Health Services In Nigeria Research Articles

COVID-19 Lockdown and Access to Health Services Among People with Mental Health Problems in Nigeria

ABSTRACT This study assessed the roles of COVID-19 lockdown on access to mental health services in Nigeria. 172 patients who visited the hospital before and during the lockdown were recruited. The methods of data analyses were descriptive, correlations and binary logistic regression. The logistic regression confirmed that socioeconomics of participants predicted their likelihood to access mental health services in hospital during the COVID-19 lockdown. Participants accessed treatments in traditional healing homes, home treatment centers, and place of religious worship. Policymakers need to expand the existing programs for accessible and affordable mental health services and standardized alternatives during health emergencies.

Stakeholder perspectives on the governance and accountability of Nigeria's Basic Health Care Provision Fund.

In recent decades, Nigeria has implemented a number of health financing reforms, yet progress towards Universal Health Coverage (UHC) has remained slow. In particular, the introduction of the Basic Health Care Provision Fund (BHCPF) through the National Health Act of 2014 sought to increase coverage of basic health services in Nigeria. However, recent studies have shown that health financing schemes like the BHCPF in Nigeria are suboptimal and have frequently attributed this to weak accountability and governance of the schemes. However, little is known about the accountability and governance of health financing in Nigeria, particularly from the perspective of key actors within the system. This study explores perceptions around governance and accountability through qualitative in-depth interviews with key BHCPF actors, including high-level government officers, academics and Civil Society Organizations. Thematic analysis of the findings reveals broad views among respondents that financial processes are appropriately ring-fenced, and that financial mismanagement is not the most pressing accountability gap. Importantly, respondents report that accountability processes are unclear and weak in subnational service delivery, and cite low utilization, implicit priority setting and poor quality as issues. To accelerate UHC progress, the accountability framework must be redesigned to include greater strategic participation and leadership from subnational governments.

Barriers and Attitudes towards Mental Health Services in Nigeria: A Systematic Review

Mental health services in Nigeria consists mainly of large government psychiatric hospitals. There are eight Neuropsychiatric hospitals and a similar number of teaching hospital psychiatric departments for a population of 200 million people. There is only one private community residential facility available with ten beds in Lagos State and it is administered by a religious organization for rehabilitation of persons with drug problems.In Nigeria, an estimated 20-30%of the population are believed to suffer from mental disorders.MEDLINE EntrezPubmed search was done in November, 2018. Studies conducted on mental health and mental health services in Nigeria done from 2009 till date were selected for review. The studies were grouped into two categories according to the key words used in the search. Category 1: Keywords used in the search: mental health,Nigeria.This search yielded a total of one thousand and fifty (1,051) publications. Category 2: Keywords used in the search: mental health services,Nigeria. Lack of incentives for health care workers and inadequate workforce were identified as some of the barriers against the use of mental health services in Nigeria. Other major barriers identified were- poor education, ignorance, and stigmatization. Absence of services in rural communities, waiting time at the facilities, bureaucracy in treatment and poor information management, high cost of service, travel distance, feelings of shame and loss of productive income were the barriers identified in some other studies conducted in Nigeria.

Preferences in adolescents and young people’s sexual and reproductive health services in Nigeria: a discrete choice experiment

BackgroundBarriers to utilization of sexual and reproductive health (SRH) services by adolescents and young people (AYP) have persisted despite evidence that youth-friendly services have a positive effect on contraceptive use, and patient knowledge and satisfaction.ObjectiveThe objective of this study was to elicit, and derive relative valuations for, attributes of SRH services that adolescents and young people value, and their willingness to pay for these services, in public health facilities.MethodsA discrete-choice-experiment (DCE) that was developed using a mixed methods approach was administered to AYP from Ogun State, Southwest Nigeria. The DCE attributes were: the type of staff; physical environment; health worker attitude; cost; waiting time; contraceptive availability; and opening hours. The choice tasks had two unlabeled alternatives and an opt-out option. Panel mixed logit choice model was used to fit the choice data, along with estimation of willingness to pay (WTP). Also, a latent class logit model was used to detect underlying preference heterogeneity among the respondents. Finally, the uptake of the services in health facilities was investigated by estimating the probabilities for selecting hypothetical health facilities under different scenarios.ResultsA total of 859 AYP participated resulting in 6872 choice observations. The physical environment attribute had the highest utility rating relative to the other attributes, followed by preference for a doctor and for a service provider who was open and friendly. The cost and time coefficients were negative, revealing preference for lower cost and shorter waiting time. The latent class model had three classes that varied by their background characteristics. Probability of choosing any of the facility alternatives increased with introduction of more favorable facility characteristics.ConclusionThe pattern of preferences identified are potential targets for service design and delivery optimization that may result in improvements in service acceptability and utilization. These results strengthen the call for involving AYP in decision-making in health interventions for them and developing context-specific SRH programs for AYP in public health facilities.

Artificial Neural Network Prediction Model for Maternal Health Services Quality in Nigeria

This study presents an innovative approach in predicting the quality of maternal health services in Nigeria using artificial neural networks (ANNs). It focuses on a binary classification task in categorizing maternal health services facilities into "High_Quality" and "Low_Quality" classes. Dataset was collected from diverse healthcare facilities in Nigeria through a WHO Health Resources and Services Availability Monitoring System (HeRAMS) cross sectional-survey report. The collected data was preprocessed; the ANN architecture was developed and trained using back-propagation method. The network was modeled using feed-forward modeling approach with 16 variables at the input layer, 2 hidden layers of 65 and 55 neurons each, and an output of 2 neurons. Hence, 87.17% accuracy with only 2.48% deviation at the 50 epoch was achieved. The model's performance was evaluated using standard metrics of accuracy (87%), precision (88%), recall (89%), and F1-score (88%) to assess its ability to accurately classify maternal health services facilities. The findings of the study can have significant implications to policymakers, healthcare providers, and maternal health advocates to optimize healthcare resources and achieve better maternal health outcomes in Nigeria. Data availability, potential biases in the data, and the subjective nature of some quality-related indicators were acknowledged as limitations. However, despite these challenges, the ANN classification model remains a valuable tool for supporting decision-making in maternal healthcare facility delivery service in Nigeria. Artificial neural network, Binary classification, Health services, Maternal health, Predictive modeling

A quasi-experimental study on health insurance coverage and health services in Nigeria.

Nigeria has the highest maternal mortality rate among sub-Saharan African countries. Recently, universal health insurance coverage has been embraced as a means to enhance population health in low- and middle-income countries. Hitherto, the effect of health insurance coverage on the utilisation of facility-level delivery is largely unknown in the face of the earnest need to lower maternal mortality rates in developing countries. To empirically investigate the association of health insurance coverage on health services utilisation of facility-level delivery and the extent to which public- and private-sector facility delivery in Nigeria had a disproportionate associational effect with health insurance coverage, in the universal health coverage era. A cross-sectional study conducted for Nigeria. This study employed a quasi-experimental method using propensity scores along with different matching methods that were applied to the most recent wave of Nigeria's Demographic and Health Survey (2020) data. Evidence suggests that childbearing mothers from insured households had an average of 25% probability of utilising facility-level delivery relative to mothers from uninsured households in the year that preceded the survey. Moreover, private-sector facility delivery had a 31% higher associational effect with health insurance coverage than public-sector facility delivery, which had an estimated probability of 21%. Expansion of health insurance coverage in Nigeria will be a desirable way to stimulate the utilisation of facility-level delivery by women of childbearing age. Consequently, coverage expansion has the potential to save many maternal and newborn lives in Nigeria.Contribution: This study has contributed to the urgent attention of the federal government of Nigeria to monitor and revamp the health insurance coverage policies of the country for better facilitation of health services to the Nigerian population.

Integrating pediatric HIV testing and treatment with other child health services in Nigeria

Integrating pediatric HIV testing and treatment with other child health services in Nigeria

Determinants of partial and adequate maternal health services utilization in Nigeria: analysis of cross-sectional survey

BackgroundAccess to health services during pregnancy, childbirth and the period after birth provides a substantial opportunity to limit cases of maternal mortality. In sub-Saharan Africa, the proportions of women who utilize health services remain below 70%. This study examined the factors associated with partial and adequate maternal health services utilization in Nigeria.MethodsThis paper used data from 2018 Nigeria Demographic and Health Survey (DHS) comprising 21,792 women aged 15–49 years who had given births within five years of the survey. The study focused on antenatal care attendance, place of birth and postnatal care using a combined model. Multinomial logistic regression was applied in the analysis.ResultsAbout 74% of the women attended antenatal care, 41% gave birth in health facilities and 21% attended postnatal care. While 68% of the women partially utilized health services, 11% adequately utilized the services. The odds of partially and adequately utilizing health services increased for ever married women, women with secondary or higher education, from richest households, living in urban area, having no problem either getting permission to visit health facility or reaching health facility.ConclusionsThis study has revealed the factors associated with partial and adequate utilization of maternal health services in Nigeria. Such factors include education, household wealth, marital status, employment status, residence, region, media exposure, getting permission to use health service, unwillingness to visit health facility without being accompanied and distance to health facility. Efforts aimed at improving maternal health services utilization should place emphasis on these factors.

The Effects of Early Marriage on the Utilization of Maternal Health Services in Nigeria

Antenatal and delivery care are essential maternal health services (MHS) for survival and wellbeing. Nigeria has the highest global burden of maternal mortality with low utilization antenatal and delivery services. Though early marriage is a strong predictor of early pregnancy and childbirth, it is not clear if it is associated with low use of MHS. This study assessed early marriage as a determinant of poor MHS utilization in Nigeria. This study used data from the 2018 Nigeria Demographic and Health Survey (NDHS) which is based on descriptive cross-sectional survey design. The data was limited to ever married women aged 15-24 years. Data was analyzed using SPSS version 20. This study indicates lower likelihood of women who marry early to use antenatal care (OR=0.25, 95%CI=0.21-0.31), receive minimum 4 ANC (OR=0.22, 95% CI=0.18-0.26), receive iron supplementation (OR=0.38, 95%CI=0.33-0.45) and IPTp for malaria prevention (OR=0.57, 95%CI=0.50-0.66). Conversely, Early marriage was found to be associated with higher likelihood of facility delivery (OR=4.6, 95%CI=4.02-5.26) and lower likelihood of delivery by unskilled attendant (OR=0.31, 95%CI=0.26-0.31). These associations disappear in the adjusted model. Nevertheless, the nuanced analysis showed association in the adjusted odd ratio for use of antenatal care (AOR=0.44, 95%CI=0.20-0.99) and number of antenatal care visits (AOR=0.37, 95%CI=0.14-0.95) among women who married at less than fourteen years. Early marriage below age 14 years negatively affect utilization of MHS. There is the need to strengthen legislation against early marriage below 14 years and address socioeconomic challenges that exacerbate vulnerability. Keywords: Antenatal care, Child marriage, Delivery, Early marriage, Maternal health services, Nigeria.

Evidence for "Whole Family Approach" in accelerating uptake of COVID-19 and routine immunizations among integrated primary health services in Nigeria.

The family is the simplest unit but possesses the strongest bond in society. These qualities - bond and proximity - that exist both within and across neighboring families, according to our research, can be instrumental in shaping a new kind of health promotion strategy that can transform health behaviors in communities. The Whole Family Approach (WFA) is a government-sanctioned approach to increase uptake of COVID-19 vaccines in Nigeria. The approach entails leveraging the high family-based demand for some primary health services, such as malaria, diabetes, hypertension, and reproductive services, to generate demand for COVID-19 and routine immunizations. However, since the announcement in 2021, there has been no available evidence to show the impact of the approach on COVID-19 vaccine uptake, though global literature generally favors family-centered health approaches. This study tests the effectiveness of the approach in increasing the utilization of target services in a Nigerian community and further provides a theoretical framework for the strategy. Two primary healthcare facilities were selected in two communities located in Abuja in a quasi-experimental design. After a small-sample landscape assessment of the communities and the facilities, family-targeting health promotion activities were facilitated in the intervention community (integrated health education by trained community health influencers) and facility (opportunistic health promotion through in-facility referrals) for one month. Anonymized service utilization data were acquired from both facilities over a period of four months to analyze their respective month-by-month service utilization trends. Time trend analysis was conducted and revealed that WFA significantly increased service utilization (N = 5870; p < 0.001, α = 0.01, 99% CI) across all the package services provided at the intervention facility. A supplementary Pearson's correlation analysis further presented a positive relationship (r = 0.432-0.996) among the services which favored the result. It can therefore be concluded that the "Whole Family Approach" of health promotion is efficacious in accelerating uptake of priority health services such as COVID-19 and routine immunizations. While there is more to be understood about this interesting approach, we recommend the improvement of communication and capacity gaps in Nigeria's primary healthcare system to ensure that promising strategies such as the WFA are adequately implemented at the community and facility levels.

Improving Community Mental Health Services in Nigeria

Improving Community Mental Health Services in Nigeria

Association between Socioeconomic Status and the Utilization of Maternal Health Services in Nigeria.

Maternal health is the mother's state of well-being before, during, and after conception. Studies have suggested that the increasing maternal mortality rate is preventable provided maternal health services are accessible during pregnancy. This study explored the association between socioeconomic status and the utilization of maternal health services in the Federal Medical Centre (FMC), Abeokuta, Ogun State. This study is a cross-sectional survey. One hundred and eighty-eight pregnant women from the antenatal unit of a tertiary hospital in Southwestern Nigeria were selected using a convenience sampling technique. Data were collected via a pretested, self-designed questionnaire. The descriptive statistics were used to analyze the resulting data, and the hypotheses were tested using the Pearson product-moment correlation at 0.05 level of significance. From the study, 72 (38.30%) and 58 (30.90%) agreed that their income and occupation influence their maternal health services utilization. Significant relationship (p < 0.05) existed between maternal health service utilization and age and between socioeconomic factors (occupation and income level) and utilization of maternal health services of pregnant women. Overall, this study revealed that the level of utilization of maternal health services among expectant women attending FMC is moderate. As this study has shown that socioeconomic factors influence the utilization of maternal health services, we recommend that interventions by health workers targeted at improving the utilization of maternal health services should consider these factors when designing such interventions. It is hoped that this will contribute to reducing maternal mortality and morbidity in this state.

Whose rights are being violated when receiving HIV and sexual and reproductive health services in Nigeria?

BackgroundIn Nigeria, vulnerability status may increase the risk for the violation of human rights while receiving health care. The present study determined the proportion and profile of people who reported rights violation while accessing HIV and sexual and reproductive health (SRH) services.MethodsThis was a cross sectional study with data collected between February and March 2021. The dependent variables were patients’ rights to autonomy: right to privacy and confidentiality of medical records; right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstances; right to decline or consent to participation in medical research, experimental procedures or clinical trials; right to quality care in accordance to prevailing standards; and right to complain and express dissatisfaction regarding services received. The independent variables were sexual identity (heterosexual/straight, gay, lesbian, bisexual, queer), HIV status (positive, negative, do not know), living with disability (yes/no), and access point to HIV services (public or donor funded/private). Five multivariate regression models were developed to determine associations between the dependent and independent variable after adjusting for age, education level (no formal education, primary, secondary, tertiary), sex (male, female, intersex), marital status (single, married, separated/divorced, cohabiting) and gender identity (male, female, transgender).ResultsComplete data from 2119 study participants were analysed. Transgender individuals had significantly higher odds of experiencing violation of their rights to privacy and confidentiality of medical records (AOR:1.70), right to be treated with respect (AOR:1.71), right to complain and express dissatisfaction regarding services received (AOR:1.57) and right to decline consent to participate in medical research, experimental research, experimental procedures or clinical trials (AOR:1.81) compared to individuals who were males.ConclusionA high proportion of recipients of HIV and SRH services in Nigeria reported rights violations. Transgender individuals appear to have higher risk and those in spousal relationships have lower risk for rights violations. Studies are needed to learn how to improve rights-based HIV and SRH service delivery in Nigeria especially for transgender individuals.

Exposure to avian influenza in poultry farms and access to veterinary healthcare services in Nigeria and Ghana

The incidence of avian influenza (AI) is on the increase in most parts of the world. This cross-sectional study examines the exposure of poultry farms to AI and the extent of poultry farmers’ access to veterinary health services in Nigeria and Ghana. A pretested questionnaire was administered on 340 poultry farmers in Nigeria and Ghana. Also, Six Key Informant Interviews and fourteen In-depth Interviews were conducted in both countries. The majority of poultry farmers in Nigeria (61.2%) and Ghana (66.5%) are aware of AI, and the mass media was reported as a major source of knowledge. The perception of AI was characterized by the threats it poses to birds, humans, and poultry assets. The study showed an association between the perceived risks of respondents’ personal hygiene in farming practice and susceptibility to AI (p = 0.026). There is also an association between respondents’ nationality and their health-seeking behaviour on poultry farms (p = 0.000). Efforts should be made by relevant stakeholders to develop public health education strategies to promote veterinary healthcare service use among poultry farmers in Nigeria and Ghana.

Impact of traditional healers in the provision of mental health services in Nigeria.

Mental health remains one of the most overlooked issues in Nigeria. The burden posed by traditional healers in the provision of mental health services is becoming a public health concern in the country. This article presents a review of the present situation on the mental health service provision in Nigeria by traditional healers and highlights way forward actions for policy makers, government, and other stakeholders. These include the need for a policy direction on the need for establishing an improved system of psychiatric and mental health services in hospitals that will drive cultural acceptability, accessibility, and affordability. Further, there is a need for policy measures to be in place towards creating long term directions and sustainability of documentations of traditional healer's activities, harmful avoidance and improved mental health services in primary health centers. The fact that traditional healers are indispensable in provision of mental health services, call for collaborative effort to improve services such as behavioral change, capacity building and referral practice that could save more lives and reduce severity of complications.

Factors consistently associated with utilisation of essential maternal and child health services in Nigeria: analysis of the five Nigerian national household surveys (2003–2018)

ObjectiveThis study aims to identify the individual and contextual factors consistently associated with utilisation of essential maternal and child health services in Nigeria across time and household geolocation.Design, setting and...

Unmarried Adolescents’ Experiences of Using Reproductive and Maternal Health Services in Nigeria and Uganda: A Qualitative Study

Adolescents’ access and use of reproductive and maternal health (RMH) services is a critical part of the global strategy for achieving the Sustainable Development Goals (SDGs). However, previous studies have shown that a complex range of factors, including restrictive policies and punitive laws, limit adolescents from accessing a full range of RMH services in Sub-Saharan Africa (SSA). Our study explores the experiences of unmarried adolescents’ access and use of RMH services in Nigeria and Uganda to understand the extent to which the diverse policy environment in both countries enables or hinders adolescents’ access to and use of RMH services. Our qualitative research design involved eight focus group discussions (FGDs) in Nigeria and in Uganda, 14 in-depth interviews, and eight FGDs among adolescents. The data were analysed thematically and organised according to the WHO’s five broad dimensions for assessing youth-friendly health services. Our findings show that RMH services were inequitably delivered in both countries. Adolescents were restricted from accessing services based on age and marital status. Being unmarried and having no partner, especially in Uganda, was a cause for discrimination during antenatal appointments. We also observed that the expectations of adolescents were not adequately met. Service providers tended to be impolite, judgemental, and unwilling to provide services, especially contraceptives, to younger and unmarried adolescents. Our findings suggest that the existence of a youth-friendly health policy does not translate into effective youth-friendly service provision. This underscores the need for further studies to understand the complexities surrounding this by using a realist evaluation method to examine how adolescent and youth-friendly health services can be designed to improve uptake of reproductive and maternal health services among adolescents in Sub-Saharan Africa.

Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: findings from a qualitative study.

BackgroundCOVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored.The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria.MethodsA qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.ResultsBarriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services.Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics.ConclusionAccess to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients’ ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-022-07996-2.

Horizontal Inequity in the Utilization of Maternal and Reproductive Health Services: Evidence From the 2018 Nigeria Demographic and Health Survey.

Maternal mortality and poor reproductive health outcomes remain major public health challenges in low-resource countries. The Sustainable Development Goals have proposed new targets to reduce global maternal mortality ratio to 70 per 100,000 live births and ensure universal access to sexual and reproductive healthcare services by 2030. Inequity in the utilization of maternal and reproductive health services leads to poor reproductive health outcomes and maternal mortality. Despite reduction in global maternal mortality over the decades, the level of maternal mortality remains unacceptably high in Nigeria with limited attention given by governments to addressing health inequities. This study aimed to examine horizontal inequity in the utilization of maternal and reproductive health services in Nigeria. Secondary data from the 2018 Nigeria Demographic and Health Survey were utilized to examine horizontal inequity in the utilization of maternal and reproductive health services such as postnatal care, delivery by cesarean section, modern contraceptive use, and met need for family planning. Equity was measured using equity gaps, equity ratios, concentration curves, and concentration indices. All analyses were performed using ADePT 6.0 and STATA version 14.2 software. The overall coverage level of postnatal care, delivery by cesarean section, modern contraceptive use, and met need for family planning was 20.81, 2.97, 10.23, and 84.22%, respectively. There is inequity in the utilization of postnatal care, delivery by cesarean section, and modern contraceptive favoring the rich, educated, and urban populations. Met need for family planning was found to be almost perfectly equitable. There is inequity in the utilization of maternal and reproductive health services in Nigeria. Inequity in the utilization of maternal and reproductive health services is driven by socioeconomic status, education, and location. Therefore, governments and policymakers should give due attention to addressing inequities in the utilization of maternal and reproductive health services by economically empowering women, improving their level of education, and designing rural health interventions. Addressing inequities in the utilization of maternal and reproductive health services would also be important toward achieving the Sustainable Development Goal targets 3.1 and 3.7.

Factors associated with poor access to HIV and sexual and reproductive health services in Nigeria for women and girls living with HIV during the COVID-19 pandemic

Aim: To determine the proportion of women and girls living with HIV (WGLHIV) who had poor access to HIV, tuberculosis and sexual and reproductive health (SRH) services in Nigeria during the COVID-19 pandemic and associated factors. Methods: This was a cross-sectional study that recruited WGLHIV with six categories of vulnerability (sex work, transactional sex, injecting or using illegal drugs, people on the move, transgender women and people with a disability) through an online survey conducted in ten Nigerian states between june and October 2021. The associations between the limited access to HIV, tuberculosis and SRH services due to COVID-19, the categories of vulnerability and the financial and non-financial barriers to these services were determined using multivariable logistics regression analysis. Results: Over 6 in 10, almost 2 in 10, and almost 4 in 10 WGLHIV had limited access to HIV, tuberculosis and SRH services respectively during the COVID-19 pandemic. Transgender women had 3.59 (95% CI 2.19–5.91) higher odds, women who engaged in sex work had 4.51 (95% CI 2.28–8.42) higher odds, and women who inject or use illegal drugs had 2.39 (95% CI 1.47–32.90) higher odds of facing limited access to sexual and reproductive health services when it was needed. In addition, the direct consequences of the COVID-19 crisis, such as the closure of HIV services and SRH service points, exacerbated pre-existing barriers significantly. Having no money, having to pay additional unofficial fees and the lack of security on the road to the health facility were the barriers with the greatest impact on access to health services. Conclusions: The COVID-19 pandemic had a negative impact on the access of WGLHIV to essential health services. This impact was disproportionately higher for marginalised groups. WGLHIV need non-discriminatory and affordable access to essential health services during the pandemic.