Reported Barriers to Healthcare Access and Service Disruptions Caused by COVID-19 in Burkina Faso, Ethiopia, and Nigeria: A Telephone Survey.

Nega Assefa,Yemane Berhane,Phyllis Kanki,Dongqing Wang,Yasir Y Abdullahi,Elena C Hemler,Ourohiré Millogo,Angela Chukwu,Ali Sié,Ayoade Oduola,Firehiwot Workneh,Till Baernighausen,Bruno Lankoande,Wafaie W Fawzi,Michelle L Korte

doi:10.4269/ajtmh.20-1619

Abstract

ABSTRACT.The coronavirus disease 2019 (COVID-19) pandemic may have short-term and long-term impacts on health services across sub-Saharan African countries. A telephone survey in Burkina Faso, Ethiopia, and Nigeria was conducted to assess the effects of the pandemic on healthcare services from the perspectives of healthcare providers (HCPs) and community members. A total of 900 HCPs (300 from each country) and 1,797 adult community members (approximately 600 from each country) participated in the study. Adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) were computed using modified Poisson regression. According to the HCPs, more than half (56%) of essential health services were affected. Child health services and HIV/surgical/other services had a slightly higher percentage of interruption (33%) compared with maternal health services (31%). A total of 21.8%, 19.3%, and 7.7% of the community members reported that their family members and themselves had difficulty accessing childcare services, maternal health, and other health services, respectively. Nurses had a lower risk of reporting high service interruptions than physicians (ARR, 0.85; 95% CI, 0.56–0.95). HCPs at private facilities (ARR, 0.71; 95% CI, 0.59–0.84) had a lower risk of reporting high service interruptions than those at governmental facilities. Health services in Nigeria were more likely to be interrupted than those in Burkina Faso (ARR, 1.38; 95% CI, 1.19–1.59). Health authorities should work with multiple stakeholders to ensure routine health services and identify novel and adaptive approaches to recover referral services, medical care, maternal and child health, family planning, immunization and health promotion, and prevention during the COVID-19 era.

Highlights

The world has dramatically changed since a new viral illness called the coronavirus disease 2019 (COVID-19) emerged.[1]
All healthcare providers (HCPs) from Ethiopia and Nigeria worked at governmental or private facilities that provided secondary or tertiary healthcare; in Burkina Faso, 23% worked at health outposts and centers that provided primary healthcare
This study examined the impacts of the COVID-19 pandemic on health service disruptions in three sub-Saharan African countries from the perspectives of healthcare providers and community members

Summary

Introduction

The world has dramatically changed since a new viral illness called the coronavirus disease 2019 (COVID-19) emerged.[1] The global burden of COVID-19 is changing; recently, more than 73 million individuals have contracted the virus, and more than 500,000 have died.[2] In Africa, more than two million established COVID-19 cases and 50,000 deaths were reported on August 15, 2020, with 48,665 total cases in Nigeria, 27,242 total cases in Ethiopia, and 1237 total cases in Burkina Faso.[3,4] To stop its spread, national governments and international organizations have introduced lockdown measures, strategies, and guidelines for infection control, including social distancing and self-isolation, severely restricting and affecting daily life.[5] Such strategies worsened the accessibility of routine health services because of the sudden freezing of economic activities and significant adverse impact on income across various employment categories.[6] This left vulnerable groups at risk for preventable diseases and complications, especially in sub-Saharan Africa.[7]

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