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Pumwani Maternity Hospital in Nairobi.

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COVID19: A chance to build resilience in Maternal Health

By Dr Steve Adudans  @SteveAdudans

Recently, a mother was captured on camera delivering at the gate of a health facility after allegedly being turned away by a security official in what was explained as blocking new patients from the facilities as part of the COVID19 containment measures.

While the lady in question was later attended to, the case illustrates how at their most vulnerable hour, pregnant women and their infants are suffering, not from COVID-19, but from the consequences of crumbling health care systems and the secondary effects of the pandemic.

Epidemics, natural disasters, and other crises have shown us, time and again, that we need to rethink how we design, develop and deliver essential services around the world for higher quality care for the most vulnerable and greater health system resilience.

Today, pregnant women, new mothers, newborns, and young children face a potentially deadly paradox: Receiving essential medical care may put them at risk for COVID-19, but they could also be endangering their health if they do not receive care. If they do decide to seek care, they often face health care systems in danger of collapsing under the strain of a pandemic. This is especially true in low- and middle-income countries where maternal and newborn mortality remains unacceptably high.

In Kenya, there are reports that up to 50% of women are either shunning health facilities for fear of contracting the virus or can not access the services. COVID-19 preys on the same health system failings that generally lead to poor outcomes for mothers and their babies. 

The response to the crisis must go beyond getting “back to normal.” Normal isn’t good enough. This health system disruption is an opportunity to redesign essential services for women, infants, and children for better quality care that is person-centered — where women are respected, informed and engaged in decision-making. These systems need to be more able to withstand the next inevitable disruption.

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This is the time to adapt available yet underutilized innovations. These can leverage existing platforms and approaches, like exploring and adapting telemedicine and using mobile technology to link patients to providers and less experienced providers to remote experts. Medical hotlines have been used successfully to provide referrals and help disseminate timely information that can be customized to the month of a woman’s pregnancy or the age of her child; in some areas, these systems are being adapted for COVID-19.

Alternative care models that provide virtual or home-based care for eligible pregnant women, with flexible schedules based on an individual woman’s medical history and preferences, can help desaturate busy clinics and improve system efficiency. 

It is also an opportunity to strengthen at-home and community-based care — delivered locally through community health workers, potentially using mobile technology, which can help ensure women are better connected to care throughout their pregnancies and afterward. 

Issues with PPE bring up a clear opportunity to strengthen supply chains. Gloves, gowns, masks, soap, and water should all be part of basic care. Investment in and focus on stable supply chains for these critical supplies will help address evolving COVID-19 needs, ensure future preparedness, and deliver essential quality care.

This is an opportunity for the governments, researchers, and academic institutions, program implementers, the tech sector, and policy and advocacy organizations — to seize this opportunity. We must invest r time, energy, and resources into designing solutions that can mitigate the consequences of the pandemic, build resilient systems, and catalyze lasting change — a change that finally welcomes newborns and new moms alike with the high-quality care they deserve.

Dr Steve Adudans is the Executive Director, Center for Public Health and Development

Twitter: @SteveAdudans

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