Global leaders must fulfil health commitments to African women, children and adolescents, as COVID-19 threatens service provision

Delegates at this week’s 10^th Annual PMNCH Accountability Breakfast: Improving health equity in Africa will call for greater accountability from governments and leaders in delivering on their commitments to improve women’s, children’s, and adolescents’ health (WCAH) during the COVID-19 response and recovery, with a special focus on sub-Saharan Africa. Without renewed effort, decades of hard-won gains are at risk, as the pandemic disrupts and undermines vital health service provision.

Over 1,000 delegates are expected to attend the summit, bringing representatives from governments, the private sector, non-governmental organizations, academic institutions, health professional associations, youth-led organizations, and grass-roots campaign groups together to review national responses to COVID-19 across sub-Saharan Africa, highlighting measures being taken by countries to maintain and improve WCAH services through increased and improved investments, policies, and services, in line with the seven asks of PMNCH’s Call to Action on COVID-19, and its Call to Action on Adolescent Well-Being.

The Accountability Breakfast will also highlight the important role of partnerships and citizen advocacy in holding global and national leaders to account for addressing health inequities, and the use of digital technology for improving accountability and action to enhance WCAH.

Following the launch of the Call to Action on COVID-19 in 2020, 14 high-, low- and middle-income countries and one foundation made commitments to strengthen policies and financing for the recovery of vital health services and social protections for women, children, and adolescents. At this week’s Accountability Breakfast, a further five countries will announce their commitments to the PMNCH Call to Action, including three from sub-Saharan Africa, bringing the total number of commitment-making countries to 19, including eight from Africa.

The imperative for swift and decisive action to address health inequities in Africa grows ever more critical, as the COVID-19 pandemic threatens to undermine and unravel decades of progress.

Before COVID-19, countries were seeing significant advances in WCAH in line with the 2030 development goals, yet progress was uneven across different regions. The African continent accounts for 23 percent of the global burden of disease, despite having only 17 percent of the world’s population, according to data from AMREF.

Despite achieving a reduction in maternal mortality of 39 percent between 2000 and 2017, Sub-Saharan Africa still accounted for more than two-thirds (68 percent) of global maternal deaths annually, and 53 percent of under-five child mortality. In 2021, six in seven new HIV infections among adolescents aged 15– 19 years are among girls in sub-Saharan Africa.

These inequities are now being further exacerbated by COVID-19, with several countries in Africa experiencing severe disruptions to essential health services. A survey conducted by the Partnership for Evidence-Based Response to COVID-19 (PERC) in 18 African Union member states, found 16 percent of respondents reporting that they, or a member of their family, missed or delayed reproductive, maternal, newborn, or child health (RMNCH) services, with disruptions more common in countries with high birth rates (such as Uganda, Nigeria, and Ethiopia). Data from the Global Financing Facility found that childhood vaccinations were the most interrupted health service among the countries studied, with reductions in the number of fully vaccinated children of 35 percent in Liberia and 13 percent in Nigeria, for example.

“The evidence is stark: COVID-19 is increasing health inequities in sub-Saharan Africa. This is deeply concerning and should encourage policymakers to take on difficult conversations about how to prioritize financing, and where to focus service provision efforts to best meet the needs of women, children, and adolescents, who are among the most vulnerable citizens in the region,” said Helen Clark, Chair of PMNCH and former prime minister of New Zealand.

Across sub-Saharan Africa, young people are proving themselves tenacious in holding their leaders to account for their promises.

“The COVID-19 pandemic has exacerbated the challenges for adolescents and youth in sub- Saharan Africa,” said Dr Natasha Kaoma, CEO, Copper Rose, Zambia. “We have seen increased sexual violence, teenage pregnancies, and school closures. Now more than ever, youth advocates need to make their voices heard. We need to take responsibility and demand for accountability from our leadership and increased investment in adolescent and youth health to achieve the ‘triple dividend’ – for adolescents now, their future lives, and the next generation.”

Despite the evident disruptions to key health services for women, children, and adolescents from COVID-19, just over three percent of the African population, including health care workers, has been vaccinated against COVID-19 to date. Seventy-five percent of the world’s COVID-19 vaccination supplies are held in just 10 countries – none of which are in Africa.

One immediate priority that will be addressed at the summit is the need for prompt and comprehensive action from the international community to redress the extreme inequities in the supply and distribution of COVID-19 vaccines in Africa, compared to other regions of the world.

Until this situation is remedied, the current limited supply of vaccines should be prioritized for certain populations, including those with high exposure to the virus (e.g., healthcare workers, particularly midwives and nurses) and those at high risk of severe disease e.g., pregnant women, women with non-communicable diseases and chronic infections and immune-compromised children.

“As with HIV, COVID has exposed the fragility of systems for health and threatens recent gains in public health and delivery of essential health and social services, especially for women, children, and adolescents in Africa,” said Winnie Byanyima, Executive Director, UNAIDS. “We have to end these inequalities for women and girls by ensuring their right to health and empowerment through education, freedom, and rights.”

The 10^th Annual PMNCH Accountability Breakfast: Improving health equity in Africa will take place online on Wednesday 22 September 2021, at 7:30-9:00 am EDT, 12:30 – 2:00 pm BST, 1:30-3:00 pm CET. Register to take part here.