A time series analysis of disruptions to maternal and child health care in northern Togo during the COVID-19 pandemic in the context of an integrated primary care program

Abstract

There are significant concerns that COVID-19-related disruptions in routine health care will reverse the gains made over the past 2 decades in reducing maternal and under-5 mortality in low- and middle-income countries. The objective of this study was to examine the extent of disruptions in community-based maternal and child health services and explore community perceptions and experiences with health care use in the year following the start of the COVID-19 pandemic in one district in northern Togo, West Africa. This study included analysis of multiple types of data including: (1) routine health management information system data from 18 public sector health centers, (2) programmatic data collected through an integrated health center- and community-based primary care program at 5 health centers, and (3) semi-structured interviews with health center managers, community health workers (CHWs), and community members at those 5 health centers. We found only short-term declines in service utilization coinciding with the COVID-19 pandemic and no decline in the delivery of community-based care by CHWs. Qualitative data were consistent with the quantitative results, reporting sustained use of health-care services. Multilevel factors related to the continued provision of care during the COVID-19 pandemic included regular and clear communication from CHWs as trusted community sources, risk minimization at the health-center level, continued provision of community-based care by CHWs, and collaboration between community leaders and health-care workers to limit COVID-19 transmission. Findings demonstrate resiliency of an integrated primary care system when equipped with an adequately trained, supervised, and supplied health workforce, implementation of infection prevention and control measures, communication by trusted community sources, and adaptations to health-care delivery that enable the continued provision of care.