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Season’s Greetings from the East and Southern Africa Region

We have come to the end of a year that challenged our plans, strategies, and programme delivery but also inspired new ways of working and fresh solutions to reaching our goals. The far-reaching impact of the COVID-19 pandemic has not spared any sector and has laid bare the deep inequalities and continued marginalization experienced by millions of vulnerable people the world over, particularly women and youth.

Yet through this, our partnerships have remained strong; on behalf of the UNFPA East and Southern Africa Regional office team, I thank you for your perseverance and commitment despite the new terrain we have had to navigate collectively.

We have seen remarkable examples of innovation, collaboration, and sheer tenacity at the global level all the way down to communities, which demonstrate that we are still moving forward in pursuit of the targets set last year in Nairobi at ICPD@25 - zero unmet need for family planning, zero preventable maternal death, zero gender-based violence and harmful practices and zero sexual transmission of HIV by 2030. 

Nairobi +1

Far from diminishing our resolve, COVID-19 has only refined our focus and increased our tenacity to achieve the ICPD agenda. The breadth and volume of commitments made during the Nairobi summit are proof that the world is serious about realizing this transformative agenda for women and girls. I saw this firsthand in Malawi where one of the first ICPD national committees in the region was launched – to ensure the full implementation of the ten commitments the country made and to keep SRHR firmly on the national agenda.

The reality on the ground also reflects this commitment as government and civil society, in partnership with UN agencies, are working together to stem rises in gender-based violence, teenage pregnancies, and child marriages through the EU funded Spotlight Initiative, the Joint Programme on Girls Education, and 2gether4SRHR. 

Hope in the warm heart of Africa: Malawi’s commitment to sexual and reproductive health and rights for all

Zero unmet need for family planning

The COVID-19 pandemic is compounding the barriers that women and young people face in accessing sexual and reproductive health services. Supply chains were interrupted, resulting in delays of essential health commodities such as contraceptives at health facilities and community distribution points. To counter these delays, UNFPA developed and disseminated guidelines on the continuum of sexual reproductive health services including family planning in the context of COVID-19.

About 2,000 health-care workers were also trained on continuity of family planning services, self-care, infection prevention, and logistics management information systems. We also worked with countries to strengthen contraceptive stock status monitoring through a platform that tracks monthly stock status. Non-UNFPA Supplies Countries (Botswana, Eswatini, and Namibia) at risk of stock out were supported to explore options including accessing Bridge Financing Facility and Third Party Procurement.

Boda Boda drivers deliver contraceptives to the door during Uganda's COVID-19 lockdown

Zero preventable maternal death

The strain of the COVID-19 pandemic on reproductive health facilities including access to services and the level of care has been felt acutely in the ESA region. A joint webinar series co-convened by UNFPA, UNICEF and WHO regional and country-level health teams, representatives from ministries of health, leading academic institutions, and developmental partners in the ESA region was held on a bi-weekly basis to discuss challenges and opportunities in the continuation of Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCAH) services as a core element of country-specific COVID-19 response and recovery plans. This included re-organization of primary health care delivery settings (where needed) and safety of health care workers. We also initiated periodic monitoring of the uptake of RMNCAH services and undertook a comparative analysis of 2020 utilization numbers with 2019 numbers.

Providing free transport to mums-to-be to reach midwives in time during coronavirus lockdown

Zero gender-based violence

Violence against women and girls escalated by an estimated 30 per cent globally during the COVID-19 pandemic. At the onset of the pandemic in the East and Southern Africa Region, UNFPA ESARO carried out a snap analysis (April-May 2020) that showed 13 out of 23 countries in the region had included the prevention of gender-based violence and support for those affected in their COVID-19 response plans to ensure continuity of services.

Working with governments, CSOs, women’s and youth networks, we have ensured the provision of GBV prevention and response services in COVID-19 contexts without compromising the safety of GBV caseworkers or survivors by supporting hotlines and other remote options; strengthening existing shelters, and identifying alternative shelters to meet demand; providing safe transport options or mobile clinics and one-stop centres for victims/survivors to access multi-sectoral services; and ensuring accurate and consistent messages on COVID-19 and GBV are shared to a broad audience through broadcast and digital media.

During the pandemic, we have also seen a global rise in harmful practices including female genital mutilation and child marriage. Through our partnerships including the Joint Programme to end Child Marriage and the EU-funded Spotlight Initiative, we continue to lead multisectoral and coordinated responses including working with CSOs, youth networks, and traditional and cultural leaders to advocate for the abandonment of these practices and reduce the number of girls and young women at risk. 

Communities step up efforts to end harmful practices: the inspiring story of Tilimbike Safe Community Space in Malawi

Zero sexual transmission of HIV

In the ESA region, where more than half of the global population living with HIV lives, mitigating the negative impact of COVID-19 on the provision of HIV and AIDS prevention, care, and treatment services has been central to our work this year. At the start of the pandemic in the ESA region, a rapid assessment of the policy outlook for HIV prevention in the context of COVID19 showed that across the region, HIV prevention services had not been significantly affected. A technical guide was however developed to ensure condom access to the general population during COVID19 lockdown restrictions, including the most vulnerable populations.

Promoting early learnings on the impact of COVID-19 on HIV response, including hosting webinars, tracking HIV response, participation in the global conference on AIDS, and initiating regional documentation of innovation in the delivery of HIV prevention were all key components of a preemptive strategy. Additionally, to ensure key populations are not left out of HIV responses during the COVID-19 pandemic, we supported the development of a regional report on innovative cases on HIV prevention and a regional assessment of the impact of COVID-19 on sex workers in the region with a focus on HIV, human rights and social protection.

We also reprogrammed funding to contribute to the procurement of PPE for health workers and community volunteers, and modern ICT to ensure sustained information dissemination to vulnerable communities. All countries in the region maintained an adequate supply of condoms, except for Botswana that recorded a two-month stock out of condoms at central levels due to supply challenges related to COVID-19 travel restrictions. Several countries innovated to ensure access to condoms in communities.

Boda Boda drivers deliver contraceptives to the door during Uganda's COVID-19 lockdown

Young people

COVID-19 has impacted young people’s lives, and livelihoods significantly. School closures, for example, have led to the disruption of Comprehensive Sexuality Education (CSE), menstrual health management support, and school feeding programmes. We also saw a disruption of health services for young people as health workers were diverted away from adolescent service delivery to COVID care.

Our response was to strengthen our risk communication interventions for young people using social media and online platforms such as with a reach of more than 3 million young people in the region and videos. We also scaled up the remote and/or virtual delivery of integrated HIV, SRHR, and GBV services to young people, accompanied by psychosocial support, including children and adolescent-specific hotlines, a CSE online course for teachers and health providers with references to COVID19, and radio programmes on CSE, Early and Unintended Pregnancy and COVID19, among others.

To ensure youth leadership in the COVID-19 response, in collaboration with WHO, UNICEF, IFCRC, Scouts, Restless Development, and AfriYAN, a webinar series equipped more than 200 adolescents and young people in the region with skills to support and lead the integration of youth issues into COVID19 responses. Online engagements on COVID19 and ASRHR guided by the Prevent, Provide and Protect youth framework were held with Speakers of Parliaments and young leaders in collaboration with SADC PF.

Youth volunteers in Eritrea ensure young people are protected against COVID-19 pandemic

How girls in informal settlements are coping with menstrual health during South Africa's COVID-19 lockdown

People with disabilities

Even before the pandemic, persons with disabilities faced extremely high barriers to sexual and reproductive health information and services. Now, with many services interrupted because of lockdown measures, these services are even less accessible.

UNFPA ESARO convened a three-part webinar series which rolled out the Inter-Agency Standing Committee on Disability Guidance for actors in humanitarian settings, to strengthen information and access to SRHR and GBV services for persons with disabilities. In collaboration with the South African Medical Research Council, dedicated CSE teaching and learning materials for young people with disabilities were developed and country offices were supported in disability-specific resource mobilization.

It is a myth that people living with disabilities do not need to prevent unplanned pregnancies, HIV and STIs – we are not asexual

SRHR, Gender and Climate Change

Climate change continues to disproportionately affect women and young girls, especially those living in the ESA region. At the start of the year, many communities were still recovering from the impact of cyclones Idai and Kenneth; others were experiencing drought or seasonal floods. ESARO co-led the UNFPA Executive Committee endorsement of the Value Proposition on Climate Change and SRHR and will continue to work towards implementing a costed work plan.

In a recent partnership with Queen Mary University London, we have developed a best practice document on Climate Change and SRHR programming informed by an extensive review of existing and pipeline programmes in the region. We are also working on a CSE module on climate change and SRHR (based on a review of existing CSE training material on SRHR and Climate Change) which will be developed with Training-of-Trainer manuals to influence Climate responsive actions by future generations. 

Why family planning is even more necessary in countries in drought due to climate change

Midwives for life

As a critical pillar of maternal health systems, midwives across the region have demonstrated courage and resilience - supporting women and newborns in difficult circumstances and often without the necessary protection to reduce the risk of contracting COVID-19. The pandemic has also significantly disrupted traditional skill building for midwives which normally involves face-to-face training and contact-based service delivery approaches.

To address this gap we established a partnership with the World Continuing Education Alliance to provide sustainable e-learning and mobile learning solutions to frontline health workers in the ESA region. This proven platform, already operational in 19 ESA countries, provides nurses, midwives, and doctors with free access to COVID-19 and SRMNCAH resources developed by leading educators. Additionally, we are working with country offices to promote innovative ICT solutions that allow for virtual care. We are also undertaking regional advocacy to ensure the rights of midwives are respected and they, in turn, can speak up to uphold the sexual and reproductive health and rights of women they serve. 

We owe a debt of gratitude to midwives saving lives during the COVID-19 pandemic

Why it is imperative that we place nurses, doctors, and midwives’ needs and rights at the frontline of the government response to COVID-19

Efficiency in Technical Support to MICs

Many of the Middle-Income Countries (MICs) in the ESA region are among the most unequal countries in the world, such that the socio-economic impact of COVID-19 is expected to further widen inequality gaps. The ESARO MICs Technical Hub supported country offices to ensure the inclusion of SRHR dimensions in socio-economic impact assessments and encourage the active participation of youth in all response and recovery efforts, including in the co-creation of innovations and start-ups that help leverage the power of modern technology to accelerate response and recovery phases.

Through the MICs Hub, UNFPA technical briefs were made available to guide and facilitate on-going national COVID-19 response and recovery actions, as further evidence on the pandemic’s impact was generated by individual countries to further target interventions. As the Covid-19 pandemic evolves and affects countries in diverse ways, the MIC Technical Hub will continue to lead on sustained scanning and information gathering to inform UNFPA engagements.

Looking to the future

We have come through one of the most challenging years in recent development history, and I believe we have emerged more knowledgeable, more dedicated, and certainly more resilient. As we move into the second year of the Decade of Action for Sustainable Development, let us use the experience of 2020 to renew our commitment to the ICPD agenda, deepen our collaboration and strengthen our partnerships to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled by 2030.