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Disruptions in Essential Health Services During the First Five Months of COVID-19: Analysis of Facility-Reported Service Volumes in Eight Sub-Saharan African Countries

24 Pages Posted: 30 Dec 2020

See all articles by Gil Shapira

Gil Shapira

The World Bank

Tashrik Ahmed

World Bank

Salomé Henriette Paulette Drouard

World Bank

Pablo Amor Fernandez

World Bank

Eeshani Kandpal

World Bank

Charles Nzelu

Nigeria Federal Ministry of Health

Chea Sanford Wesseh

Liberia Ministry of Health

Nur Ali Mohamud

Nigeria Federal Ministry of Health

Francis Smart

Sierra Leone Ministry of Health and Sanitation - Directorate of Planning, Policy, and Information

Charles Mwansambo

Ministry of Health. Malawi

Martina L. Baye

Cameroun Ministére de la Sante Publiqué

Mamatou Diabate

Ministère de la Santé et de l'Hygiène Publique du Mali

Sylvain Yuma

Democratic Republic of Congo - Ministry of Health

Munirat Ogunlayi

The Global Financing Facility for Women, Children, and Adolescents

Rwema Jean De Dieu Rusatira

The Global Financing Facility for Women, Children, and Adolescents

Tawab Hashemi

The Global Financing Facility for Women, Children, and Adolescents

Petronella Vergeer

The Global Financing Facility for Women, Children, and Adolescents

Jed Friedman

World Bank - Development Research Group (DECRG); World Bank Group

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Abstract

Background: The COVID-19 pandemic and its secondary effects pose a major global threat to the continuity of essential health services. Disruptions in essential services can lead to increases in morbidity and mortality and a protracted public health crisis. We quantify the disruption of the COVID-19 crisis on essential health services, focusing on maternal and child health, in eight sub-Saharan countries.

Methods: Service volumes are extracted from administrative systems for the months between January 2018 and July 2020 in eight sub-Saharan countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone, and Somalia. We examine monthly data for 59,546 facilities covering eight selected services. We employ a regression model using data from January 2018 to February 2020 to predict what service utilization levels would have been in March-July 2020 in the absence of the pandemic, accounting for secular trends, seasonality, and facility characteristics. Estimates of disruption are derived by comparing these predictions to the observed service utilization level during the pandemic period.

Findings: All countries experienced service disruptions for at least one month, but the magnitude, and duration of the disruptions vary. Although decreases in service volume were most common in April and May, there were still significant disruptions as of July. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5,445,068 OPD consultations and 277,018 third doses of pentavalent vaccine during the five months in these eight countries. Decreases in maternal health service utilization are less generalized. Significant declines in institutional deliveries, antenatal care, and postnatal care were detected in four, six, and five countries, respectively. Of the eight countries, the strongest and most persistent disruptions were detected in Liberia, Mali, Nigeria, and Sierra Leone. More limited disruptions were found in Cameroon, the Democratic Republic of Congo, Malawi, and Somalia.

Interpretation: Results show that the COVID-19 pandemic caused substantial interruptions in the delivery of essential health services, albeit with significant cross-country variation. While this analysis cannot speak to the causes behind the declines in service utilization, they may be driven by changes in care-seeking behavior due to fear of infection, reallocation of resources, lockdown policies, and income shocks. The design of interventions to mitigate these disruptions requires detailed local knowledge and additional data on the behaviors of health providers and households during the pandemic. Timely monitoring of service volumes through administrative data should be an integral component of a responsive pandemic strategy.

Funding Statement: The Global Financing Facility for Women, Children, and Adolescents.

Declaration of Interests: No conflicts of interest.

Suggested Citation

Shapira, Gil and Ahmed, Tashrik and Drouard, Salomé Henriette Paulette and Fernandez, Pablo Amor and Kandpal, Eeshani and Nzelu, Charles and Wesseh, Chea Sanford and Mohamud, Nur Ali and Smart, Francis and Mwansambo, Charles and Baye, Martina L. and Diabate, Mamatou and Yuma, Sylvain and Ogunlayi, Munirat and Rusatira, Rwema Jean De Dieu and Hashemi, Tawab and Vergeer, Petronella and Friedman, Jed Arnold, Disruptions in Essential Health Services During the First Five Months of COVID-19: Analysis of Facility-Reported Service Volumes in Eight Sub-Saharan African Countries. Available at SSRN: https://ssrn.com/abstract=3757414 or http://dx.doi.org/10.2139/ssrn.3757414

Gil Shapira (Contact Author)

The World Bank ( email )

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

Tashrik Ahmed

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Salomé Henriette Paulette Drouard

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Pablo Amor Fernandez

World Bank

1818 H Street, NW
Washington, DC 20433
United States

Eeshani Kandpal

World Bank ( email )

1818 H Street, NW
Washington, DC 20433
United States

Charles Nzelu

Nigeria Federal Ministry of Health ( email )

Chea Sanford Wesseh

Liberia Ministry of Health ( email )

Congo Town, Monrovia
Liberia

Nur Ali Mohamud

Nigeria Federal Ministry of Health ( email )

Francis Smart

Sierra Leone Ministry of Health and Sanitation - Directorate of Planning, Policy, and Information

Charles Mwansambo

Ministry of Health. Malawi ( email )

Lilongwe
Malawi

Martina L. Baye

Cameroun Ministére de la Sante Publiqué ( email )

Mamatou Diabate

Ministère de la Santé et de l'Hygiène Publique du Mali ( email )

Sylvain Yuma

Democratic Republic of Congo - Ministry of Health ( email )

Congo, Democratic Republic of the (Zaire)

Munirat Ogunlayi

The Global Financing Facility for Women, Children, and Adolescents ( email )

Rwema Jean De Dieu Rusatira

The Global Financing Facility for Women, Children, and Adolescents ( email )

Tawab Hashemi

The Global Financing Facility for Women, Children, and Adolescents ( email )

Petronella Vergeer

The Global Financing Facility for Women, Children, and Adolescents ( email )

Jed Arnold Friedman

World Bank - Development Research Group (DECRG)

1818 H. Street, N.W.
MSN3-311
Washington, DC 20433
United States

World Bank Group ( email )

1818 H Street, N.W.
Washington, DC 20433
United States

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