Disruptions in Essential Health Services During the First Five Months of COVID-19: Analysis of Facility-Reported Service Volumes in Eight Sub-Saharan African Countries

Abstract

Background: The COVID-19 pandemic and its secondary effects pose a major global threat to the continuity of essential health services. Disruptions in essential services can lead to increases in morbidity and mortality and a protracted public health crisis. We quantify the disruption of the COVID-19 crisis on essential health services, focusing on maternal and child health, in eight sub-Saharan countries.Methods: Service volumes are extracted from administrative systems for the months between January 2018 and July 2020 in eight sub-Saharan countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone, and Somalia. We examine monthly data for 59,546 facilities covering eight selected services. We employ a regression model using data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for secular trends, seasonality, and facility characteristics. Estimates of disruption are derived by comparing these predictions to the observed service utilization level during the pandemic period.Findings: All countries experienced service disruptions for at least one month, but the magnitude, and duration of the disruptions vary. Although decreases in service volume were most common in April and May, there were still significant disruptions as of July. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5,445,068 OPD consultations and 277,018 third doses of pentavalent vaccine during the five months in these eight countries. Decreases in maternal health service utilization are less generalized. Significant declines in institutional deliveries, antenatal care, and postnatal care were detected in four, six, and five countries, respectively. Of the eight countries, the strongest and most persistent disruptions were detected in Liberia, Mali, Nigeria, and Sierra Leone. More limited disruptions were found in Cameroon, the Democratic Republic of Congo, Malawi, and Somalia.Interpretation: Results show that the COVID-19 pandemic caused substantial interruptions in the delivery of essential health services, albeit with significant cross-country variation. While this analysis cannot speak to the causes behind the declines in service utilization, they may be driven by changes in care-seeking behavior due to fear of infection, reallocation of resources, lockdown policies, and income shocks. The design of interventions to mitigate these disruptions requires detailed local knowledge and additional data on the behaviors of health providers and households during the pandemic. Timely monitoring of service volumes through administrative data should be an integral component of a responsive pandemic strategy.Funding Statement: The Global Financing Facility for Women, Children, and Adolescents.Declaration of Interests: No conflicts of interest.