Adapting High Impact Practices in Family Planning During the COVID-19 Pandemic: Experiences From Kenya, Nigeria, and Zimbabwe.

BACKGROUND: We describe how High Impact Practices (HIPs) in family planning (FP) were adapted across Kenya, Nigeria, and Zimbabwe to maintain access to services in response to the coronavirus disease (COVID-19) pandemic. METHODS: Using a qualitative data collection tool structured around 3 HIP categories (service delivery, demand creation, and enabling environment), adaptations in FP programs during the pandemic were documented. We describe adaptations made to 3 specific HIPs: mobile outreach, community health workers, and digital health for social and behavior change. PROGRAM EXPERIENCES: In Zimbabwe, the Mhuri/Imuli project adapted its mobile outreach model integrating community-based outreach with facility-based outreach. The number of outreach clients served per week peaked at 1,759 (July 2020) from a low of 203 (May 2020). Clients choosing long-acting reversible methods increased from 22% to 59% during the 3 months before and after lockdown, respectively.In Kenya, a program addressed youth's hesitation to visit health facilities through youth community health volunteers, who provided counseling, community dialogues, contraceptive pills, and condoms. Over 6 months, the program reached 1,048 youth with community dialogues, and 4,656 youth received FP services. In Nigeria, peer mobilizers provided services through a socially distanced community-based program to help adolescent girls access contraceptive self-injection when movement restrictions limited youth's ability to travel to facilities.In Nigeria, Adolescents 360 adapted sexual and reproductive health information programs for virtual delivery through WhatsApp. A contraceptive education Facebook campaign gained more than 80,000 followers, reached 5.9 million adolescents, and linked 330 adolescents to program-supported facilities from January to March 2021. In Kenya, the Kibera-based project used WhatsApp to reach youth with discussion groups and health workers with skills strengthening. CONCLUSION: Monitoring how projects adapt HIPs to ensure continuity of care during the COVID-19 pandemic can help inform the implementation of successful adaptations in the face of present and future challenges.

Keeping essential reproductive, maternal and child health services available during COVID-19 in Kenya, Mozambique, Uganda and Zimbabwe: analysis of early-pandemic policy guidelines.

BACKGROUND: The COVID-19 pandemic has disrupted the provision of essential reproductive, maternal, newborn, and child health (RMNCH) services in sub-Saharan Africa to varying degrees. Original models estimated as many as 1,157,000 additional child and 56,700 maternal deaths globally due to health service interruptions. To reduce potential impacts to populations related to RMNCH service delivery, national governments in Kenya, Mozambique, Uganda, and Zimbabwe swiftly issued policy guidelines related to essential RMNCH services during COVID-19. The World Health Organization (WHO) issued recommendations to guide countries in preserving essential health services by June of 2020. METHODS: We reviewed and extracted content related to family planning (FP), antenatal care (ANC), intrapartum and postpartum care and immunization in national policies from Kenya, Uganda, Mozambique, and Zimbabwe from March 2020 to February 2021, related to continuation of essential RMNCH services during the COVID-19 pandemic. Using a standardized tool, two to three analysts independently extracted content, and in-country experts reviewed outputs to verify observations. Findings were entered into NVivo software and categorized using pre-defined themes and codes. The content of each national policy guideline was compared to WHO guidance related to RMNCH essential services during COVID-19. RESULTS: All four country policy guidelines considered ANC, intrapartum care, FP, and immunization to be essential services and issued policy guidance for continuation of these services. Guidelines were issued in April 2020 by Mozambique, Kenya, and Uganda, and in June 2020 by Zimbabwe. Many elements of WHO's 2020 recommendations were included in country policies, with some notable exceptions. Each policy guideline was more detailed in some aspects than others - for example, Kenya's guidelines were particularly detailed regarding FP service provision, while Uganda's guidelines were explicit about immediate breastfeeding. All policy guidance documents contained a balance of measures to preserve essential RMNCH services while reducing COVID-19 transmission risk within these services. CONCLUSIONS: The national policy guidelines to preserve essential RMNCH services in these four countries reflected WHO recommendations, with some notable exceptions for ANC and birth companionship. Ongoing revision of country policy guidelines to adapt to changing pandemic conditions is recommended, as is further analysis of subnational-level policies.