Disruption in Essential Health Service Delivery: A Qualitative Study on Access to Family Planning Information and Service Utilization During the First Wave of COVID-19 Pandemic in Uganda

Abstract

Background Coronavirus disease 2019 (COVID-19) remains a challenge to public health with profound impact on people’s lives. With several mitigation measures implemented to curb the spread of COVID-19, these impacted on access and utilization of general health services including family planning (FP) services. The objective of the study was to understand the extent to which COVID-19 interrupted access and utilization of FP services as well as highlight the challenges faced during the lockdown in Uganda. Methods A qualitative study was carried out in August and September 2020 across the country. A total of 21 key informant interviews among researchers, policy makers, funding agencies, district family planning focal persons, district health officers and service providers with implementing partners were conducted. These were conducted using face to face (7), phone calls (11) and zoom (3) meetings. All interviews were audio recorded and transcribed verbatim. Transcripts were used to identify and generate codes, sub themes and themes. Analysis was done using the thematic framework analysis and results presented in themes. Results Five themes were identified in this study which included; (i) financial and psychosocial needs, (ii) mobility hindrances, (iii) disrupted service delivery, (iv) responsive reproductive health services. The financial and psychosocial needs themes included: household and individual financial constraints, unpredictable future and community acceptance, loss of employment and unemployment, misconceptions and unintended pregnancies; while mobility hindrances included; restricted movement, high transport costs, and difficulty in finding transport. Conclusion Results showed that the pandemic had immediate and significant long-term effects on family planning service accessibility, utilization and delivery. The study recommends implementation of telehealth services, country-wide sensitization on use of long-term contraceptive methods, empowering village health teams and making family planning services mandatory and free to all private facilities in order to lower any disruptions during pandemics.

Impact of the COVID-19 pandemic on access to and delivery of maternal and child healthcare services in low-and middle-income countries: a systematic review of the literature

“…Overall, 14 studies reported data from four low-income countries ( 34–47 ), 21 studies were focused on 13 lower-middle income countries ( 48–68 ), seven studies were conducted in five upper-middle income countries ( 69–75 ) and three were multi-centred ( 76–78 ). Out of 45 included studies, 11 studies were cross-sectional ( 41 , 45 , 48 , 51 , 55–57 , 65 , 69 , 70 , 76 ), 14 were pre-post studies ( 34 , 38 , 49 , 50 , 52 , 53 , 56 , 62 , 64 , 72–75 , 77 ), nine were time-series ( 35 , 37 , 39 , 43 , 58 , 59 , 67 , 71 , 78 ), five were mixed methods ( 36 , 42 , 47 , 61 , 63 ) and six were qualitative ( 40 , 44 , 46 , 54 , 60 , 68 ). The included studies’ characteristics are summarised in Table 1 .…”

“…COVID-19 demonstrated rapid community transmission, resulting in widespread outbreaks across countries and continents. The exponential growth in cases has instilled fear of contagion in many individuals and communities ( 36 , 40 , 42 , 44 , 46 , 47 , 54 , 60 , 61 , 68 ). Participants shared that healthcare facilities were considered as potential sources of COVID-19 transmission ( 36 , 40 , 42 , 44 , 47 , 60 ); therefore, they tend to postpone or avoid general healthcare visits and antenatal care due to the “fear of acquiring the disease” ( 47 ).…”

“…The exponential growth in cases has instilled fear of contagion in many individuals and communities ( 36 , 40 , 42 , 44 , 46 , 47 , 54 , 60 , 61 , 68 ). Participants shared that healthcare facilities were considered as potential sources of COVID-19 transmission ( 36 , 40 , 42 , 44 , 47 , 60 ); therefore, they tend to postpone or avoid general healthcare visits and antenatal care due to the “fear of acquiring the disease” ( 47 ). Participants also highlighted having anxious thoughts about the requirement to wash hands frequently ( 68 ) and the fear of testing positive for COVID-19 ( 40 ).…”

Development of a Multi-Level Family Planning Intervention for Couples in Rural Uganda: Key Findings & Adaptations Made from Community Engaged Research Methods

“…CBFP methods are an effective strategy to scaling up contraceptives in rural areas where structural barriers like geographic distance and long wait lines impede uptake, and Uganda has pledged to scale up CBFP as part of their FP2030 strategy [50]. Moreover, this approach may be important to explore in the context of COVID-19 outbreaks and related lockdowns preventing communities from receiving family planning from facilities [51]. However, CBFP efforts need to be paired with demand generation activities to optimize their effect, while also addressing the structural barriers identi ed in our study related to stock out and low health worker capacity to provide LARCs.…”

Impact of urban slum residence on coverage of maternal, neonatal and child health service indicators in the Greater Accra Region of Ghana: an ecological time-series analysis, 2018-2021

“…Although the impact of COVID was accounted for in the regression models, we still believe that overall impact of COVID-19 on the disruption of the provision of essential health services including maternal, neonatal and child health outcomes cannot be underestimated and the pandemic had the potential to affect the pattern of health coverage between 2020 and 2021 (23,24).…”