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Correspondence to Phillip Wanduru; wandulup@ gmail. com © Author(s) (or their employer(s)) 2021. Reuse permitted under CC BYNC. No commercial reuse. See rights and permissions. Published by BMJ. INTRODUCTION In 2020, Africa had a lower incidence of COVID-19 infections and deaths per 100 000 population compared with many highincome counterparts. 2 Various reasons were hypothesised to contribute to this phenomenon, including political commitment, prompt contact tracing, demographic pyramid, genetics among others. 3 This story changed in mid-2021. Then, many countries that were thought to have ‘successfully’ suppressed COVID-19 infections were battling surging infections and deaths. For example, in Uganda, between July 2020 and May 2021, there were only 362 COVID-19 related deaths officially recorded. This completely changed in June 2021 when there were over 1500 deaths in single month. The deaths in 1 month were fivetimes more than those that occurred during the entire preceding pandemic period. We also saw similar trends during the months of May, June and July 2021 for countries like Zambia, Kenya, Rwanda and the Democratic Republic of Congo. In this article, we focus on the importance of countryled policy development to aid the continuity of essential reproductive, maternal, newborn, child and adolescent health (RMNCAH) services to mitigate the indirect effects of COVID-19 pandemic in countries in subSaharan Africa (SSA). We have focused on RMNCAH services because women, children and adolescents are a vulnerable population whose health has been negatively impacted by the pandemic, and thus the need to prioritise continuity of their healthcare services. CHANGING PARADIGMS IN COUNTRY POLICY DEVELOPMENT AND THE NEED FOR COORDINATION In nonpandemic circumstances, policy making often followed a pattern in which WHO synthesised evidence and issued recommendations, which country programmes could then adapt or make specific to their own context. At the start of pandemic, the need for Summary box