How R4D is responding to the COVID-19 pandemic

The COVID-19 pandemic has been devastating for health systems, economies and overall human and socioeconomic conditions in many countries.

Governments and global partners often respond to a health crisis caused by an infectious disease by focusing solely on reducing transmission and mitigating the immediate effects of the disease. However, when health systems are overwhelmed or patients and health workers stay away from health facilities due to fear of transmission or lack of trust, mortality from other treatable conditions can also increase dramatically. Other health threats can become exacerbated as attention shifts to the outbreak response, and new threats can emerge.

In addition to the direct strain on health systems, the pandemic is putting stress on other sectors and systems as well. For example, 1.37 billion students have been affected by school and university closures, representing more than 3 out of 4 children and youth worldwide. The pandemic is also is also impacting food systems and is driving up food insecurity and malnutrition around the world.

A systems-focused multi-sectoral response to the pandemic is imperative. And a highly effective response has potential to leave aspects of health and education systems stronger in the future.

How R4D is positioned to help:

R4D brings a combination of technical expertise and approaches to engagement at the country, regional and global level to effectively support a systems-focused multi-sectoral response to the pandemic.

R4D is well-placed to engage with country stakeholders, with locally-hired staff in nine countries in Africa and Asia (Benin, Botswana, Ethiopia, Ghana, Indonesia, Kenya, Nigeria, Senegal, and Tanzania) that are well connected to Ministry of Health officials and other key stakeholders. R4D also has built strong partnerships with regional and country institutions that are the go-to source of health system strengthening support for their countries and/or regions.

R4D is supporting the COVID-19 response in four ways:

Providing direct support to country change agents

We support change agents to translate knowledge, adapt innovations, and build institutions and processes to solve system challenges. Due to the pandemic and the inability to work alongside change agents in every instance, R4D is embracing approaches such as virtual co-creation. R4D is also working with local and regional experts to support change agents through the coaching approach.

  • In Ghana, R4D’s Health Systems Strengthening Accelerator is supporting the Office of the Presidential Coordinator on COVID-19 to coordinate the national response across all relevant sectors, levels of the health system, and partners. R4D is helping the government identify and connect with local, and international experts, to develop contextually appropriate approaches for testing, quarantine, treatment, social distancing, risk communications and command structures. The team is also working with the University of Ghana to develop dashboards to provide real-time insights for Ghana’s Presidential Coordinator. The program’s support is helping Ghana determine its own approach to the pandemic, and will help prepare the country to deal with future health emergencies and disease surveillance efforts.
  • Through our African Collaborative for Health Financing Solutions (ACS) project, R4D is supporting local CSO partner Réseau Accès aux Médicaments Essentiels (RAME) with its COVID response in Burkina Faso. RAME brought together a small group CSO leaders and all agreed that a coordinated response was needed and helped to launch a social campaign dubbed “Communities get rid of COVID-19” (COMVID COVID-19), which put out a call for help and quickly mobilized a network of 300 civil society organizations, representing many different sectors. The group has created committees to spearhead activities in the 52 sectors (similar to districts) in Ouagadougou. These activities range from disseminating accurate information to distributing face masks and handwashing stations. The group has also been involved in distributing food and advocating for the government to clarify its position on masks. Another R4D partner in Burkina (RESAD) is documenting the experience to share with others. (The photo above, courtesy of RAME, features members of COMVID COVID-19.)
  • In Ethiopia, R4D is playing a lead role in the Ethiopian Pharmaceutical Supply Agency’s (EPSA) COVID-19 Supply Chain Response Coordination Taskforce, to ensure that critical commodities for COVID-19 and essential health services are available where they are needed, despite a range of global supply chain, governance and operational risks. Under the umbrella of R4D’s Market Shaping Capacity Improvement Project, R4D has worked with EPSA and other partners to develop new guidelines on supply chain risks, mitigation strategies, coordination structures and communication mechanisms. R4D will also support EPSA on implementation of these guidelines to ensure all supply chain players in Ethiopia are collaborating effectively and vital commodities are available. R4D is also providing ongoing technical assistance to EPSA on areas such as market shortcomings diagnostics, procurement improvements, and increase of supply from international and local manufacturers — and determining how this can be most impactful in the context of COVID-19.
  • In Tanzania, R4D is mobilizing financial and market shaping technical resources to support government-led efforts to address respiratory conditions. As the COVID-19 crisis unfolded, R4D worked with a key donor to increase financing support for procurement of amoxicillin dispersible tablets (the first line treatment for child pneumonia) in order to expand the government’s fiscal space for the pandemic response. R4D also pivoted from conducting an in-person survey to leveraging remote modalities to understand trends around the availability and stocking of amoxicillin dispersible tablets and other essential medicines at frontline public health facilities. In order to support the government’s analysis of their needs for a comprehensive COVID-19 response, R4D has also curated and shared evidence from a public health facility survey we conducted in 2017 on Tanzania’s capacity for oxygen treatment, highlighting gaps in the availability of diagnostics and treatment modalities, as well as training and human resource needs.
  • As the Guinean government works to roll out their COVID-19 response plan, community health services have nearly grinded to a halt throughout the country. Meanwhile, the government is working to continue implementation of the National Community Health Strategy in the midst of this pandemic. Through the USAID-funded Rapid Feedback Monitoring, Evaluation, Research, and Learning (RF MERL) initiative, R4D is providing rapid feedback to guide adaptive implementation and scale-up of this strategy. RF MERL is partnering with Jhpiego to conduct remote data collection and analysis (through phone-based interviews with community health workers and other health system stakeholders) to determine the degree to which community health workers are trained and equipped to support the roll-out of the strategy, particularly in the COVID-19 context. This engagement will support ongoing efforts to strengthen the health system in Guinea as it works to manage current and future health crises.
  • Civil society, media and other partners around the world are facing challenges related to their freedom to report, to act, and to support human rights as the covid-19 pandemic is being used as a tool by governments to restrict civil liberties and civic space. Through the Illuminating New Solutions and Programmatic Innovations for Resilient Space (INSPIRES) project, R4D is leading evaluation and learning to understand what strategies for protecting and enhancing civic space in these difficult times work best. R4D is conducting data collection and analysis activities and learning checks with partners to assess programming such as analyzing laws related to anti-money laundering efforts, providing media outlets with training on virtual and covid-specific reporting, and undertaking capacity building with CSOs in Africa and Eastern Europe to better protect themselves from the shocks related to the pandemic. The project is currently supporting and analyzing activities in nineteen countries and plans to expand this work in the coming months.

Acting as evidence and innovation brokers and aggregators

We build knowledge about the “how-to” of systems change, including innovations that can accelerate progress, in countries, with emphasis on getting that knowledge into practice.

Facilitating cross-country sharing and learning

We develop networks and platforms that connect individuals and institutions to share, amplify and put into practice evidence on what works.

  • In R4D’s role as the technical facilitator for the Joint Learning Network’s Primary Health Care (PHC) Financing and Payment collaborative sub-group, we have brought 19 JLN member countries together to learn more about various countries’ COVID-19 responses and specifically the role of PHC and community health systems. On April 22, R4D hosted a webinar during which countries heard experiences from China, South Korea and Liberia. Key insights from the webinar included: allowing for greater flexibility in the use of public funds to get information, support and resources to frontline responders; reducing financial barriers to patients seeking care and improving financial incentives for providers delivering care; explicitly identifying COVID-19 services in provider payment systems and fee schedules; and providing adequate payment rates for COVID-19 services. There was also broad agreement that we need to use the COVID-19 crisis response to make the system stronger for the next public health crisis.
  • As the coordinator of the Learning Network for Countries in Transition (LNCT), a country-led network of 17 countries moving toward sustainable immunization programs, R4D is connecting countries with their peers and global experts to exchange challenges and good practices as they continue efforts to maintain immunization coverage in the context of the COVID-19 pandemic. LNCT is using its virtual platform to bring member countries together to address challenges through webinars and discussion groups, its online discussion forum, and a resource page dedicated to resources for COVID-19 response with a focus on national immunization program response. LNCT is hosting a series of webinars focused on COVID-19, including a virtual discussion group for countries to share how they have adapted immunization activities in response to the pandemic, and a webinar to present behavioral strategies for generating demand for immunization during COVID-19. Subsequent webinars will focus on challenges such as maintaining demand for immunization and ensuring the availability of financial resources to strong immunization programs. LNCT is also adapting previously planned activities in the area of demand creation and addressing hesitancy to incorporate response to the unique factors that are influencing demand during the COVID-19 pandemic.
  • As a technical partner of the Primary Health Care Performance Initiative (PHCPI), R4D is facilitating action-oriented collaborative learning to improve countries’ primary health care (PHC) performance. In April 2020, PHCPI launched its digital community of practice with a focus on resilience and PHC. The COP offers members an opportunity to share information and resources on maintaining essential health services and leveraging the PHC system to combat COVID-19. The first community dialogue Strengthening PHC Financing During Emergencies focused on  how to balance autonomy and flexibility for frontline providers to allocate funds for adequate supplies and medicines during the COVID-19 response with accountability for the appropriate use of funds. All who are working to improve PHC measurement and improvement are invited to join the forum.  PHCPI is also collaborating with the Joint Learning Network for Universal Health Coverage to support learning exchanges among country government actors and other key stakeholders to respond to country members’ priority PHC challenges arising through the COVID crisis.
  • As the Secretariat for the International Development Innovation Alliance (IDIA), R4D facilitates the Gender & Innovation Working Group which embarked on a process to identify innovative approaches, partners and solutions to address gender-based violence (GBV). Under COVID-19 rates of GBV have increased, highlighting the urgent need to strengthen systems and approaches to address violence. This paper Innovating to Address Gender-Based Violence presents a collection of 60+ innovative practices to prevent and respond to GBV, including innovations in health, education, policy and services, among others. The collection draws from innovations from a range of bilateral, multilateral, philanthropic and civil society actors. It is meant to encourage further learning and serve as a call to action to develop stronger systems and to further refine, adapt and scale innovations that prevent gender-based violence and promote gender equality.

Informing global policy and action

We conduct global analyses and assessments, and promote learning among international partners to better support country-led systems change.

  • R4D is part of the Standing Together for Nutrition consortium, which just published a study on the impacts of COVID-19 on childhood malnutrition and nutrition-related mortality that was featured in the Lancet. The analyses show dramatic impact for children: Child wasting is projected to increase more than 14% this year due to COVID 19. Wasting and reduced nutrition services will result in nearly 130K additional deaths in 2020 alone without immediate action. In September, the consortium also plans to publish impact estimates for all forms of undernutrition, together with a costed set of priority interventions, and estimates of the impact of the crisis on the donor and domestic financing landscape for nutrition (with R4D responsible for the latter set of analyses).
  • Through its work with Data for Decisions to Expand Nutrition Transformation (DataDENT) — an initiative that aims to transform the availability and use of nutrition data by addressing gaps in nutrition measurement and advocating for strong nutrition data systems — R4D is engaged with the Data for Nutrition community of practice (COP). In response to the challenges stemming from COVID-19, the COP recently hosted a webinar, which highlighted key findings from R4D’s analysis of global nutrition data visualization tools and India-specific nutrition data visualization tools that may have important lessons for COVID-19 data tools.

Photo © RAME

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