As the COVID-19 pandemic escalates in low- and lower-middle income countries, global health and development leaders warned today of the growing risk of widespread disruptions in access to reproductive, maternal, newborn, child and adolescent health and nutrition services, and urged immediate steps to prevent a secondary global health crisis. A rapid survey of the 36 countries currently supported by the GFF found that nearly half are already reporting life-threatening service disruptions.

The warning came from top representatives of the Global Financing Facility (GFF) Investors Group in response to emerging findings that the COVID-19 pandemic is halting delivery in GFF-supported countries of essential services such as ante-natal care visits, attended births, delivery of child vaccinations and access to family planning, which have been key drivers in recent global reductions in maternal and child mortality. These disruptions are likely to lead to significant increases in preventable maternal and child illness and death.

Considerable evidence from the 2014-16 West African Ebola outbreak exists of the massive negative impact these health emergencies can have on access to basic health and nutrition services. New estimates[1] by researchers based at the Johns Hopkins Bloomberg School of Public Health suggest that, under a scenario in which COVID-19 causes similar disruptions to what was seen in West Africa during the Ebola outbreak, almost 1.2 million children and 57,000 mothers could die over just the next six months. This would represent a 45 percent increase over existing child mortality levels.

“The COVID-19 pandemic poses a potentially enormous setback for global efforts to end preventable maternal and child deaths and achieve universal health coverage by 2030, and could reverse decades of progress,” said Muhammad Ali Pate, Global Director for Health, Nutrition and Population at the World Bank Group and Director, GFF. “The message from GFF partners is clear: Preserving safe and equitable delivery of essential health services for women, children and adolescents must be a central part of an effective global COVID-19 response and recovery.”

In the case of COVID-19, access to reproductive, maternal, newborn, child and adolescent health and nutrition services in poorer countries may be further affected by extremely limited supplies of protective gear for health workers and other lifesaving equipment, restrictions on rights and population movements, and severe economic losses that will affect the ability of poor women and their families to secure transport to health facilities or pay for services. One past study estimated that a 1 percent decrease in per capita Gross Domestic Product (GDP) was associated with a 0.24 to 0.40 percent increase in infant mortality per 1,000 children born, with girls two to three times more affected than boys.

The Investors Group supported rapid action by the GFF to protect essential health and nutrition services in GFF partner countries as part of the COVID-19 response, including by:

  • Building on the GFF’s strong engagement with national policymakers and partnership with the World Health Organization and other international organizations to:
    • Support the development of plans to maintain essential services during the pandemic;
    • Ensure effective coordination of financing (e.g., through resource mapping and expenditure tracking) so that resources are used efficiently;
    • Promote the sharing of good practices and guidance among leaders and health workers in affected countries;
  • Complementing efforts by the World Bank Group and other partners to supply protective equipment for health workers by providing flexible funding and technical assistance for training and other support to frontline health workers;
  • Assisting countries to introduce the service delivery changes that are needed to maintain essential services, such as by separating patients seeking routine health care from those with COVID-19, scaling up the use of telemedicine and other digital health channels, and rethinking strategies for safely getting essential health products into the hands of users through community-based distribution and partnerships with the private sector;
  • Quickly mobilizing technical assistance to develop innovative approaches to social and behaviour change communication to help communities respond to the pandemic, including sharing information on how to safely access essential health services during the outbreak;
  • Taking actions to avoid supply chain disruptions for essential commodities for women, children, and adolescents, such as for family planning;
  • Providing grants for COVID-19 response to countries not eligible for financing through the World Bank Group’s Fast Track COVID-19 Facility.

Supporting Quotes from GFF Investor Group Leaders:

“The COVID-19 health crisis is affecting women, children, and adolescents disproportionately by disrupting basic health services. Afghanistan has come a long way in expanding access to these lifesaving services and we do not plan to see our hard-earned gains compromised. As part of our COVID-19 response, we are working with the GFF and our development partners to ensure equitable and continued access to quality health services and to protect healthcare workers in the frontlines. We stand in solidarity with other countries working to do the same”. Dr. Bashir Noormal, Deputy Minister of Policy and Plan, Ministry of Public Health, Afghanistan

“The experience of past crises has taught us that we need to combine short and medium-term objectives. In responding to this unprecedented pandemic, it is fundamental to ensure the continuity of basic services for women, children and adolescents while minimizing the risk of contagion. This is one of the priorities of the action we want to take  with the support of the GFF in order to avoid a maternal and child mortality catastrophe at the end of this health crisis.” Prof. Léonie Claudine Lougué Sorgho, Minister of Health, Burkina Faso

 "A health crisis of this magnitude can reveal the vulnerabilities of health systems. But it can also prompt us to rethink our response to ensure access to essential services. Coordination of efforts has never been more important than in this response. With the support of the GFF, we have built a strong alliance of financial partners, experts, members of civil society and the private sector to strengthen our response to address the outbreak while ensuring continuity of care.” Dr. Eugène Aouélé Aka, Minister of Health and Public Hygiene, Côte d'Ivoire

“As African countries are in the process of preparing to limit the impact of COVID-19, the pandemic reinforces the crucial importance of investing in health system strengthening and primary health care, particularly in countries with more fragile systems such as CAR. More than ever, the country process supported by the GFF provides an opportunity to integrate crisis response activities and support to health systems to organize and strengthen access to essential services so as not to undermine progress in maternal and child health.” Dr. Pierre Somse, Minister of Health and Population, Central African Republic

“Rwanda has made considerable progress towards achieving Universal Health Coverage due to its vision of inclusiveness, equity and integrated quality service delivery. To sustain the progress amidst Covid-19 pandemic, it requires comprehensive health policies that recognize the importance of building strong primary health care systems and ensures continuation of basic lifesaving services, especially for women, children and adolescents. We are working with the GFF and other partners to ensure that these groups aren’t left out.” Dr. Daniel Ngamije, Minister of Health, Rwanda 

 “As we are beginning to experience the impact of the COVID-19 crisis both on our economy and health systems, one thing has become clear: that investing in health is investing in economic growth. Together with the GFF and other partners, we are working to prioritize our response to protect the poor and most vulnerable both from a health and economic perspective to ensure that the COVID-19 pandemic does not derail the gains we have made over the last decades.” Prof. Mthuli Ncube, Minister of Finance and Economic Development, Zimbabwe

“The lockdown doesn’t prevent women from having babies, so they need to access sexual and reproductive health services, and we are happy to collaborate with the GFF to ensure services are accessible and available to those who need it.  Amos Mwale, CSO Representative to the GFF IG, and Executive Director of Center for Reproductive Health and Education, Zambia 

“We are experiencing a global health emergency that requires a true global response to make sure we don’t lose the significant progress that’s been made to improve the health of so many women and children around the world. We must collectively act now to provide essential services in the short term and also continue to lay the groundwork for stronger, more equitable primary health care systems that will save millions of lives in times of crisis and in calm.” Dr. Chris Elias, President of the Global Development Division at the Bill & Melinda Gates Foundation and Chair, GFF Investors Group

“The COVID-19 virus knows no borders. This has been a wake-up call for the world to stand in solidarity and work together. If there was ever a time for countries and governments to support one another and maintain the delivery of health, nutrition, and sexual and reproductive health and rights services for women, children, and adolescents, it is right now.” Karina Gould, Minister of International Development, Global Affairs, Canada

"Germany supports the efforts of the GFF and its partners in strengthening health systems to tackle the COVID-19 pandemic and sustain essential health services, especially for women, adolescents and children. Continued and safe access to key services for sexual and reproductive health remains key to resilient societies and economies.“ Dr. Maria Flachsbarth, Parliamentary State Secretary, Federal Ministry for Economic Cooperation and Development (BMZ), Germany and SheDecides Champion.

 “In situations like the current COVID-19 pandemic it is crucial to work simultaneously on immediate crisis response as well as regular care for most vulnerable groups. The Netherlands strongly supports the GFF approach: populations and health workers should maintain confidence in health systems so COVID-19 patients can get proper care and women can safely give birth.” Sigrid Kaag, Minister for Foreign Trade and Development Cooperation, the Netherlands

 “In the extraordinary situation the world is facing, we need to protect women, children and adolescents from becoming more vulnerable. It is imperative that we reach the most marginalised with health and nutrition services also during crisis. Norway supports GFF’s efforts in assisting countries in Covid-19 preparedness and response.” Dag Inge Ulstein, Minister of International Development, Norway

“Protecting the health of women, adolescents and children is our unchanged priority and an important part of our mission to realize human security, despite the challenge of the Covid-19 pandemic.  We all should come together to fight against this unprecedented threat to the global community, and to help the most vulnerable. JICA will continue to work with the GFF and its partners to ensure undisrupted delivery of quality health services anchored in Universal Health Coverage, which leads to establish a more resilient society.” Shinichi Kitaoka, President, Japan International Cooperation Agency (JICA)

“Given the current Coronavirus crisis, our commitment to global health security is more essential now than ever. We must make sure sexual, reproductive, maternal and new-born health services continue to be prioritised in our response to the pandemic, to stop mothers and babies dying unnecessarily. The UK supports the GFF’s critical work to protect these services and we call on our partners to make supporting them a priority in the current crisis.” Wendy Morton, Minister for International Development and the Foreign and Commonwealth Office, United Kingdom

“Safeguarding life-saving routine immunisation programmes during the COVID-19 response and recovery is key to avoid the resurgence of preventable diseases, which will overwhelm already stretched health systems and increase inequities. Gavi is actively supporting partner countries in their national response plans and sustaining immunisation programmes, as well as helping accelerate the development, manufacturing and distribution of the eventual COVID-19 vaccines”. Dr. Seth Berkley, CEO, Gavi the Vaccine Alliance

“The COVID-19 pandemic has created hardship for millions worldwide, but as usual, the rights and health of women and girls are being impacted in disproportionate and profound ways. They are even more at risk for issues like unwanted pregnancy and gender-based violence, all while many have taken on increased caretaking duties. The urgency of these issues cannot be understated. The GFF’s Investor’s Group recognizes that the needs of women and girls should be central in all COVID response efforts and stands in solidarity with all those working to ensure continuation of these essential services at this unprecedented time” Dr. Senait Fisseha, Director of Global Programs, the Susan Thompson Buffett Foundation

 “We need to ensure health workers are competent, confident and safe, through capacity building for managing the new situation, but also avoiding disruption in ongoing continued professional development, training of students and newly educated staff. In a situation like this we need to respond fast and we need to do it together.” Tore Laerdal, Chairman of Laerdal Global Health

“COVID-19 is exacerbating many issues in healthcare delivery, including maternal health services. How we act now – working across sectors to address these gaps and strengthen health systems for the long-haul – will have far-reaching implications, and we are committed as part of the private sector to help bring the resources and innovations needed for women and girls.” Mary-Ann Etiebet, Executive Director, MSD for Mothers

“Now is a time for solidarity, resolve and selflessness. We must not forget that there are people we may not immediately see, who are at great risk as a result of the consequences of the crisis: the pregnant women, who need antenatal care, but are unsure whether it is safe to go to the clinic. The women in abusive relationships trapped at home for the foreseeable future and fearing for their safety. The tens of millions of people in refugee camps, who are counting down the days until the coronavirus arrives.” Dr. Natalia Kanem, Executive Director, United Nations Population Fund (UNFPA) 

“As COVID-19 cases surge worldwide, the survival of pregnant women and children is at great risk due to strained healthcare systems, and the disruption life-saving health services. To save lives, we must invest in better quality care for women and children and continue to provide essential services and supplies to them.”  Dr. Stefan Peterson, Associate Director and Global Chief of Health, United Nations International Children's Emergency Fund (UNICEF)

About the Global Financing Facility and the Investors Group

The Global Financing Facility (GFF) is a multi-stakeholder partnership helping countries tackle the greatest health and nutrition issues affecting women, children and adolescents. The GFF brings partners together around a country-led plan, prioritizing high-impact but underinvested areas of health. Contributors to the GFF Trust Fund include the Governments of Burkina Faso, Canada, Côte d'Ivoire, Denmark, Germany, Japan, the Netherlands, Norway, Qatar, and the United Kingdom; the Bill & Melinda Gates Foundation; the Susan T. Buffett Foundation; the European Commission; Laerdal Global Health; MSD for Mothers and the Rockefeller Foundation. To support the GFF’s work at the country level, these and other partners that are part of the GFF—including representatives of other governments, civil society organizations, WHO and other UN agencies, Gavi, Global Fund and private sector organizations—come together regularly as members the GFF Investors Group to discuss progress and collaboration. The GFF Trust Fund acts as a catalyst for financing, linking to the World Bank’s IDA and IBRD financing, aligned external financing, and private sector resources. Each GFF investment is multiplied by countries’ own commitments—generating a large return on investment, ultimately saving and improving lives.

Learn more: www.globalfinancingfacility.org and @theGFF

Media Contact:

Nansia Constantinou, Global Financing Facility, +1 (202) 458-5008, nconstantinou@worldbankgroup.org 

[1] The estimates are from a study published in the Lancet