Abstract
The COVID-19 pandemic has increasingly disrupted the global delivery of preventive health care services, as a large number of governments have issued state of emergency orders halting service delivery. However, there is limited evidence on the realized effects of the pandemic and associated emergency orders on access to services in low-income country contexts to date. To address this gap, this paper analyzes administrative data on utilization of contraceptive health services by women referred via community health promoters in two large urban and peri-urban areas of Mozambique. We focus on the period immediately surrounding the national state of emergency declaration linked to the COVID-19 pandemic on March 31, 2020. Data reported for 109,129 women served by 132 unique promoters and 192 unique public health facilities is analyzed using logistic regression, interrupted time series analysis and hazard analysis. The results demonstrate that the imposition of the state of emergency is associated with a modest short-term drop in both service provision and utilization, followed by a relatively rapid rebound. We conclude that in this context, the accessibility of reproductive health services was not dramatically reduced during the first phase of the pandemic-related emergency.
Highlights
The onset of the COVID-19 pandemic in March 2020 has disrupted the delivery of both primary and preventive health care services across the globe
This paper focuses in particular on its effects on the Integrated Family Planning Program (IFPP), a reproductive health program funded by USAID
Additional limitations include that the analysis focuses on only prescribed contraception provided in public health facilities in a specific setting, and focuses on one particular model of service delivery via community health promoters and public clinics
Summary
The onset of the COVID-19 pandemic in March 2020 has disrupted the delivery of both primary and preventive health care services across the globe. This disruption reflects a range of complex factors, but one important cause is the imposition of government restrictions (states of emergency, travel limitations, and other related measures) that limit the provision of health services. In the developing world especially, these pandemic-related shocks may stall recent gains in enhancing access to primary health care, especially for vulnerable women and children [1, 2]. Progress toward the related Sustainable Development Goals (namely goal 3.1, reduction of the global maternal mortality ratio, and goal 3.2, reduction of neonatal and under-5 mortality) may be at risk [3].
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