Provision of sexual- and reproductive-health services during COVID-19: Perspectives from civil society organisations in Eastern and Southern Africa

Civil society organisations remain some of the most important role players in the provision of services related to sexual and reproductive health and rights to young people and other vulnerable groups in Africa. However, they have always faced many challenges, which the COVID-19 pandemic has now worsened. By Lorenza Fluks and Finn Reygan

In Africa, civil society organisations (CSOs) that support the awareness and provision of services related to sexual and reproductive health face several challenges. These include sociocultural and religious resistance to comprehensive sexuality education, insecure funding support, continued loss of skilled human capital, economic decline, food insecurity, unsupportive legislation and persistent stigma towards lesbian, gay, bisexual, transgender, queer and intersex (LGBTQI) persons.

COVID-19 and lockdown regulations were bound to make things even more difficult. In a recent article published in the International Journal of Infectious Diseases, Rouzeh Eghtessadi and her colleagues warned that “as efforts intensify to tackle the pandemic, it is prudent to prevent COVID-19 from potentially becoming ‘the crisis that crumbled CSOs’ ’’.

Since 2018, the HSRC has worked on the School’s Out Project, engaging CSOs in rolling out education on and support for sexual and reproductive health and rights for young people in the Eastern and Southern African region. Part of the work is to improve understanding of the sociocultural contexts in which programmes linking youth to these services and support are carried out. In 2020, the researchers asked CSO representatives about the impact of COVID-19 on their implementing their programmes. This work used narrative assessment, a qualitative methodology that allows advocacy workers to share their views on whether an approach works in a particular context, as well as whether a strategy helps or hinders the availability and use of services. Using the Zoom videoconferencing platform, HSRC researchers conducted 13 semi-structured, in-depth interviews with 17 CSO representatives from Botswana, Eswatini, Malawi, Mozambique, Namibia, South Africa, Uganda and Zambia.  

Key findings
In line with current literature on CSOs in Africa, the participants in this study confirmed that they needed to cover many impacts of COVID-19 regulations on their staff and programming. School closures as well as restrictions on personal movements and how many people were allowed at gatherings appear to have had the most negative impact. Most notably, organisations that work with young people in schools suddenly had no access to their target populations, and at health facilities, the focus shifted to managing coronavirus-related issues. In many cases, these facilities needed to relook at their normal operational models.

“… the numbers have gone down because we haven’t been able to meet with our customers in the same way we used to meet them before COVID-19 came in.” – Male participant in Malawi

“It has really impacted on our programmes … like the numbers of young people we need to reach. We are not even reaching as many as we thought we would.” – Male participant in Namibia

CSO activities that had been conducted in person were adapted so they could be done online where possible. This was more challenging in countries with poor internet connectivity and high data costs. Where people could access such online opportunities, limited technological know-how presented a challenge.

“Uganda as a country, you know, telecommunication is one of the places that is really, really expensive … and then they have smartphones but they don’t know how to use it. So, there was no way, you know, of helping them to let them know on how to use the phone, you know. They were hearing Zoom calls and stuff like that. What is that? ... How can I participate in this workshop when I cannot connect to Zoom? You know, to connect – stuff like that – that part became such a barrier.” – Male participant in Uganda

In other instances, programmes were scaled down or stopped suddenly, as these were deemed nonessential. Among these were sensitisation programmes on gender-based violence as well as orientation and awareness programmes focusing on diversity and inclusion of LGBTQI persons. Participants viewed this stalling of programming as a potential threat to the gains that they had made before COVID-19, with no opportunities to provide refresher courses or reach the target number of recipients due to movement restrictions and the cost of repeating activities with far fewer participants.

Staff of CSOs are often the heartbeat of the organisation, so their wellbeing is vital. Several staff members who worked from home reported mental fatigue because of isolation. Especially for LGBTQI persons in places where the law is not as supportive as it is in others, isolation meant even more fear and anxiety because of being isolated with people they would normally avoid by spending much time at the office. This situation placed the added burden on CSOs of providing ongoing psychosocial support to staff, with many organisations using wellbeing-focused check-in meetings via Zoom.

“I think initially the fact that we have to start working from home – we weren’t able to go and implement as staff and interns the way we were working. I think … there was a lot of mental fatigue because we couldn’t interact with people, we couldn’t work, we couldn’t do anything and it was a very gloomy period. So, what we did is … we would have check-ins – check-ins on Zoom – just to know how you are doing, ‘how is your mental state?’ and all those things … So, on that aspect, I think we were able to manage.” – Female participant in Zambia  

Despite challenges such as looming stockouts of essential sexual-and-reproductive-health supplies in the Eastern and Southern African region due to closed borders, limited access to the people they usually serve, and unintended impacts on already limited budgets, CSOs adapted swiftly so they could carry out their programmes effectively and ensure the safety of their staff and clients. However, we echo the view of Eghtessadi and her colleagues that the vital role CSOs play in filling the gap between governments and communities should not be overlooked as aid agencies may choose to invest in governments directly, thereby endangering CSOs amid this crisis.

Participants in the School’s Out Project study urged aid organisations to remain flexible with how CSOs use the funds allocated to them during this time, for example, allowing them to improvise on how they give information to target populations, such as through radio and TV programmes, if face-to-face interventions are not possible. We emphasise the continued acknowledgement of and support for CSOs in Eastern and Southern Africa, as they play a key role in the broader development agenda and support democracy in the region. At the same time, CSOs remain intimately connected and up to date with the needs of the communities they serve.

Authors: Dr Lorenza Fluks, a postdoctoral fellow, and Prof Finn Reygan, acting strategic lead of the Identities and Belonging research group and the principal investigator of the School’s Out Project, in the HSRC’s Human and Social Capabilities division.

Acknowledgements: Nomthandazo Mbandazayo, project manager, and Nombuso Khanyile, research assistant), in the HSRC’s Human and Social Capabilities division. Amplify Change funds the School’s Out Project.