DURING the opening session of the East and Southern Africa regional SRHR symposium in Victoria Falls, Zimbabwe, United Nations Population Fund-East and Southern African Region (UNFPA-ESARO)) Deputy Regional Director, Chinwe Ogbonna called on regional leaders and implementers of Sexual Reproductive Health and Rights (SRHR) to devise new strategies to protect the gains that have been attained in as far as SRHR is concerned.
By Michael Gwarisa
The symposium is running under the banner of the Joint UN Regional 2gether 4 SRHR Programme which combines the unique strengths and contributions of four United Nations agencies – the Joint Programme on HIV and AIDS (UNAIDS), UN Children’s Fund (UNICEF), UN Population Fund (UNFPA), and the World Health Organization (WHO) to support countries in the region to improve the SRHR of all people fostering the delivering as one UN agenda.
Over the past three to four years, the ESAR region has experienced a series of shocks ranging from flooding as a result of Cyclones (Zimbabwe, Mozambique and Malawi), famine (Madagascar), and economic induced hardships among other health emergencies affecting countries in the region. The adolescent birth rate in ESAR is twice the global rate, at 92 births per 1,000 girls, and AGYW continue to be at higher risk of HIV compared to adolescent boys and young men (ABYM). According to a UNICEF report, most AGYW in ESAR live in families and communities struggling with persistently poor socio-economic conditions, inequities and socially constructed gender roles that undermine their health.
In all these scenarios, it has become evident that implementing healthcare services especially SRHR, HIV and GBV in silos might not attain the intended results and many might fall by the wayside in terms of access to critical healthcare services. Speaking during a plenary session on Integrating SRHR and the indirect impact of COVID-19during the Regional SRHR symposium, Elizabeth Zishiri, the Programme Specialist: M&E in the UNFPA-ESARO said the 2gether 4 SRHR Programme had four main objectives which include creating an enabling legal, policy and financial environment, scale-up the provision of integrated services, to empower all people to exercise their SRH rights and also to amplify the lessons learnt.
The whole programme focused on integration. Integration was at the centre of what we did in the 2gether 4 SRHR Programme. Integration is the process of bringing together in a holistic manner, different types of related SRHR and HIV interventions at the levels of administration, policy, programing and service delivery to ensure access to comprehensive integrated services,” said Elizabeth.
She added that the integration under the 2gether4SRHR program was focused mainly around SRHR, HIV and Gender Based Violence (GBV) and was building on the linkages program which initially just spoke of the linkages between SRH and HIV, leaving out GBV. Under the integration program, when one visits a healthcare facility, they receive a comprehensive package of services that respond to their individual needs.
“The package of services is aligned to the nine essential SRH elements and the integration package depended on the country context ad also depended on the facility and how the facility was set up and also depended on the individual needs.”
A lot of work was also done in the development and updating of the national and regional SRH policies and incorporated the principle of integration was also incorporated. There was also strengthened accountability to the use of regional accountability mechanisms such as the SADC Score card and there was significant support in other score-cards at country level. Coordination mechanisms strengthened the interface between regional, national, sub-national and local actors and fostered sharing and learning amongst entities.
To date, seven training curricula and/modules have been developed or updated across 3 countries, 12 countries have supported mentorship and support supervision on the provision of integrated services and 44704 Health Care Workers (including community HCWs) had their capacity built in providing integrated services across the 12 countries.
In terms of strengthening the delivery of quality integrated SRHR Services, the 2gether4SRHR Programme supported piloting of integrated services in select facilities in Kenya, Malawi, South Africa, Uganda and Zambia and also supported the scaling up of integrated services in Botswana, Eswatini, Lesotho, Zambia and Zimbabwe. A model of catalytic funding for joint programming in countries (Joint SRHR Fund (JSF)) in Tanzania, South Sudan, (Eswatini and Namibia) was tested during the four year period.
Elizabeth however bemoaned the effects of COVID-19 on integrated services and indicated that COVID-19 disrupted delivery of integrated services at both health facility and community levels i) HCWs assigned to the COVID response, ii) Reduced number of clients at facilities and disruption of staff mobility due to lockdown restrictions and fear of contracting COVID iii) Hold/reduction on provision of what was deemed non-essential and iv) Shortages of RH commodities especially contraceptives.
Dr Manala Makua, the Director and Maternal Reproductive Health in the National Department of Health in South Africa said there is need to protect the gains around SRH order to achieve Universal Health Coverage especially in the face health emergencies such as the COVID-19.
“When the COVID-19 came In Africa, South Africa had the most devastating effects of the COVID-19. During the first phase, the SRH space was affected by the fact that somehow, somewhere, it was not clearly defined as an essential service for some reason. When that happened, it called for advocacy, we needed to respond and respond very soon.
“When COVID-19 came, we were at the verge of attaining the SDG goal or reducing maternal deaths. We were at 88 per 100,000 live births in South Africa. We were almost seeing 70 just in the next few months. However, SRH was the collateral damage of COVID because at that point, while everyone was still focused on generating evidence, one thing that was not clear was that the severity of COVID-19 was worse in the maternal unit health space. We need to protect the gains that have been achieved in SRHR,” said Dr Makua.
Meanwhile, SRH interventions in Zimbabwe were not spared by the COVID-19 as services were disrupted due to restrictions to movement and access to healthcare services was greatly affected. Mr Llyod Machacha Deputy Director Performance Monitoring and Evaluation in the Ministry of Health and Child Care said while Zimbabwe was also affected, they are now seeing a return to normalcy.
“In Zimbabwe, the challenges that we faced as a country during COVID-19 were numerous but the government did implement a number of interventions to try and arrest the situation. There were issues around teenage pregnancies. When we were doing our analysis we realised that there was a 13 percent increase from the previous years.
“But after some interventions were implemented including issue of engagements with the churches and also traditional leaders, there were also efforts by the first lady were she reached some hard to reach areas where most of these issues are happening. Currently we are seeing a downward trajectory, I cannot give statistics, but the numbers are going down because of the efforts that are ongoing. Especially after opening up where access in terms of other services have been generally improved across the country,” said Mr Machacha.
Comprehensive sex education was a challenge initially but now where we are trying to reach churches and traditional leaders are playing an important role to try and raise those issues. Education 5.0 also embeds within it the issues of sexual reproductive health and comprehensive sexuality education on schools so this is one area where government is also trying to push to ensure that the message goes out there.
