Covid-19 draws the bulk of health sector’s focus, at the expense of children

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Primary healthcare visits for children aged under five years dropped 23% in 2020, as the sector’s focus largely shifted to the response to the  Covid-19 pandemic.

This significant decrease curtailed efforts in the treatment of HIV, tuberculosis and malnutrition among children “in ways that are going to impact on children’s health for years to come, according to Lori Lake, a communication and education specialist at the Children’s Institute at the University of Cape Town. Lake is the co-editor of a series of eight advocacy briefs highlighting the effects of Covid-19 on children based on data in the Western Cape.

“Fifty-nine children died of Covid-19. Yet thousands more children have been affected by the illness and death of family members with over one million children around the world estimated to have lost a primary caregiver from March 2020 to April 2021,” Lake said during virtual launch of the advocacy briefs on Tuesday.

“So there is a need to be thinking about children, even when we are providing adult services.”

Although experts argue children that were spared the brunt of actual Covid-19 infections, their needs were sidelined in the fallout, said Maylene Shung-King, the co-editor of the advocacy briefe.

“While [the experts’ argument] was true in terms of relative numbers of child infections, it completely overlooked the disastrous collateral damage reaped by the pandemic on many facets of children’s lives. As the health system battled to cope with large numbers of sick adults, children’s needs were somewhat sidelined,” Shung-King said. 

She added: “Even in this relatively well-resourced province, our initial responses in protecting children were, unfortunately woefully inadequate.” 

Lake noted that resources, including hospital wards, beds and elective surgeries, were channelled towards the care of adult Covid-19 patients. 

“The in-hospital mortality rate increased, raising concerns about life-threatening delays in seeking care, as children came in later, and sicker,” she said.

On the plus side, measles immunisation coverage in the Cape Town metro ticked up 5% compared with 2019. Hospital admissions for diarrhoea and pneumonia decreased, partly because of Covid-19 non-pharmaceutical prevention measures, like wearing masks, washing hands constantly and physical distancing. 

The advocacy briefs on nutrition and food security predict that child hunger will intensify. South Africa’s current child support grant of R460 a month, or about R15 a day, cannot compete with increasing food prices. This is despite research suggesting a decline in severe and acute malnutrition cases reported at primary care facilities and hospitals in the Western Cape.

“One of the key concerns is whether this means there was actually a decrease at a community level, or whether things have shifted dramatically on the ground and that we are simply not seeing it, because that kind of data is not picked up in the district health information system … That means those cases were not seen, they were not recorded and they were not treated,” Lake said.

Health activist and South African director of the Clinton Health Access Initiative, Dr Yogan Pillay, addressed the inequity affecting children in the country.

“Children should not only survive, but thrive,” Pillay said. “The pandemic provides us with a unique opportunity to reflect on the type of society we have, and what we would like to see it be. The two urgent priorities are to rethink how economies are structured, and place the needs of the most excluded front and centre.”

View all eight briefs on how Covid-19 affected children here.