Effect of COVID-19 pandemic on provision of sexual and reproductive health services in primary health facilities in Nigeria: a cross-sectional study

Abstract

Background Nigeria, like many other countries, has been severely affected by the COVID-19 pandemic. While efforts have been devoted to curtailing the disease, a major concern has been its potential effects on the delivery and utilization of reproductive health care services in the country. The objective of the study was to investigate the extent to which the COVID-19 pandemic and related lockdowns had affected the provision of essential reproductive, maternal, child, and adolescent health (RMCAH) services in primary health care facilities across the Nigerian States. Methods This was a cross-sectional study of 307 primary health centres (PHCs) in 30 Local Government Areas in 10 States, representing the six geopolitical regions of the country. A semi-structured interviewer-administered questionnaire was used to obtain data on issues relating to access and provision of RMCAH services before, during and after COVID-19 lockdowns from the head nurses/midwives in the facilities. The questionnaire was entered into Open Data Kit mounted on smartphones. Data were analysed using frequency and percentage, summary statistics, and Kruskal–Wallis test. Results Between 76 and 97% of the PHCS offered RMCAH services before the lockdown. Except in antenatal, delivery and adolescent care, there was a decline of between 2 and 6% in all the services during the lockdown and up to 10% decline after the lockdown with variation across and within States. During the lockdown. Full-service delivery was reported by 75.2% whereas 24.8% delivered partial services. There was a significant reduction in clients’ utilization of the services during the lockdown, and the difference between States before the pandemic, during, and after the lockdown. Reported difficulties during the lockdown included stock-out of drugs (25.7%), stock-out of contraceptives (25.1%), harassment by the law enforcement agents (76.9%), and transportation difficulties (55.8%). Only 2% of the PHCs reported the availability of gowns, 18% had gloves, 90.1% had hand sanitizers, and a temperature checker was available in 94.1%. Slightly above 10% identified clients with symptoms of COVID-19. Conclusions The large proportion of PHCs who provided RMCAH services despite the lockdown demonstrates resilience. Considering the several difficulties reported, and the limited provision of primary protective equipment more effort by the government and non-governmental agencies is recommended to strengthen delivery of sexual and reproductive health in primary health centres in Nigeria during the pandemic.

Changes in Access to Health Services during the COVID-19 Pandemic: A Scoping Review

“…Of the 53 articles selected, 37 analyzed changes in realized access applying quantitative methods , through the analysis of medical records (Table 1), 8 analyzed changes in potential access [83][84][85][86][87][88][89][90] via surveys of different population groups, except for one that did the same via analysis of medical records [90] (Table 2), 7 used qualitative methods to analyze the impact on potential access [91][92][93][94][95][96][97] (Table 3), and, finally, 1 study analyzed changes in both realized and potential access [98] using mixed methods (analysis of medical records and semi-structured interviews). Only six of the studies that explored changes in potential access included professionals from the health centers analyzed as a study population, [87,89,92,93,97,98], while the rest focused on patients or the general population. Reduction in visits to pediatric emergencies (57 to 70%), especially during the peak of the pandemic (March-April 2020), compared to previous periods.…”

“…With regard to the type of service, of the studies on realized access, 5 focused on health services in general [46][47][48][49][50]; 12 on emergencies [51][52][53][54][55][56][57][58][59][60][61][62] (of which 5 were related to pediatric emergencies [56][57][58]60,61]); 15 on secondary care (SC) (outpatient visits, hospital admissions, etc., for nephrology [63], oncology [64,65], pediatrics [66], psychiatry [67,68], rehabilitation [69], respiratory diseases [70], sexual and reproductive health (SRH) [71,[73][74][75], and traumatology [78,79]); two on primary care (PC) [80,81]; one on preventive services [82]. Of the studies on potential access, 1 focused on health services in general [91], 13 on SC (endocrinology [83], rare diseases [86], pediatrics [84], psychiatry [85], SRH …”

“…In terms of geographical area, 19 studies were conducted in European countries [47,51,53,55,57,62,64,[67][68][69][70]75,79,83,84,88,90,92,95], 9 in North American countries [49,58,59,77,78,80,82,85,86], 9 in Sub-Saharan Africa [46,48,71,72,76,87,93,94,98], 3 in Latin America [60,91,96], 5 in the East Asia-Pacific region [50,56,61,66,81], 3 in South Asia [63,65,74], 2 in the North Africa-Middle East region [52], and, lastly, 3 studies covered various regions…”

“…The 16 studies that analyzed potential access [83][84][85][86][87][88][89][90][91][92][93][94][95][96][97][98] described changes in the factors that influenced access before the COVID-19 pandemic and the emergence of new barriers, in terms of both the characteristics of the services and those of the population (Tables 2 and 3).…”

Looking ahead in the COVID-19 pandemic: emerging lessons learned for sexual and reproductive health services in low- and middle-income countries

“…As per available evidence, in Nigeria, there was only a slight decrease in the proportion of primary health centres offering FP services from 98% before the pandemic, 95% during the lockdown, to 92% after the lockdown. Though the number of clients who received care halved during the lockdown compared to before the lockdown, there was a 3% increase in cases after lockdown compared to pre-pandemic times [ 24 ]. Similarly, in Ethiopia, there was a short-term reduction in adolescent modern contraceptive service provision between March and April 2020 across the public sector and in the country's two largest private sector providers of SRH (3.5% reduction across both public and private sectors) [ 25 ].…”