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

Abstract

IntroductionThere are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women’s, Children’s and Adolescents’ Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation.MethodsMonthly routine health facility data by district for the period 2017–2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020.ResultsThe completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March–December 2020 was 3.9% (range: −8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=−17.0%) and outpatient admissions (median=−7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from −2% to −6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March–June 2020 for general services, when the response was strongest as measured by a stringency index.ConclusionThe district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

COVID-19 Preventive Practices, Psychological Distress, and Reported Barriers to Healthcare Access during the Pandemic among Adult Community Members in Sub-Saharan Africa: A Phone Survey

“… 67 , 68 Some challenges in scaling the testing and diagnostic facilities for COVID-19 in SSA include gaps in service delivery and health systems, unskilled staffing, poor healthcare financing, sociocultural values, and the absence of infrastructure and technology to initiate and maintain diagnostic services. 69 – 71 This finding indicates the need for reform programs for strengthening and sustaining healthcare systems through appropriate health policy, adequate governmental focus and investment, and capacity-building in human resources, governance, and financing.…”

Healthcare utilization and maternal and child mortality during the COVID-19 pandemic in 18 low- and middle-income countries: An interrupted time-series analysis with mathematical modeling of administrative data

“…At the start of the COVID-19 pandemic, statistical models projected maternal and child mortality increases based on hypothesized service disruption scenarios [10][11][12]. Multiple sources have since confirmed increases in adverse maternal outcomes but lower than expected utilization of reproductive, maternal, and child (RMNCH) services during the pandemic [13][14][15][16]. Studies have quantified decreases in total health facility attendance, complementing the qualitative reports by health workers and stakeholders [13,17,18].…”

When one door closes: a qualitative exploration of women’s experiences of access to sexual and reproductive health services during the COVID-19 lockdown in Nigeria

“…Our ndings complement the report of previous quantitative studies in Nigeria: Adelekan et al reported a 2-6% reduction in utilisation of various SRH services in primary healthcare settings in Nigeria [16] while Balogun and colleagues reported that about a third of the women seeking SRH care in Lagos during the lockdown had a challenge with accessing orthodox services [18]. Results from other settings also show that the Nigerian experience is similar to what obtains in several sub-Saharan African countries and other lowand middle-income settings [12,23,[27][28][29].…”