they have made which leads to issues like them overcharging PPE and a general inflation of costs.  They also put their patients at high risk of contracting the virus as one PPE kit is often used across different patients in wards much as each patient is paying for a kit.

While there seem to be insurmountable challenges in the response to COVID-19 and the effects it will have on health systems and the reversal of health gains made over many years, the collective efforts being put in by health and legal professionals across the world serves as a beacon of hope. It’s expected that the world will be very different post-COVID-19 but the hope is that the effort jointly being put in in different areas like innovation, creativity and capital will keep drawing people together and people will keep having a continuous need for a community and each other.

Acknowledgements:

Many thanks to the speakers in the COPASAH webinar:

• Noor Nakibuuka Musisi-CEHURD, Uganda
• Zoran Bikoviski-NGO KHAM, Delcevo, Macedonia
• Inayat Singh Kakar-Medical Support Group (Delhi) & PHM, India
• Joyce L. Kilikpo-Public Health Initiative, Liberia
• Dr. Amina Magashi Garba- COPASAH Co-Convener, AHNBN, Nigeria