On March 11th 2020 the World Health Organisation declared COVID-19 a pandemic. Taking preemptive measures President Yoweri Museveni issued a set of measures to curb the spread of of the virus and included a directive banning all flights in and out of the country, temporary closure of schools, colleges, religious gatherings and public gatherings. On the 21st March, 2020, Uganda confirmed its first case of COVID 19, this was followed by further restrictions including a 14-day ban on all public transport, closure of all businesses not providing essential services. These and safety guidelines like social and physicall distancing, washing hands and staying at home are designed to curb the spread of the pandemic. However, these contrictions as well increased demands placed on the health sytem have resulted in disruptive impacts on key SRH services. These include constrained access to Maternal Health, HIV treatment, access to contraceptives, and an increase in gender-based violence among others. The efficiency of a health system must be measured on its resilience and capability to take forward the other aspects of the health system even in crisis or pandemic outbreaks like COVID19.
While the ongoing lockdown and resrictions are crucial measures in helping to flatten the curve, it is inadvertently leading to the rise in SRH and public health issues including:
- Domestic violence; There has been an increase in domestic violence cases as reported by Police who revealed that Cases of domestic violence are on the increase during the COVID-19 partial lockdown. Lockdown orders during COVID19 also mean that victims of domestic violence are unable to leave the house to seek appropriate help and are more likely to be cut off from their usual support systems. Domestic violence survivors suffer a range of serious physical and mental health consequences that require urgent health responses, and these should be readily available during COVID19.
- As the government focuses on COVID19, cases of child and maternal mortality are on the rise as people struggle to access health services amidst the ban on all means of transport. Namawanga Health Centre IV is grappling with increased child mortality attributed to late presentation to the health Centers. There are reported cases where women are struggling to reach facilities. They are dying or delivering along the road. This is not good for our health system and Government should pay attention to this issue.
- When schools close there is potential for increased drop-out rates which will disproportionately affect adolescent girls and vulnerable children further entrenching gender gaps and inequality in education. This will also heighten increased risk of sexual exploitation, early pregnancy and early and forced marriage. In many cases. School dropout will be driven by increased domestic and caring responsibilities and a shift towards income generation particularly for girls.
While the magnitude of the COVID-19 crisis is unprecedented, we can look to the lessons learnt from the Ebola epidemic in Africa.
- We anticipate to see shortages of medications such as contraceptives, antiretrovirals for HIV/AIDS and antibiotics to treat STIs, due to disruptions in overall supply chains. China, the second-largest exporter of pharmaceutical products in the world, has shut down several drug-manufacturing plants, which has, in turn, caused delays at Indian factories that produce generic medicines, People Living with HIV and newly infected people with HIV are likely to either miss out or not to start medication due to either stock out and poor attitude by health workers claiming that they do not have protective gears to enable them to continue with usual services as well protect from COVID19. There are also limitations in reaching health centres because of limited and restricted movement, hence possibilities of missed ART appointments. People with TB are also not only vulnerable to but can also be viewed as COVID-19 patients which increases stigma and discrimination.
- With the increased burden of health systems diverted to COVID19 in Uganda, we shall see a trend of health care being diverted to address the epidemic while also putting health workers at risk of acquiring the disease. This will create a shortage of health workers who can provide sexual and reproductive health services and increase wait times for patients in need. In places that already have a limited number of providers, this will put an extreme strain on the capacity to serve patients, especially for non-emergency care.
- The Government of Uganda in diverting financial resources to COVID-19 response, will take funding away from reproductive health programs and decrease access for patients who rely on free or subsidized care. Likewise, the need for new precautionary equipment, training and protocols will further draw time and resources away from other work, including projects and programs related to sexual and reproductive health. This burden may not be distributed equally across the health care system, as vulnerable facilities or marginalized geographic areas may be most impacted by the outbreak and not recieve the more focused action they need.
The concept of a most affected community may be different for each epidemic. The history of the HIV epidemic has made clear that any response will only be effective when affected communities are meaningfully involved in its development, implementation and monitoring. While temporal limitations of rights may be argued in certain circumstances, the experience in the HIV epidemic has also shown that there is no public health situation that would justify limiting freedom of expression or access to information. A case in point is the Uganda Network of Uganda People Living with HIV (UNYPA) which is partnering with key service providers like Mildmay, TASO Uganda to support door- to-door deliveries of ARVs as they also conduct awareness-raising on COVID19.
Different SRH service provision and information platforms can be utilized to disseminate accurate information and counselling about COVID19. This would, ensure continuity is SRH services and information. Peer Educators, Community Health Workers and Village Health Teams who have been supporting the provision of health education and short-term family planning methods to rural communities can be integrated into District Taskforces to strengthen the prevention of unplanned pregnancies, unsafe abortion among others.
Although the consequences of COVID19 on health and health services are uppermost in the public consciousness, it also an opportunity that can trigger and shape broader discourse on different SRH laws and policies, sexual and reproductive health and social justice.
Stay Safe! Stay Home! Wash Your Hands Frequently! Keep Social Distance.
 NTV News: COVID-19 LOCKDOWN: Police warn of rising cases of domestic violence https://www.youtube.com/watch?v=WlKaegv6-58
 Two children dead as parents fail to secure transport to hospital https://observer.ug/news/headlines/64140-two-children-dead-as-parents-fail-to-secure-transport-to-hospital
 NBS News: Transport ban leading to increased death https://www.youtube.com/watch?v=pcRHpeK2TIc
 Mother Bleeds to death as RDC puts off the phone. https://ekyooto.co.uk/2020/04/06/pregnant-woman-bleeds-to-death-as-rdc-puts-off-phone/