Impact of COVID-19 on health services utilization in Province-2 of Nepal: a qualitative study among community members and stakeholders

Devendra Raj Singh,Dev Ram Sunuwar,Lalita Kumari Sah,Sunil Kumar Shah,Bipin Adhikari,Rajeeb Kumar Sah,Kshitij Karki

doi:10.1186/s12913-021-06176-y

Abstract

BackgroundThe COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, particularly affecting the effective delivery of essential health services in resource-poor countries such as Nepal. This study aimed to explore community perceptions of COVID-19 and their experiences towards health services utilization during the pandemic in Province-2 of Nepal.MethodsThe semi-structured qualitative interviews were conducted among purposively selected participants (n = 41) from a mix of rural and urban settings in all districts (n = 8) of the Province 2 of Nepal. Virtual interviews were conducted between July and August 2020 in local languages. The data were analyzed using thematic network analysis in NVivo 12 Pro.ResultsThe findings of this research are categorized into four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and iv) COVID-19: testing, isolation, and quarantine services. Most participants shared their experience of being worried and anxious about COVID-19 and reported a lack of awareness, misinformation, and stigma as major factors contributing to the spread of COVID-19. Maternity services, immunization, and supply of essential medicine were found to be the most affected areas of health care delivery during the lockdown. Participants reported that the interruptions in health services were mostly due to the closure of health services at local health care facilities, limited affordability, and involvement of private health sectors during the pandemic, fears of COVID-19 transmission among health care workers and within health centers, and disruption of transportation services. In addition, the participants expressed frustrations on poor testing, isolation, and quarantine services related to COVID-19, and poor accountability from the government at all levels towards health services continuation/management during the COVID-19 pandemic.ConclusionsThis study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2. It is critical to expand and continue the service coverage, and its quality (even more during pandemics), as well as increase public-private sector engagement to ensure the essential health services are available for the population.

Highlights

The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, affecting the effective delivery of essential health services in resource-poor countries such as Nepal
This study found that essential health services were severely affected during the COVID-19 pandemic in all districts of Province-2
The results are presented under the four global themes: i) Community and stakeholders’ perceptions towards COVID-19; ii) Impact of COVID-19 and lockdown on health services delivery; iii) Community perceptions and experiences of health services during COVID-19; and, iv) COVID-19: testing, isolation and quarantine services

Summary

Introduction

The COVID-19 pandemic has posed unprecedented challenges and threats to the health care system, affecting the effective delivery of essential health services in resource-poor countries such as Nepal. The lockdown measures have severely affected economic activities, population health and mental wellbeing, health care delivery, and health services utilization, in resource-poor countries such as Nepal [6,7,8]. On 24 March 2020, the Government of Nepal imposed a nationwide lockdown which affected the day-to-day activities of the majority population in both rural and urban areas of Nepal. This lockdown came at a very early stage of the pandemic in Nepal and well before COVID-19 community transmissions were observed in the country [11]. Nepal has already been facing a high prevalence of maternal deaths, child deaths, different forms of malnutrition, and the burden of mortality and morbidity associated with both non-communicable and communicable diseases, which may have worsened further by the disruption of health services due to the lockdown [12]

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