National policy responses to maintain essential health services during the COVID-19 pandemic

Gurley, Nikki; Ebeling, Elan; Bennett, Ashley; Kashondo, Jean-Jacques Kayembe; Ogawa, Victoria Ayano; Couteau, Clemence; Felten, Claire; Gomanie, Naakesh; Irungu, Pauline; Shelley, Katharine D.; Shearer, Jessica

doi:10.2471/blt.21.286852

Cited by 9 publications

(14 citation statements)

References 3 publications

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“…A large proportion of the plans found and included in this review were published early in the pandemic: 75% of the CPRPs we identified were published between January and April 2020, and 78% between January and June 2020. The lack of publicly available updates to national plans was also observed by PATH’s COVID-19 Essential Health Services Policy Tracker 27. Our findings demonstrate the importance that global guidelines not only integrate essential health service provision from the first publication, but that this integration considers specificities of services including MNCAAH, sexual and reproductive health, nutrition and non-communicable diseases (NCDs).…”

Section: Discussionmentioning

confidence: 59%

“…Earlier reviews have suggested that national plans and policies published until the later months of 2020 had limitations in their consideration of essential health services alongside immediate COVID-19 response to stop the pandemic,26 27 their overall processes to prioritise scarce healthcare resources28–30 or their consideration of the needs of specific populations 31 32…”

Section: Introductionmentioning

confidence: 99%

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National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

Czerniewska,

Sharkey,

Portela

et al. 2024

BMJ Glob Health

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IntroductionInfectious disease outbreaks have historically led to widespread disruptions in routine essential health services. Disruptions due to COVID-19 responses led to excess deaths, including among women and children. This review builds on earlier reviews of essential health services in national COVID-19 response and preparedness plans, focusing specifically on maternal, newborn, child, adolescent and ageing health (MNCAAH) in the context of renewed global emphasis on monitoring, recovering and strengthening these services.MethodsUsing Google searches, we identified publicly available COVID-19 response and preparedness plans authored by a national government body or Public Health Institute from any country, territory and/or area, published between January 2020 and December 2022. We assessed whether each plan considered maintenance of MNCAAH services with related activities, costing or monitoring plans, and whether these considerations were integrated into the national incident management system for COVID-19.ResultsWe identified plans from 110 countries, representing 56% of our sample, in 10 languages. Most plans came from low-income and middle-income countries. Three quarters of dated documents were published between February and April 2020. 22% of plans referenced the impact of COVID-19 on MNCAAH, but only 13% included a planned activity for monitoring or mitigating this impact and less than 5% included relevant indicators, costing or integration of services in the incident management system.ConclusionWe propose that unless content specifically related to the services and needs of these populations is integrated, these services will suffer in a future disruptive event. The COVID-19 response demonstrated the need for an interdisciplinary response to address the unforeseen impacts that arose, yet plans continue to have a narrow focus and a generic approach which may be limiting.

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Section: Discussionmentioning

confidence: 59%

Section: Introductionmentioning

confidence: 99%

National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

Czerniewska,

Sharkey,

Portela

et al. 2024

BMJ Glob Health

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“…Containment policies or closures might be necessary to reduce infection, but they should be combined with other policies to promote essential health service utilization. Policies to promote essential health services during times of crisis should be expansive and extend beyond just maternal and child health [ 44 ]. Several service adaptations to maintain essential non-COVID healthcare have been implemented in the studied countries and have included the use of telemedicine, community outreach and innovations for medicine delivery.…”

Section: Discussionmentioning

confidence: 99%

Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries

Reddy

Kapoor

Kubota³

et al. 2023

BMC Health Serv Res

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Background Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. Methods Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People’s Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. Findings Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. Conclusions Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.

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“…We found that the Ethiopian health system was significantly affected in the early months of the pandemic, as were health systems in many countries [ 1 ]. Service provision shifted dramatically to accommodate the need for COVID-19 treatment and prevention efforts, at times at the expense of essential SRH services.…”

Section: Discussionmentioning

confidence: 99%

“…The COVID-19 pandemic has led to disruption, illness, and death around the world. As is common in times of crisis, the pandemic's consequences have been experienced most acutely by those who already experience marginalization, exacerbating existing social and economic inequities [1]. In low-resource settings, the pandemic has contributed further strain to health systems already stretched thin, drawing resources away from often underfunded and neglected issues, such as sexual and reproductive health (SRH) [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders

Chekol¹,

Muluye²,

Sheehy³

2023

PLOS Glob Public Health

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Ethiopia has made significant improvements to sexual and reproductive health (SRH) in recent decades, yet the COVID-19 pandemic brought new challenges to SRH service delivery. In the early months of the pandemic, health facility and health management information system data showed reductions in SRH service utilization, however more evidence is needed on ongoing SRH impacts to inform policy and program decision-making. Our study aimed to assess the impacts of COVID-19 on SRH service utilization and access from the perspective of providers, clients, and stakeholders in Addis Ababa and Amhara Regional State. We collected data from May through July 2021 via six focus group discussions with health service providers, 50 in-depth interviews with SRH service clients and 15 key informant interviews with policy and programmatic stakeholders. All audio recordings were transcribed and translated from Amharic into English. Data were coded and analyzed for content and themes using Excel and NVivo 10. We found that COVID-19 and associated public health mitigation measures had consequences on SRH prioritization, funding, and service delivery. Efforts to halt the spread of COVID-19, such as gathering and transportation restrictions, also reduced access to SRH services. Fear of infection, costly and inaccessible transportation, commodity stockouts, and limited service availability all impeded access to and use of SRH services. For some women, this meant losing timely access to contraception and subsequently facing unwanted pregnancies. Providers experienced increased workloads, anxiety, and stigma as possible sources of infection. Our findings offer useful learnings for program and policy stakeholders aiming to meet SRH needs during the pandemic, and during times of crisis more broadly.

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National policy responses to maintain essential health services during the COVID-19 pandemic

Cited by 9 publications

References 3 publications

National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

National COVID-19 preparedness and response plans: a global review from the perspective of services for maternal, newborn, child and adolescent health and older people

Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries

Impacts of COVID-19 on reproductive health service provision, access, and utilization in Ethiopia: Results from a qualitative study with service users, providers, and stakeholders

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