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COVID-19 and the Urban Poor in Kenya, Mary Amuyunzu-Nyamongo, Regional Vice President for IUHPE/AFRO (Interim)

Africa has recorded 69,707 cases with 24,141 recoveries and 2,399 fatalities while Kenya is now at 737 cases, 231 recoveries and 40 fatalities. Compared to the rest of the world, the number of people directly affected by the virus in Africa is low. However, the main concern I have with the spread of Covid-19 is on the vast expanse of informal settlements in the region, more so in large cities and urban centers. It is estimated that 55% of urban dwellers in Kenya live in informal settlements. These settlements are characterized by poor environments, poor and crowded housing, lack of access to water and sanitation, and general poverty. The fact that over 80% of the informal settlement dwellers work in the informal sector, which has been adversely affected by the pandemic, adds to my fear for the country and the region generally.

The four social and health promotion actions promoted globally for containing the virus are:  (i) stay-in-doors; (ii) physical (social) distancing; (iii) wash hands and sanitize; and (iv) wear masks. Although there is credence in observing these guidelines, it is not practical for people who have lost their only source of income and who are currently jobless. A woman in an informal settlement in Nairobi asked me: "how can I distance when I live with my 5 children and one grandchild in a small room? Some of these measures are meant for people in big houses, they are not for us.”

The guidance of stay-at-home is also problematic for people who have no food and whose children are hungry. I met a group of women who normally wash clothes and/or houses for people on a daily wage waiting at a roadside in Nairobi. Most were initially hired as domestic workers but soon after the announcement of the first COVID-19 case, their services were terminated. When I asked them what they were doing on the roadside, one of them said: “the donations that come to the settlements never reach us, we are usually excluded and told that the support is for widows, or for one group or other that are on the list of the chief, or on the list of the government. Some of us have given our names to many groups to be considered for social support but we have never received that help. Sitting along this road is better because people can see us here.” In a nutshell, COVID-19 has effectively created a new cadre of poor people who originally were in employment.

For one to wash hands, he/she needs water, yet water is a scarce commodity in informal settlements, and even nationally. In Kenya only 34% of the population has access to water. Sanitizers are also expensive especially for families struggling to buy food and pay rent among other utility costs. Wearing a mask means tapping into resources that are not available. A young man interviewed on media asked: "for me to buy a mask I need Kes. 200 (US2.00), how can I spend this money on a mask when I do not have food?" 

A national curfew was put in place in April and a lockdown in specific places considered hotspots was effected around the same period. These two measures have not only limited movement of people, they have interrupted the flow of food into the urban centers. This could potentially make the cost of food too expensive, especially for the urban poor who are barely surviving. It is clear that the pandemic is exposing our social cleavages with the poor suffering the brunt of the impacts of the disease.

The COVID-19 health promotion activities are being coordinated by the Ministry of Health, however, it is clear that this being a global pandemic, decision-making has been elevated to the level of government ministers and the presidency. However, some of the decisions taken do not take into consideration the individuals and their communities. Consultations with community leaders and opinion leaders are at most ad hoc while the use of the community health structures is still limited. As COVID-19 morphs into community transmission (as opposed to travelers), there is an urgent need to identify and work with community structures. There is a need to empower the communities to put and implement measures to protect themselves. The Government should be at the forefront of providing relief to the poor and vulnerable and ensuring that accurate information is developed, updated and synthesized for use by the different communities. This pandemic will be won through active participation of the communities that are well informed and sufficiently facilitated through resource support by the Government.

May 2020

 


COVID 19 in South Africa, Hans Onya

As at 3 June 2020, there were a total of 37 525 confirmed cases of COVID 19 in South Africa, 19, 682 recoveries and 792 deaths. As of today, a total number of 785 979 tests have been conducted. They has been a daily increase of new cases with 1713 new cases confirmed within the last 24 hours. All 9 provinces have reported confirmed cases and several hot spots have been identified.

As full national lockdown ended 30 May 2020, South Africa shifted to a system of alert levels at provincial and in some cases the district level, based on clear criteria and the rate of infection as well as health system capacity in each area. Many restrictions on public life and gatherings, as well as high – risk activities remains regardless of the alert level.

The difficulty stopping the spread of this virus in South Africa is that people keep spreading it without knowing it before they get ill (pre-symptomatic), people spreading it without ever knowing they have the infection (asymptomatic). Majority of these people live in the urban fringes and informal settlements in cities as well as Black communities living in villages, having limited facilities, including access to quality health care and health literacy/education. Added to these is the level of misinformation and local traditional practice behaviours among community members.

South Africa averted exponential curve in March and the whole country is currently on alert level 3 of 5 levels, (restrictions on many activities, including at workplaces and socially, to address a high risk of transmissions) counting downward. This level 3 allows people to return to work including opening up businesses. In line with WHO/Global Public Health Measures/guidelines, South Africa imposed the following measures in level 3 in all provinces:

Testing, improving health care capacity, field hospitals, PPE procurement, etc. is taking place. As South Africa returns to work, risk mitigation becomes very paramount. Risk communication and community engagement is, more than ever, needed. Government both National and Provincial are intensifying effort including communication using conventional media (including social media platforms) but the extent these strategy achieves its intended outcomes remain questionable.  Case numbers are rising and South Africa is expecting outbreaks (flames). There is already an indication in the Western Cape Province. Additional action is needed from NGOs, CBOs, religious groups, civil society organisations and community leaders to complement Government effort in fighting COVID 19 in South Africa.

June 2020 


COVID-19 has brought an imminent crisis to sexual and reproductive rights and gender equality in low-income countries – the case of Uganda, Patrick Mwesigye

 

The COVID-19 pandemic constitutes the largest global public health crisis in a century, with daunting health and socioeconomic challenges. Governments are taking unprecedented measures to limit the spread of the virus, ramping up health systems and restricting the movement of millions. While COVID-19 has been acclaimed as a public health crisis, its response has also brought an equally imminent crisis to human rights; especially as regards women’s rights and sexual reproductive health and rights and the intersections between the two sub-fields. The pandemic has worsened existing inequalities for women and girls, and deepened discrimination against other marginalized groups. The pandemic is also compounding existing gender inequalities. Uganda like many low-income countries has witnessed an increase in reports of violence against women and even death due to the lack of access to maternal health services due to gender insensitive government guidelines.

In Uganda particularly, health and social systems across the country are struggling to cope. The situation is especially challenging because of the country’s weak health and social systems. Services to provide sexual and reproductive health care has been sidelined, with all attention being put on the COVID-19 response. Over the last three months, the media has reported an increase in the number of women giving birth at home, on the road side as they struggle to reach health facilities and this can only risk high cases maternal mortality and morbidity. The pandemic is also compounding existing gender inequalities. The disruption of social and protective networks, and decreased access to services has exacerbate the risk of violence on women. There are growing reports of increases in gender-based violence and sexual exploitation and abuse, even as related services for prevention and response are under pressure.

The health impacts of violence, particularly intimate partner/domestic violence, on women and their children, are significant. Violence against women has even greater outcomes resulting into serious physical, mental, sexual and reproductive health problems, including sexually transmitted infections, HIV, and unplanned pregnancies. 

As social distancing measures are declared and people are encouraged to stay at home, the risk of intimate partner violence is likely to increase. For example: the likelihood that women and girls in abusive relationships and their children will be exposed to violence is dramatically increased, as family members spend more time in close contact and families cope with additional stress and potential economic or job losses.[1] In Uganda, women are also more vulnerable to economic fragility during confinement and movement restrictions, for reasons that include their far greater representation in informal sector jobs. This vulnerability is in turn and will continue to affect family income and food availability, and leads to malnutrition, especially for children, and pregnant and breastfeeding women.

World Health Organization has noted that ‘the impact of an epidemic on SRHR often goes unrecognized due to the fact that they are not a direct result of the infection but instead the indirect consequences of strained health care systems, disruptions in care and redirected resources. It is therefore crucial for Civil society, community groups and local movements to take up arms and ensure that the rights of women and girls and vulnerable communities are respected and upheld amidst this global pandemic.

And at Uganda Youth and Adolescents Health Forum, we have been active and at the forefront of the COVID-19 response but working towards advancing sexual reproductive health rights and gender rights.

Particularly we have mobilized and created an e-policy platform for dialogue, sharing and learning among policy makers, media, practitioners and young people on making a case for SRHR and gender rights come back to life amidst COVID-19 crisis. We have organized five webinars since March 2019 that have among other things brought together over 1000 key partners and stakeholder together to share experiences and make key recommendations to; challenge negative social norms, address stigma, discrimination as well as challenge myths and misconception on family planning. Our webinars have also built a case for relevant stakeholders to take action to address the rising cases of sexual and gender based violence, child marriages, understand unique menstrual health management challenges for girls and addressing maternal mortality and morbidity. Our books before babies campaign has produced very informative podcasts conversations that are discussing access to contraception, safe abortion, reporting of cases of sexual and gender based violence while the recently launched Suubi Helpline a 24/7 Youth4Youth telephone service is providing accurate information to young people on SRHR issues and making referrals to essential sexual and reproductive health services, post rape care services, and providing psychosocial support and counselling services. Through our coordination role for She Decides Uganda Movement, we have also been able to mobilize and coordinate over 30 CSO partners who are members of the movement to work together to harness the power of our local movement to advance gender equality and SRHR rights amidst COVID-19.

Additionally, we have been running a very vibrant social media campaign under our signature campaign Youth Engage and Take Action for SRHR. The campaign has produced and shared video tool, comics story series among others that have reached out to over 5000 adolescents and young people since the COVID-19 lock down was announced. The animated videos have covered several topics ranging from menstruation, child marriages (part 1 and 2), safe abortion, understanding teenage pregnancies among others.

Furthermore, our change champions have been actively involved in mobilizing and educating refugee communities in Kyaka II refugee settlement on keep safe from and reducing the spread of COVID-19. The have trained the communities in making hand washing facilities like Tippy Taps, making face masks, and they have also been supporting distribution of essential reproductive health commodities like condoms, oral contraception as well as facilitating community referrals for young people to access family planning services, safe abortion services, post abortion care, post rape care services and psychosocial counseling and support. The change champions are also offering sexuality education and contraceptive information to young people through virtual dance parties that feature Uganda’s celebrated music and dance artists.

We are extremely excited and grateful that despite the inconveniences caused by the COVID-19 crisis and the effects of the measure to contain its spread, as a youth led organization, we have been able to made a significant contribution to the response through ensuring that young people’s sexual reproductive rights and gender rights are realized. 

June 2020