By Mahua Sen, Senior Adviser, Health Information Systems and Dr Heidi Gagnebe-Marriott, Director, Organizational Learning and Evaluation, members of the COVID-19 Taskforce.
During the global crisis resulting from COVID-19, IPPF’s priority has been to minimize the disruption and ensure the continuity of sexual and reproductive health (SRH) service provision, especially to those who are most vulnerable. While IPPF members are working hard to ensure access to quality SRH services, the Secretariat’s challenge was to document the impact of COVID-19 on members and use the information to support them with critical resources, including additional funds, contraceptive commodities and personal protective equipment. Expertise on the implementation of digital health interventions was also shared widely.
To document the impact, two rounds of online surveys were conducted by the COVID-19 taskforce before seeking service utilization data. Findings from both rounds provided a wealth of qualitative information, demonstrating clear evidence of the impact of COVID-19 on members’ service provision. Following the surveys, the Secretariat sought access to more detailed quantitative data from a sample of members to investigate further the impact of COVID-19 on their SRH programmes.
It was important to find answers to a number of questions using the qualitative and quantitative data:
- Have SRH service volume and client numbers been impacted by COVID-19 in the member countries?
- If yes, has any particular category of SRH service been impacted more than others?
- Is the reason internal (provider scarcity, clinic closure etc.) or external (lockdown by government, banning transport, change of rules not pronouncing SRH services as non-essential services)?
- Is the decline in SRH service provision linked directly to COVID-19 or is it caused by seasonal variation in uptake of services or other external factors?
- How far have members been able to utilize innovations in service delivery, including comprehensive sexuality education (CSE), using digital health interventions?
Conscious of not adding to the data burden on staff during these difficult times, and respecting the diversity of the Federation, we gave the option for members to either grant us access to their databases to collate more frequent, granular data directly in the format that we needed or complete a simple template. While some members were willing to provide direct access to their databases, others preferred to complete the template we shared.
We obtained monthly, age and sex-disaggregated data for major categories of SRH services, such as contraceptive, safe-abortion, HIV, STI, obstetrics and gynaecology; along with data on contraceptive items provided, client numbers and provision of CSE to young people through face-to-face versus digital sessions.
To date, we have analysed monthly data over an 18-month period of time (January 2019 – June 2020) from 11 members, both large and small and from four regions. We compared data in three blocks of three months each, that is March-May 2020 data was compared with the same period last year (March-May 2019) as well as the previous three-months (December 2019 – February 2020).
Data collected on each indicator showed an overall reduction. Total number of clients decreased by 42% while the overall SRH services provided declined by 44%. The decrease is steeper still in the number of young clients (49%) and services provided to young people (50%).
This exercise was a learning for all of us in better understanding the data culture across the Federation, and in appreciating data as a critical asset. At a global level, we currently collect institutional data for our Annual Performance Report, but to ensure data are used in decision-making for actionable outcomes, as COVID-19 has made us acutely aware, we need to collect data more frequently and at a more detailed level to utilize it effectively. The COVID-19 pandemic has highlighted the need to ensure access to more frequent and disaggregated datasets by the Secretariat to be prompt in customizing support and be responsive to donors, trustees and all stakeholders.
The foundation of a robust data culture is trust and transparency. IPPF’s Health Information Systems policy and the Data Management Strategy both emphasize the importance of data governance – that is, how the flow of and access to data is monitored and controlled, and how changes to data systems are agreed and implemented. Data governance also covers policies to ensure confidentiality, protection and security of all data. Both these publications describe processes to improve and maintain data quality so that users can have access to the data they need and confidence in using data for decisions. While the principles of confidentiality and data security were respected at all times during this exercise, there was a lack of consistent understanding to provide access to some databases that would have enabled a more detailed and useful analysis.
The findings from these analyses will now need to be thoroughly discussed at the members’ headquarters and clinics. Furthermore, programmatic input and critical thinking from the COVID-19 Task Force will be vital before we draw conclusions on prioritization and make decisions based on these findings. Members are best placed to make an in-depth review of the reasons behind increases or decreases within individual country contexts and taking into account how the period of lockdown has affected service provision. We will continue to engage with members to clarify whether other factors such as seasonal variations, strategic or programmatic changes have influenced the results to assess the actual impact of COVID-19. But it seems clear that, even after accounting for other influences, the effect of the pandemic on members has been significant and unprecedented.
In the near future, we will intensify our work to harmonize data collection systems across the Federation and to strengthen processes and systems to improve access to data for timely decision-making. However, beyond the technology, we need open engagement among staff across the Federation who are willing and ready to measure better, share better, and as a result implement their SRH programmes better.
It is still uncertain when services requiring providers’ physical interaction with clients will be fully restored, or how long will it take for demand generation to return to the normal level or what kind of long-term changes the COVID-19 situation will bring to the SRHR sector. Nevertheless, IPPF will closely monitor and assess the situation as it progresses globally and take targeted and comprehensive measures to ensure that we continue to strive towards an open, collaborative, user-centred and accountable data culture in IPPF and we will need your continued support and constructive engagement to achieve that goal.
The IPPF COVID-19 Taskforce is setting a new benchmark of collective decision making and actions to contribute to the vision of a Unified Secretariat. Its Microsite and Slack channel have been invaluable to share news throughout the Federation.
Please do continue to engage with each other and the Taskforce through them. In particular, the #innovation and #services Slack channels are a great place to share members experience and enable peer support where other members would like to replicate DHIs.
And you can stay up to date on the work of the Taskforce through the actions and decisions page here: Actions and decisions from the COVID-19 Taskforce
In solidarity,
Mahua Sen and Dr Heidi Gagnebe-Marriott
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