This article was originally published in the Pacific Journal of Reproductive Health. 2020;1(12):626–8 and is reproduced here with permission.

Sexual and reproductive health services have been significantly impacted by the COVID-19 pandemic globally including in the Pacific. The responses to the pandemic by these services have also been affected by the number of cases in different countries. There have been reports in the Pacific of resource reallocation and reprioritisation, fear-based decision making, and the closing of family planning programs due to resource limitations and in response to COVID-19 transmission.¹

During crises such as COVID-19, services provided by local health providers such as the Reproductive and Family Health Association of Fiji (RFHAF) and the Tuvalu Family Health Association (TuFHA) are essential. This is because during a crisis, vulnerable populations, particularly women and girls, are disproportionately affected.²

Furthermore, travel bans and border closures, such as those that have occurred in both Fiji and Tuvalu, contribute to supply chain issues and stock outs of contraceptive supplies and the social and economic impact of physical distancing and lockdowns in these countries have prevented people from accessing the essential services during this crisis.³

Yet, the pandemic has also provided an opportunity for these services to reach new clients, and trial new ways of operating such as providing outreach services, and the use of social media to attract new clients. This article will focus on the impacts of COVID-19 on service delivery, and explore how, even with severe restrictions, local non-government organisations have been able to continue serving their communities.

Fiji

Fiji has recorded limited cases of COVID-19 since it closed its borders in March 2020. With assistance from Family Planning Australia through the Australian NGO Cooperation Program, RFHAF has worked with government agencies to ensure that sexual and reproductive health and rights information and services were offered during the pandemic.

One particular area of focus for RFHAF since March 2020 has been mobile outreach clinics. This model has ensured that service delivery is brought to communities rather than requiring then to access a fixed clinic. This is because many people are unable to travel to receive services, partly due to COVID-19 lockdowns, but also because of the devastating impact of Cyclone Harold on much of the country in March 2020.

Since March 2020, RFHAF have used mobile outreach clinics to visit districts where services are hard to reach. This has led to an increase in the number of clients receiving positive messages on sexuality education, contraception, cervical cancer and sexually transmitted infections (STI). From these outreach sessions, clinical services have increased both during the outreach services, but also through word of mouth to friends and relatives who may be able to access the fixed clinic.

RFHAF have also utilised social media effectively during the pandemic to reach new clients. For example, a campaign using TikTok and Facebook focused on key messages to vulnerable populations such as young people, who have traditionally not accessed RFHAF services. The messages were focused on creating inviting spaces for key populations to access contraception and STI screening services.

The results from the outreach clinics and the social media campaign have been very encouraging. RFHAF clinical data has shown an increase in the number of vulnerable and marginalised community members accessing these essential services, including adolescent girls, sex workers, LGBTQI and young people. This has led to RFHAF considering how to incorporate these ways of reaching clients into business as usual.

Tuvalu

As at August 2020, Tuvalu had not recorded any COVID-19 cases. While there was an initial lockdown period, the country has self-isolated and no longer receives international flights, which has mitigated the risk of COVID-19.

TuFHA is the main provider of sexual and reproductive health services in the country besides the Ministry of Health run hospital and clinics. TuFHA was included as a member of the government-led National COVID-19 Taskforce and has continued to engage closely with Ministry of Health post-lockdown, particularly in the health subcommittee of the taskforce.

The biggest impact on TuFHA has been on its awareness and education activities. This was because one of the early restrictions imposed when a national state of emergency was declared was a ban on public gatherings. Many of the planned workshops and awareness activities, which were mostly integrated with clinical services, were put on hold.

Clinical services on the main island and the outreach program to the outer islands were also affected due to a massive relocation of the population from the capital Funafuti to the outer islands. This was in line with the recommendations of the National Taskforce and Government. Because TuFHA’s clinical services were mostly focussed on Funafuti, the number of people that could be reached by these programs was greatly reduced. Due to fears and uncertainties regarding COVID-19, many of the outer island communities refused visitations from any teams coming from Funafuti.

To counter this, TuFHA incorporated COVID-19 awareness sessions into the program they were able to conduct after the gathering ban and travel restrictions were eased. There is still some hesitation from the outer island communities with regards to travellers from Funafuti. TuFHA, however, was able to utilise a small window of opportunity to visit two outer islands in June and conducted much needed awareness on sexual and reproductive health and rights and COVID-19 to the communities on the islands. The outreach teams were also able to deliver clinical services to these communities during these visits.

Another impact has been on cervical cancer screening. Currently, Tuvalu only has opportunistic cervical cancer screening. TuFHA, in partnership with Family Planning Australia through the Australian NGO Cooperation Program, had planned to roll out a full program in partnership with the Ministry of Health in 2020. The training required to get the program operational however, has not been able to happen due to COVID-19 travel restrictions which has limited the ability to import the required medical equipment and receive training from international trainers.

The program is set to become operational in 2021, with options currently being investigated on how to ensure delivery of both medical supplies and training in light of expected ongoing international restrictions.

Service delivery must continue

Sexual and reproductive health and rights services remain critical in a COVID-19 world. Despite challenges for both RFHAF and TuFHA, including lockdowns and closed or partially-closed borders, both organisations have been able to respond in their own way to the crisis.

This leads us to two main takeaways. Firstly, the demand for these services does not cease in a crisis but in fact increases. Secondly, delivery of health services by non-governmental organisations is an efficient and effective way of reaching communities because these organisations are part of local communities and are therefore trusted to reach these communities during periods of crisis.

The resilience and determination that both RFHAF and TUFHA have shown by continuing to provide services to their communities provide an example of how to approach sexual and reproductive health and rights during a crisis, and demonstrate the essential nature of these services to communities. It is therefore critical that governments and donors continue to support local stakeholders who have a proven record of delivering healthcare in these environments.

Family Planning Australia acknowledges the support of the Australian Government through the Australian NGO Cooperation Program (ANCP).

1. Church K, Gassner J, Elliott M. Reproductive health under COVID-19–challenges of responding in a global crisis. Sexual and Reproductive Health Matters. 2020;28(1):1-3. DOI: 10.1080/26410397.2020.1773163
2. World Health Organization. Gender equity in the health workforce: Analysis of 104 countries. 2020. Available from: www.who.int/hrh/resources/gender_equity-health_workforce_analysis/en/.
3. UNFPA. UNFPA supplies COVID-19 update. 2020. New York: United Nations Population Fund. Available from: www.unfpa.org/resources/unfpa-supplies-covid-19-update-16-april-2020.