Here are some more observations from the LSHTM study, with examples of local solutions.
B. Overall quality of care is deteriorating, owing to:
1. Under-staffing of existing services
- High levels of staff absenteeism and resignation.
- Health workers redeployed elsewhere.
- Less skilled/unqualified health workers assigned to maternity care (locum staff, students and interns).
- Stressed, demotivated and tired health workers, with fear of unsafe working environment, including key support workers such as cleaners.
- Badges/permits to allow health workers to travel during lockdown/curfew.
- Telementoring to support (lone) healthcare workers.
- Change in rosters of nurses and doctors to reduce numbers of people per shift and lengthen shifts, with the intention of limiting exposure of all personnel at the same time.
- Active involvement of facility staff in forums to share ideas for adapting services/care and for problem-solving.
- Peer support systems for health workers’ mental health and psychosocial well-being.
2. Rapidly changing guidelines with unclear or inconsistent communication
- Some advice may become outdated or may be proven dangerous; mechanisms to share updates are not clear and dissemination slow and limited.
- New information coming in rapidly, no systems to digest/disseminate this to health workers.
- Minute-by-minute barrage of fake and real news, causing anxiety and fear.
- Confusion over PPE for different contexts and workers.
- Hospital-produced protocols in every department on managing suspected and confirmed COVID-19 cases.
- Virtual training to strengthen IPC knowledge and practice, for COVID-19 cases, and dissemination of new guidelines.
3. COVID-19 aggravates existing challenges and weaknesses in provision of maternity and newborn care and brings new ones.
- Limited availability of COVID-19 test kits; results take 1–2 days.
- Disruption of imports of medicines/commodities, increased costs.
- Lack of PPE...
- Forced separation of mothers with suspected/confirmed COVID-19 (and those in isolation while waiting for test results) from their newborns, breastfeeding prohibitions, barring parental visits to newborns in neonatal units.
- Local fundraising to purchase PPE for maternity ward staff.
- Guidelines for wearing and laundering facility health worker uniforms.
- Improving maternity ward layout consistent with outbreak management, emergency hotlines for PPE shortages...
CITATION: Protecting hard-won gains for mothers and newborns in low-income and middle-income countries in the face of COVID-19: call for a service safety net
Wendy Jane Graham et al. BMJ Global Health 2020
Correspondence to Professor Wendy Jane Graham; Wendy.Graham@lshtm.ac.uk