The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries

Fejfar, Donald; Andom, Afom T.; Msuya, Meba; Jeune, Marc Antoine; Lambert, Wesler; Varney, Prince F; Aron, Moses Banda; Connolly, Emilia; Juárez, Ameyalli; Aranda, Zeus; Niyigena, Anne; Cubaka, Vincent Kalumire; Boima, Foday; Reed, Vicky; Law, Michael R.; Grépin, Karen A; Mugunga, Jean Claude; Hedt‐Gauthier, Bethany; Fulcher, Isabel R.

doi:10.1080/16549716.2023.2178604

Cited by 7 publications

(4 citation statements)

References 30 publications

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“…The COVID-19 pandemic has tested the resilience of health systems globally including those that have been considered to be highly robust [51][52][53][54] . The COVID-19 pandemic has been characterized by major disruptions in routine health services in both high-income countries and LMICs 53,55,56 , which has had a profound negative impact on the utilization of Reproductive, Maternal, Newborn, Child Health (RMNCH) services 53,[57][58][59] . This has contributed to an increase in maternal mortality rates during and after the pandemic 60,61 .…”

Section: Discussionmentioning

confidence: 99%

“…While the above results could be seen as evidence towards ADP widening the inequality putting ADP in bad light, we could not be confident that these results are casual as we expect that the impact of Covid-19 pandemic are masked in our estimates. COVID-19 pandemic has been characterized by major disruptions in routine health services in both high-income countries and LMICs [59][60][61] , which has had a profound negative impact on the delivery as well as utilization of Reproductive, Maternal, Newborn, Child Health 15/22 (RMNCH) services globally as well as in India [62][63][64] . Multiple studies have found that women who have visited health facilities or have received advice from health workers are more likely to adopt early initiation of breast feeding [65][66][67] .…”

Section: Discussionmentioning

confidence: 99%

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Health Impact Evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

Agarwal,

Mishra

2023

Preprint

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Background: Aspirational Districts (ADs) initiative was launched by Government of India in 2018 with the objective of reducing inter-district economic and social inequalities with health and nutrition, education, agriculture and water resources, financial inclusion and skill development and infrastructure as the focus areas for development. 117 most backward districts across the country were identified as aspirational districts (ADs) which received priority in funding and scheme implementation so that these districts can catch up with the rest of the districts. We conduct an impact evaluation of the AD initiative on the health and nutrition outcomes. Methods: The research employed a quasi-experimental approach, utilizing the difference-in-differences (DID) method and another method that combined propensity score matching with DID. Findings: The research found a positive impact of the AD program on maternal health through an increase in the percentage of home births attended by Skilled Birth Attendants (SBA) in the Aspirational Districts (ADs) by on an average 1.26% in the ADs. In addition, with respect to family planning an increase of 0.44% was found in percent of male sterilization. Additionally, weak evidence suggests a 3% improvement in ADs for immunization against the first dose of measles vaccine and three doses of penta or hepatitis B vaccine was observed. No strong evidence of adverse impacts of the AD initiative exist. Interpretation The Aspirational District (AD) initiative, a flagship program of the Indian government, aims to address inter-district economic and social inequalities. Our research evaluated the impact of AD on health and nutrition outcomes. Using PSM-DID, we found significant improvements in home births attended by skilled birth attendants and an increase in percentage of male sterilization in ADs. No strong evidence of any adverse impact of AD was observed. Covid-19 pandemic and inter-sector competition for resources within a district might have undermined the performance of ADs on health and nutrition outcomes. Future research efforts should be put for a holistic impact evaluation of all the targeted sectors and outcomes of the AD initiative. Funding: None Keywords: Aspirational Districts Programme, Inequality, Difference-in-differences (DID), Propensity score matching (PSM) PSM-DID, Full matching method, Average Treatment Effect in Treated (ATT), National Family Health Survey

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Health Impact Evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

Agarwal,

Mishra

2023

Preprint

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“…This, due to the need to continue to provide home follow-up for chronically ill patients—including the provision of medications—and pregnant and puerperal women, and to promote the use of CES-supported health facilities among these populations. A major concern of CES was the detection of a decline in utilization of health care services during the summer of 2020 [ 39 ], so one of the strategies to regain pre-pandemic utilization levels was communication by CHWs of the safety measures that had been implemented at CES-supported facilities to protect patients from SARS-CoV-2 infection.…”

Section: Methodsmentioning

confidence: 99%

Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021

Aranda,

Vázquez,

Gopaluni

et al. 2024

BMC Health Serv Res

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Background Mexico is one of the countries with the greatest excess death due to COVID-19. Chiapas, the poorest state in the country, has been particularly affected. Faced with an exacerbated shortage of health professionals, medical supplies, and infrastructure to respond to the pandemic, the non-governmental organization Compañeros En Salud (CES) implemented a COVID-19 infection prevention and control program to limit the impact of the pandemic in the region. We evaluated CES’s implementation of a community health worker (CHW)-led contact tracing intervention in eight rural communities in Chiapas. Methods Our retrospective observational study used operational data collected during the contract tracing intervention from March 2020 to December 2021. We evaluated three outcomes: contact tracing coverage, defined as the proportion of named contacts that were located by CHWs, successful completion of contact tracing, and incidence of suspected COVID-19 among contacts. We described how these outcomes changed over time as the intervention evolved. In addition, we assessed associations between these three main outcomes and demographic characteristics of contacts and intervention period (pre vs. post March 2021) using univariate and multivariate logistic regression. Results From a roster of 2,177 named contacts, 1,187 (54.5%) received at least one home visit by a CHW and 560 (25.7%) had successful completion of contact tracing according to intervention guidelines. Of 560 contacts with complete contact tracing, 93 (16.6%) became suspected COVID-19 cases. We observed significant associations between sex and coverage (p = 0.006), sex and complete contact tracing (p = 0.049), community of residence and both coverage and complete contact tracing (p < 0.001), and intervention period and both coverage and complete contact tracing (p < 0.001). Conclusions Our analysis highlights the promises and the challenges of implementing CHW-led COVID-19 contact tracing programs. To optimize implementation, we recommend using digital tools for data collection with a human-centered design, conducting regular data quality assessments, providing CHWs with sufficient technical knowledge of the data collection system, supervising CHWs to ensure contact tracing guidelines are followed, involving communities in the design and implementation of the intervention, and addressing community member needs and concerns surrounding stigmatization arising from lack of privacy.

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“…Existing frameworks on health-seeking behavior posit that disruptive factors within the environment can influence women’s health-seeking behavior, affecting their health-services use [ 21 , 22 ]. For instance, the three-delay model noted that women’s hesitation to seek care results from barriers such as inadequate transportation, leading to women arriving late to the hospital, long travel distances to get to the hospital, and poor awareness of health issues [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“We Live Our Life Normal”: A Qualitative Analysis of Nigerian Women’s Health-Seeking Behavior during the COVID-19 Pandemic

Ndu,

Teachman,

Martin

et al. 2024

IJERPH

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Background: This study examined where women sought healthcare during the COVID-19 pandemic and their reasons for doing so. We aim to understand further how women accessed care during the COVID-19 pandemic to inform future preparedness and response efforts. This knowledge gained from this study can inform strategies to address existing gaps in access and ensure that women’s health needs are adequately considered during emergencies. Methods: This study used an interpretive phenomenological-analysis approach to analyze data on women’s experiences with healthcare in Nigeria as the COVID-19 pandemic progressed. Semi-structured interviews were conducted with 24 women aged 15 to 49 between August and November 2022 and were supplemented with three focus-group discussions. Results: Following our analysis, three superordinate themes emerged: (i) barriers to seeking timely and appropriate healthcare care, (ii) the influence of diverse health practices and beliefs on health-seeking behavior, and (iii) gendered notions of responsibility and of coping with financial challenges. Conclusions: This paper examined women’s decision to seek or not seek care, the type of care they received, and where they went for care. Women felt that the COVID-19 pandemic affected their decision to seek or not seek care.

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The impact of COVID-19 and national pandemic responses on health service utilisation in seven low- and middle-income countries

Cited by 7 publications

References 30 publications

Health Impact Evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

Health Impact Evaluation of Aspirational Districts Program in India: Evidence from National Family Health Survey

Evaluation of the implementation of a community health worker-led COVID-19 contact tracing intervention in Chiapas, Mexico, from March 2020 to December 2021

“We Live Our Life Normal”: A Qualitative Analysis of Nigerian Women’s Health-Seeking Behavior during the COVID-19 Pandemic

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