Recommendations for Technical Advisors
What FP/RH Programs Can Do Right Now in Response to the COVID-19 Pandemic
The COVID-19 pandemic has changed virtually every aspect of life around the world. Restrictions on movement and gatherings are impacting access to contraceptives and health care. Community health workers and providers, who are key linkages to service provision in many contexts, are also limited in their movements. Adapting programs to this changing landscape, or even knowing where to start, can feel daunting. Several organizations have provided important guidance on voluntary reproductive health care and family planning and gender and gender-based violence in the current context of COVID-19.
Here are concrete actions that you can take today.
Incorporate advocacy messaging
Emphasize solutions
Recognize evolving needs
Integrate psychosocial support
Rethink business processes
Explore new partnerships
Advocate for representation
Address fear, stigma, and bias
Offer humanitarian response training
Protect responders’ mental health
Update communication methods
Localize decision making
Learn from others
Act now
Address fear, stigma, and bias
Advocate for representation
Explore new partnerships
Rethink business processes
Integrate psychosocial support
Recognize evolving needs
Emphasize solutions
Incorporate advocacy messaging
Conclusion
The COVID-19 pandemic continues to test response structures at the global, regional, national, and subnational levels. These recommendations will position programs and organizations to better adapt to shifting realities and help to ensure that the needs of women and girls are met in these uncertain times. The ability to act quickly, efficiently, and effectively are critical in outbreak responses. As indirect impacts to reproductive health care and voluntary family planning continue to evolve, these skills will be paramount. And they will strengthen your program’s position no matter what the future holds.
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This interactive collection is made possible by the support of the American People through the United States Agency for International Development (USAID) under the Knowledge SUCCESS (Strengthening Use, Capacity, Collaboration, Exchange, Synthesis, and Sharing) Project. Knowledge SUCCESS is supported by USAID's Bureau for Global Health, Office of Population and Reproductive Health and led by the Johns Hopkins Center for Communication Programs (CCP) in partnership with Amref Health Africa, The Busara Center for Behavioral Economics (Busara), and FHI 360. The contents of this website are the sole responsibility of CCP. The information provided in this collection does not necessarily reflect the views of USAID, the United States Government, or the Johns Hopkins University.
Act now
Learn from others
Localize decision making
Update communication methods
Protect responders’ mental health
Offer humanitarian response training
Incorporate this advocacy message into every interaction with all stakeholders, not just decision-makers, and in all COVID-19 communications and materials. Some outbreak and humanitarian responders think of voluntary reproductive health care and family planning as secondary in emergency settings, despite evidence that supports its place as a priority.
Spread the Word: FP/RH is essential
GET STARTED See Kenya’s Council of Governors Memorandum to Continue Essential Health Services Including Family Planning
GET STARTED FIGO Statement on COVID-19 Contraception and Family Planning
There is no “quick fix” in a pandemic response but there are immediate actions we can take to ensure continued care. Some of those actions, recommended by FIGO and Breakthrough Action, include broadening access to voluntary reproductive care through telehealth, expanding postpartum family planning care (particularly long-acting reversible contraceptives [LARCS]), and promoting self-care for family planning, including through fertility awareness. Address the needs of the most vulnerable -- young people and those with disabilities -- to ensure they are not forgotten. If these approaches aren’t already built into your program, consider how they could be with your donor or partners.
Emphasize clear and attainable interim solutions
COVID-19 may have shifted priorities among women and girls whose needs and preferences will continue to evolve and change as the pandemic does. Economic instability and strain, lockdowns and stay at home orders, social norms and cultural beliefs all play a factor in demand for contraceptives and voluntary reproductive health care. Your program’s context and clients will guide you.
Recognize that FP/RH needs have changed
Lauren Archer, Director Kenya Regional Office, DKT International
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If the economy is a challenge, people might be less inclined to be thinking about children so they might want longer term protection. But at the same time, I think people will be more hesitant to go [to a facility], especially when the virus is still at its peak or growing. I think it will play out differently in different contexts, just depending on the different restrictions and accessibility. This is a fairly unprecedented time in terms of the changes that have gone into place in society.
From unemployment and persistent health effects to caring for others, clients are living through and grappling with trauma. A study recently found that the pandemic led to a 74 percent drop in overall emotional well-being in China. The study also found that the potential of contracting the disease, the extent of possible harm, as well as relational issues (i.e. unemployment or relationship strain) worsen a person’s well-being during an epidemic. Programs and services should integrate and expand psychosocial support targeted towards the impacts of COVID-19. Traumatic events can have lingering impacts; the need for continued care should be considered.
Integrate psychosocial responsive services and activities for clients
From unemployment and persistent health effects to caring for others, clients are living through and grappling with trauma. A study recently found that the pandemic led to a 74 percent drop in overall emotional well-being in China. The study also found that the potential of contracting the disease, the extent of possible harm, as well as relational issues (i.e. unemployment or relationship strain) worsen a person’s well-being during an epidemic. Programs and services should integrate and expand psychosocial support targeted towards the impacts of COVID-19. Traumatic events can have lingering impacts; the need for continued care should be considered.
Have discussions on incorporating COVID-19 considerations into program design and messaging. The Ministry of Health in many countries is advising providers to give users of short-acting methods at least three months’ supply. Innovative solutions have allowed users to receive resupplies without face-to-face interaction through pharmacy apps and mail services. Those seeking a method that is unavailable may use an option such as self-injection of DMPA-SC. Current users of implants and IUDs may continue using their current method for a few months after removal periods included on product labeling. Research supports implant and IUD effectiveness beyond removal periods on labeling.
Recognize this is not business as usual
Have discussions on incorporating COVID-19 considerations into program design and messaging. The Ministry of Health in many countries is advising providers to give users of short-acting methods at least three months’ supply. Innovative solutions have allowed users to receive resupplies without face-to-face interaction through pharmacy apps and mail services. Those seeking a method that is unavailable may use an option such as self-injection of DMPA-SC. Current users of implants and IUDs may continue using their current method for a few months after removal periods included on product labeling. Research supports implant and IUD effectiveness beyond removal periods on labeling.
Much has been done to integrate family planning and reproductive health into other health sectors, such as immunization and nutrition. COVID-19 has emphasized the interconnectedness of health sectors, from blood donations to water, sanitation and hygiene (WASH). Exploring new integrations and partnerships with those outside the health sector, such as programs working in community economic development and the environment, will help to ensure that programs consider all impacts of the pandemic—not only those traditionally related to health.
Have discussions on incorporating COVID-19 considerations into program design and messaging. The Ministry of Health in many countries is advising providers to give users of short-acting methods at least three months’ supply. Innovative solutions have allowed users to receive resupplies without face-to-face interaction through pharmacy apps and mail services. Those seeking a method that is unavailable may use an option such as self-injection of DMPA-SC. Current users of implants and IUDs may continue using their current method for a few months after removal periods included on product labeling. Research supports implant and IUD effectiveness beyond removal periods on labeling.
Expand existing integrations and explore new ones
[One] issue that we have been facing has been a dwindling stock nationally of blood. We know that women are giving birth, and the biggest percentage of maternal deaths in the country is due to hemorrhage and lack of blood. So in this lockdown we are seeing that less people are donating blood, there are very little resources to collect blood, and people don’t have the transport to go and donate this blood. We are trying to mobilize but really it’s very little and it’s a scare that we are living with at the moment.
Diana Kabahuma Muhwezi, Communications Coordinator, Reproductive Health Uganda
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Health task teams guide the strategic direction of a country’s health sector response during emergency phases, including collaborating with other sectors and coordinating response efforts. The integration of reproductive health and family planning on response teams will help to promote cross-sectoral approaches. This is where and how decisions get made, and having a voice in these spaces is especially important to advocate for the integration of voluntary reproductive health care and family planning programs into the response.
Have discussions on incorporating COVID-19 considerations into program design and messaging. The Ministry of Health in many countries is advising providers to give users of short-acting methods at least three months’ supply. Innovative solutions have allowed users to receive resupplies without face-to-face interaction through pharmacy apps and mail services. Those seeking a method that is unavailable may use an option such as self-injection of DMPA-SC. Current users of implants and IUDs may continue using their current method for a few months after removal periods included on product labeling. Research supports implant and IUD effectiveness beyond removal periods on labeling.
Advocate for inclusion of reproductive health experts on health task teams
There is fear of any form of health service right now, including voluntary reproductive health care and family planning. Clients stigmatize providers and health facilities by assuming that all healthcare workers and health facilities carry the infection. Unconscious bias and fear lead providers to stigmatize patients who they fear may be infected with COVID-19. As programs work to dismantle family planning provider bias, messages and guidelines for providers should address COVID-19 stigma, eliminating false assumptions and biases on the part of providers and clients. Messaging at the facility level should focus on measures being implemented to keep everyone safe.
Address fear, stigma, and bias
There is fear of any form of health service right now, including voluntary reproductive health care and family planning. Clients stigmatize providers and health facilities by assuming that all healthcare workers and health facilities carry the infection.
dismantle family planning provider bias, messages and guidelines for providers should address COVID-19 stigma, eliminating false assumptions and biases on the part of providers and clients. Messaging at the facility level should focus on measures being implemented to keep everyone safe.
COVID-19 has emphasized the need for every program implementer or service provider to understand the basics of humanitarian and outbreak responses. These have previously been viewed as a niche field, with only a handful receiving such training. Given the current pandemic, as well as an increase in humanitarian crises, it is critical to know how to operate within such contexts. Humanitarian response training--understanding how decisions are made related to service delivery, protective versus harmful factors that contribute to a client’s vulnerability, and how to maintain networks of care in humanitarian settings--equips everyone to respond more effectively and efficiently.
Include humanitarian response training in general training
During times of uncertainty, the mental health of frontline responders, whether in direct contact with those affected or not, is often overlooked. The impact on those providing programs and care amidst a pandemic can be severe. Fostering a supportive work environment is important, including equipping implementers with tools to manage their own mental health. These include training in the basics of psychological first aid to recognize mental health crisis signs in themselves and others, virtual confidential consults with therapists, and a peer-support network. If these services are not possible at an organizational level, know where to direct those in need.
Protect the mental health of your program implementers
During times of uncertainty, the mental health of frontline responders, whether in direct contact with those affected or not, is often overlooked. The impact on those providing programs and care amidst a pandemic can be severe. Fostering a supportive work environment is important, including equipping implementers with tools to manage their own mental health. These include training in the basics of psychological first aid to recognize mental health crisis signs in themselves and others, virtual confidential consults with therapists, and a peer-support network. If these services are not possible at an organizational level, know where to direct those in need.
This is the time to have important discussions about how to reach those who may have limited access to technology. Programs are adapting to providing voluntary reproductive health care and family planning using telehealth, remote consultations, and even no-contact pharmacies. However, technology and discussions around subnational access not only apply to service provision, but also to advocacy efforts and engaging with stakeholders. How do you advocate for family planning funding without face-to-face meetings? How do you engage with stakeholders when technology isn’t available? This may mean embracing community radio and print.
Be flexible with communication methods and technologies
Since the COVID-19 pandemic looks different in every country, it is important to be able to localize decision-making and program adaptation. The ability to make decisions quickly is critical right now, at a time when global offices may be inundated with requests. In-country offices that are able to move things forward on their own could be the difference between receiving restock supplies in a few weeks or a few months.
Shift or lean into decentralized and localized decision-making mechanisms
Supply chains have been disrupted, hampering importation of RH supplies as well as last mile delivery to service delivery points. It takes much longer to process regulatory approvals for transportation of supplies to locations outside Juba, the capital. This increases the likelihood of stock outs, especially in peripheral health facilities in difficult and hard to reach areas with the rainy season looming. This also has negative implications for the marginalized and furthest behind.
Stephen Mawa, Programme Specialist (RHCS/FP), UNFPA South Sudan
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While the pandemic may look different in different contexts, countries can learn from one another in their response efforts. Countries that have successfully “opened back up” may have crucial lessons for other countries who are considering such measures. Rapid, continuous knowledge exchange is vital to ensure the application of best practices, evidence, and lessons learned during and after the response as programs adapt and evolve. Developing inter-country networks and taking advantage of existing connections for critical reflections will ensure that countries continue to improve their responses. Furthermore, much can be learned from previous outbreak responses including Ebola and Zika.
Learn from the responses of others
There is no time to wait. Quick and ongoing adaptation will ensure that programs are able to continue without interruption in services. This includes not waiting to determine what the ongoing impacts of COVID-19 might be in your context--three months from now, six months from now, a year from now. Data might be incomplete and the situation might continue to evolve, but this does not mean that action cannot be taken now to address immediate needs and plan for a variety of potential future scenarios.
Act now
This collection was compiled and written by Brittany Goetsch with contributions from Tamar Abrams. With special thanks to Reproductive Health Uganda, DKT International, and UNFPA for their contributions.
guidance on voluntary reproductive health care
gender and gender-based violence in the current context of COVID-19.
GET STARTED SBC Guidance for COVID-19
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GET STARTED RHSC MICRO Modeling Tool
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GET STARTED Psychosocial Support to Clients and Program Implementers
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GET STARTED RHSC Micro Modeling
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GET STARTED Linking Family Planning and Global Development
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GET STARTED Task Sharing Family Planning Services to Increase Health Workforce Efficiency and Expand Access: A Strategic Planning Guide
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GET STARTED Practical Communication Tips to Prevent Stigma
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GET STARTED The Sphere Handbook
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GET STARTED SBC Guidance for COVID-19
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GET STARTED Family Planning in Humanitarian Settings: A Strategic Planning Guide
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GET STARTED Ebola Lessons Learned and Best Practices
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GET STARTED Zika Lessons Learned and Best Practices
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GET STARTED Tracking Short and Long-Term Effects on Family Planning Programs
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There is no time to wait. Quick and ongoing adaptation will ensure that programs are able to continue without interruption in services. This includes not waiting to determine what the ongoing impacts of COVID-19 might be in your context--three months from now, six months from now, a year from now. Data might be incomplete and the situation might continue to evolve
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GET STARTED Psychosocial Support to Clients and Program Implementers
GET STARTED Psychosocial Support to Clients and Program Implementers
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