Has COVID-19 disrupted essential health services for women and children?
Observations from UNICEF staff in Tigray Region, Ethiopia
Ghassan Madieh, Chief of Field Office, Tigray Region
Tigray is the only region in Ethiopia to have imposed a strict 14-day quarantine for travelers to the region. As of 03 June, the region had reported 52 cases of COVID-19.
Essential UNICEF staff have continued to work from the office and the rest from home, but as internal movement restrictions are eased, many staff are travelling to the field to provide technical support to our partners and monitor programme implementation.
Recently, UNICEF health and water, sanitation, and hygiene (WASH) teams were in the south of the region to assess service provision in selected health facilities in six woredas (districts). We are aware that some essential primary health care services have been disrupted. As per the latest health and nutrition survey conducted by the regional health bureau, some service indicators are showing a decline. For example, delivery rates by skilled personnel are down by nine per cent and malnutrition screening for under-five children is down by seven per cent. This is due to restrictions in movement and the reluctance of parents and caregivers to bring their children to health facilities for fear of contracting the coronavirus, among other reasons.
We wanted to fact-check, through this one-week mission, how health services for children and women were being affected. Our focus was on vaccination and maternal health.
Dr. Tsebaot Meressa, Assistant Health Officer, UNICEF Tigray Field Office
It is day two and we plan to visit six health centers during our field mission. In Enderta Woreda (district), we arrive at Dengolat Health Centre on a beautiful morning. We can see a small number of people queuing up for consultations, maintaining physical distance, and wearing face masks.
The first person we meet is Sister Genet, a young midwife who has been working at the health centre for the past two years. As we walk around the health centre, we ask Sister Genet about the challenges of working in a rural health center during COVID-19.
“It is not easy working in a health centre where resources are not readily available,” she says. “But I try my best despite the challenges.
“There are times when power goes off for 2-3 days. When that happens, vaccines and medications deteriorate, and there is nothing we can do,” she says.
We told Sister Genet about the practice in other health centers of transporting the vaccines to nearby health centers where there are solar-powered fridges.
“That used to be the practice even here, but it isn’t the case anymore due to a lack of transport. What we need is a backup generator, but we are yet to receive a response from the woreda,” she says. We learnt that delivery of the generator has been delayed because the woreda health bureau was focused on COVID-19. We promised to follow up.
Genet’s other pressing concern is the sharp reduction in the number of pregnant and breastfeeding women visiting the health center. Before COVID-19, on average, fifteen mothers delivered at the health center per week, she says. Now there are only two on average. The delivery room she showed us was unoccupied.
“It concerns me because I know that if they don’t come here, they will deliver at home, and that can come with serious complications for both mother and baby,” she told us.
Genet believes the reduction in the number of mothers delivering in the health center began with the declaration of a state of emergency in the region on 25 March. She and her colleagues plan to reach out to the community in the hope of dispelling any misconceptions. We told Genet about the UNICEF-supported national COVID-19 communication plan which also includes addressing rumors.
From everything we learnt and saw during the mission, it was evident that the impact of COVID-19 has been all round on the provision of essential health services - from a reduction in the number of mothers coming for antenatal care to the number of women delivering their babies in health facilities. Ethiopia’s COVID-19 communication plan includes messages about the importance of people, especially children, continuing to access services to prevent ill health and death.
The decline is sensed by all the health workers we spoke to. This is of great concern to us as the health system risks being burdened not only by the pandemic but also by people seeking health care when it is too late.