Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
Highlights
During a health crisis such as the COVID-19 pandemic, high-quality and resilient health systems have two tasks: respond to the crisis and maintain provision of other essential health services[1–3]
We used administrative and Routine Health Information System (RHIS) data on the number of health services provided each month for the period of January 2019 to December 2020
Using administrative and RHIS data from ten countries, we assessed the effect of the COVID-19 pandemic on a spectrum of health services
Summary
During a health crisis such as the COVID-19 pandemic, high-quality and resilient health systems have two tasks: respond to the crisis and maintain provision of other essential health services[1–3]. As of December 2021, more than 270 million people have been infected with COVID-19, leading to 5.3 million deaths globally[4]. Owing to its prolonged nature, the pandemic will have widespread indirect effects. Among these effects, concern is increasing that lasting declines in healthcare use could reverse decades of progress in improving health outcomes in low- and middle-income countries (LMICs) and puts people at increased risk of avoidable illness and death. Several reasons have been cited for declining healthcare use during the pandemic, including the public’s fear of becoming infected while visiting health facilities, the suspension. Public sector (serves approximately 80% of the population) and private sector for some indicatorsa All health facilities in the country (except Tigray region)b All health facilities in the country
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