COVID-19 and resilience of healthcare systems in ten countries

Abstract

Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total outpatient visits declined by 9–40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.

The COVID-19 pandemic and disruptions to essential health services in Kenya: a retrospective time-series analysis

“… 19 A comparison of essential health services across multiple low-income, middle-income, and high-income countries revealed no particular patterns of disruptions by the income grouping of the country or the intensity of the pandemic, but the disruptions often preceded the waves of the pandemic. 16 …”

The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic

“…The first year of the pandemic saw disruptions and constraints on routine health services in many countries due to COVID-19 containment measures, prioritization of COVID-19 health care, and population reluctance to seek services out of concern over exposure, and other causes [ 1 , 2 ]. The disruptions in routine preventive, screening, and curative services generated significant backlogs in care and increased population risk for preventable morbidity and mortality [ 1 , 2 ]. In 2020, multiple countries faced excess mortality that was higher than COVID-19-related fatalities, pointing to substantial indirect mortality [ 3 ].…”

Modeling vaccine allocation and equity implications of COVID-19 containment strategies

“…Consistent criteria that can be subject to objective scrutiny to ensure accountability, equity, and fairness are required 71 . Various human efforts are of necessity to maintain healthcare operations 72,73 .…”