Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

Abstract

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services

“…This was not related to closing of health facilities, as facility reporting rates were excellent in 2020, but possibly due to changed practices such as admission criteria and opening hours, as well as patient factors 35. In addition, there is some evidence that effective measures were put in place to mitigate the impact on maternal service utilisation 36…”

Exploring solutions to improve antenatal care in resource-limited settings: an expert consultation

“…This paper contributes to the idea that ANC services and delivery in LMICs and in resource-limited settings continue being disrupted by different challenges and barriers. The COVID-19 pandemic had further highlighted these obstacles [ 36 ]. Innovative measures are required to address these obstacles and ensure women are not denied access to available, accessible, acceptable, and high-quality maternal healthcare services in normal situations and in spite of emergencies, such as COVID-19.…”

The impact of the COVID-19 pandemic on the provision & utilisation of primary health care services in Goma, Democratic Republic of the Congo, Kambia district, Sierra Leone & Masaka district, Uganda

“…We found no evidence of an impact on measles vaccine doses delivered across Goma. In Sierra Leone, data from two facilities in Bo region found a 32% decline in the number of ANC visits(19), whereas data from Kambia region showed no change in ANC. No impact on OPD visits for malaria was recorded at malaria reference centres in a variety of regions of Uganda(20), which contrasts with the 20-30% reduction observed in malaria OPD visits in Masaka.…”