Reproductive health under COVID-19 - challenges of responding in a global crisis.
Reproductive health under COVID-19 - challenges of responding in a global crisis.
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DOI：
10.1080/26410397.2020.1773163
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发表时间：
2020-12
影响因子：
6
通讯作者：
Elliott M
中科院分区：
文献类型：
--
作者：
Church K;Gassner J;Elliott M
2019冠状病毒病大流行迅速而显著地改变了性与生殖健康（SRH）护理的规划格局。自2020年3月宣布全球大流行以来，前线服务提供能力一直受到威胁。像许多提供者一样，我们的组织玛丽斯托普斯国际（MSI）是世界上最大的非政府性健康和生殖健康护理提供者之一，正在迅速发展其服务提供模式，以应对这一挑战。这一观点是根据作者的经验建立的，他们是玛丽·斯托普斯国际组织证据、营销和全球业务部门的负责人，也是我们工作人员的经验，以及从我们开展业务的37个国家方案的情况分析跟踪、内部沟通、工作组和会议中收集的信息。来自一线服务提供组织的越来越多的报告表明，避孕、堕胎、堕胎后护理和更广泛的性健康服务的供应和提供正受到COVID-19的严重影响。1，2根据我们自己的经验，这影响了多个服务提供渠道。在多个国家，我们的静态诊所因严格的封锁而被迫关闭，大多数诊所的营业时间缩短。在孟加拉国、印度、尼泊尔和津巴布韦等一些国家，严格的封锁正在放松;在其他国家，人们乐观地认为，随着政府认识到避孕和堕胎服务的重要性，服务可以恢复。许多由捐助者资助的国际性健康和生殖健康方案利用移动的外展服务，在偏远农村或服务不足的城市地区提供免费避孕药具。我们的团队要么被暂停（由于旅行限制或担心冠状病毒从提供者传播到客户，反之亦然），要么团队不得不大幅减少他们的地理覆盖范围。有些人仅限于在较大的、更城市化的、静态的保健设施提供护理;另一些人不得不停止提供永久性和长效避孕药具。疫情亦影响国际组织向公共部门提供技术援助：内部旅行限制限制了培训及质量保证工作，而在我们经营业务的多个国家，基层医疗服务提供者需要重新专注于COVID-19应对或限制与客户的接触。我们还观察到，由于无法进入、社区参与减少或担心感染，所有渠道的客户数量都在下降。在某些情况下，后者增加了对医疗保健提供者和客户的耻辱。在灵活的捐助者的帮助下，服务提供组织可以适应，尽管计划枢轴不太可能弥补大流行对性健康和生殖健康服务的巨大负面影响。我们能够迅速作出的调整包括物理距离政策（例如通过在诊所引入预约制度）、加强感染预防，以及重新利用社区参与或健康促进活动，以提供准确的COVID-19信息和性健康和生殖健康信息。例如，乌干达玛丽·斯托普斯正在帮助地区卫生办公室利用扩音器和挨家挨户访问分享国家感染预防信息。传统的脸-
The COVID-19 pandemic has rapidly and dramatically altered the programming landscape for sexual and reproductive health (SRH) care. Frontline service delivery capacity has been threatened since the March 2020 declaration of a global pandemic. Like many providers, our organisation, Marie Stopes International (MSI), one of the world’s largest non-governmental SRH care providers, is rapidly evolving its service delivery models to respond. This perspective is built from the experience of the authors, who head the evidence, marketing and global operations divisions in MSI, and of our staff, with information gathered from situational analysis tracking, internal communications, working groups, and meetings across the 37 country programmes where we operate. A growing number of reports from frontline service delivery organisations indicate that the supply and provision of contraception, abortion, postabortion care and wider sexual health services is being heavily affected by COVID-19. 1, 2 In our own experience, this is affecting multiple service delivery channels. In several countries, our static clinics were forced to close due to strict lockdowns, and most are operating on reduced hours. In some countries, like Bangladesh, India, Nepal, and Zimbabwe, strict lockdowns are easing; in others, there is optimism that services can resume as governments recognise contraception and abortion services as essential. Many donor-funded international SRH programmes use mobile outreach to deliver free contraception in remote rural or under-served urban locations. Ours have either been suspended (due to travel restrictions or fear of coronavirus transmission, from providers to clients, or vice versa), or teams have had to drastically reduce their geographical coverage. Some have been limited to delivering care in larger, more urban, static health facilities; and others have had to cease delivery of permanent and long-acting contraceptives. The pandemic is also affecting provision of technical assistance by international organisations to the public sector: internal travel restrictions limit training and quality assurance work, and in several countries where we operate, primary care providers have needed to refocus on COVID-19 response or limit contact with clients. We have also observed declining client numbers across all channels, due to inaccessibility, reduced community engagement, or fears of infection. In some instances, the latter has increased stigma towards health care providers and against clients.Helped by flexible donors, service delivery organisations can adapt, although programme pivots are unlikely to compensate for the overwhelmingly negative impact of the pandemic on SRH services. Rapid adaptations that we have been able to make include physical distancing policies (for example through the introduction of appointment systems in clinics), enhanced infection prevention, and repurposing of community engagement or health promotion activities to deliver accurate COVID-19 information and SRH information. Marie Stopes Uganda, for example, is helping district health offices to share national infection prevention information using megaphones and door-to-door visits. Traditional face-