https://orcid.org/0000-0001-5006-6276
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ABSTRACT
Background
The COVID-19 pandemic has disrupted health services worldwide, which may have led to increased mortality and secondary disease outbreaks. Disruptions vary by patient population, geographic area, and service. While many reasons have been put forward to explain disruptions, few studies have empirically investigated their causes.
Objective
We quantify disruptions to outpatient services, facility-based deliveries, and family planning in seven low- and middle-income countries during the COVID-19 pandemic and quantify relationships between disruptions and the intensity of national pandemic responses.
Methods
We leveraged routine data from 104 Partners In Health-supported facilities from January 2016 to December 2021. We first quantified COVID-19-related disruptions in each country by month using negative binomial time series models. We then modelled the relationship between disruptions and the intensity of national pandemic responses, as measured by the stringency index from the Oxford COVID-19 Government Response Tracker.
Results
For all the studied countries, we observed at least one month with a significant decline in outpatient visits during the COVID-19 pandemic. We also observed significant cumulative drops in outpatient visits across all months in Lesotho, Liberia, Malawi, Rwanda, and Sierra Leone. A significant cumulative decrease in facility-based deliveries was observed in Haiti, Lesotho, Mexico, and Sierra Leone. No country had significant cumulative drops in family planning visits. For a 10-unit increase in the average monthly stringency index, the proportion deviation in monthly facility outpatient visits compared to expected fell by 3.9% (95% CI: −5.1%, −1.6%). No relationship between stringency of pandemic responses and utilisation was observed for facility-based deliveries or family planning.
Conclusions
Context-specific strategies show the ability of health systems to sustain essential health services during the pandemic. The link between pandemic responses and healthcare utilisation can inform purposeful strategies to ensure communities have access to care and provide lessons for promoting the utilisation of health services elsewhere.
Responsible Editor Stig Wall
Responsible Editor Stig Wall
Acknowledgments
We would like to acknowledge the data collectors, both at health facilities and elsewhere, who work hard to make routine data such as this available. The Partners In Health Cross-site COVID-19 Working Group includes: Harvard University: Dale Barnhart, Isabel Fulcher, Anuraag Gopaluni, Bethany Hedt‐Gauthier, Nick Link, Megan Murray, Karina Vasudeva, Kaylin Vrkljan; Partners In Health/Boston: Donald Fejfar, Julia Higgins, Stefanie Joseph, Jean Claude Mugunga; Partners In Health/Haiti: Jeune Marc Antoinne, Maurice Junior Chery, Mary Clisbee, Kobel Dubique, Peterson Abnis I Faure, Wesler Lambert, Fernet Leandre; Partners In Health/Lesotho: Afom T. Andom, Mathabang Mokoena, Meba Msuya, Melino Ndayizigiye, Patrick Nkundanyirazo; Partners In Health/Liberia: Emma Boley, Luke Krangar, Prince F. Varney; Partners In Health/Malawi: Moses Aron, Emilia Connolly, Chiyembekezo Kachimanga, Beatrice Matanje, Manuel Mulwafu, Fabien Munyaneza, Haules Zanikuh; Partners In Health/Mexico: Zeus Aranda, Daniel Bernal, Sandra Vázquez; Partners In Health/Peru: Leonid Lecca, Jesús Peinado, Marco Tovar; Partners In Health/Rwanda: Vincent K. Cubaka, Placide Habinshuti, Nadine Karema, Fredrick Kateera, Alphonse Nshimyiryo; Partners In Health/Sierra Leone: Thierry Binde, Foday Boima, Gregory Jerome, Marta Patino, Ricard Pognon.
Author contributions
This study was conceived and designed by DF, AA, IF, and BH with the help of the Partners In Health Cross-site COVID-19 Working Group. DF and IF led protocol development, data cleaning, and methods development. DF was responsible for data processing and visualization. DF and AA were responsible for literature search, writing the first draft, and revision and submission of subsequent versions. All authors contributed to data collection, interpretation of results, discussion of implication, review and revision, and signed off on the final drafts of this study.
Disclosure statement
No potential conflict of interest was reported by the authors.
Data availability statement
Data from this study may be shared upon reasonable request to the corresponding author and approval from country-teams.
Ethics and consent
This study was approved by: the Harvard Faculty of Medicine IRB (IRB20-1049); the Zanmi Lasante Institutional Review Board (ZLIRB01252021); the Ministry of Health Research and Ethics Committee of Lesotho (103-2020); the University of Liberia-Pacific Institute for Research & Evaluation Institutional Review Board (17-06-048); the National Health Science Research Committee of Malawi (1216); the Instituto Tecnológico y de Estudios Superiores de Monterrey, Mexico (P000666-COCESCOVID-CEIC-CR002); the Rwanda National Ethics Committee (811/RNEC/2021); and the Sierra Leone Ethics and Scientific Review Committee (22-02-2021 22 February 2021).
Paper context
COVID-19-related disruptions to essential health services have been documented worldwide. However, few studies assess the relationship between the intensity of national pandemic containment responses and their impact on essential health service utilisation during the COVID-19 pandemic. This study quantitatively links the intensity of national-level pandemic containment responses to the utilisation of outpatient services. We also provide information on the mitigation strategies employed by specific countries to maintain essential health services during the COVID-19 pandemic.
Supplementary material
Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2023.2178604