The influence of first wave of COVID-19 outbreak on routine healthcare services, Liberia, August 2020: a mixed study approach

Abstract

Background The COVID-19 pandemic left countries to rapidly implement diverse and stringent public health measures without recourse to mitigate its effect on the sustenance of routine healthcare services. This study described routine health service disruption and restoration strategies at 6 months into the epidemic in Liberia. Methods Liberia, with 15 counties, has 839 health facilities, with one-third in Montserrado County. A cross-sectional study using a mixed approach - quantitative and qualitative research with concurrent triangulation was conducted using a structured guide for group discussions among key health workers at 42 secondary and most patronized health facilities in 14 counties and 7 Montserrado districts. Additionally, routine health data between January and June 2019 and 2020 were extracted from the source documents to the electronic checklist. We performed a descriptive analysis of quantitative data and plotted the line graph of the relative percentage change. Transcribed audio recording notes were synthesized using ATLAS ti for content analysis to identify the themes and subthemes in line with the study objectives and excerpts presented in the results. Results Liberia declared COVID-19 outbreak on March 16, 2020. From conducted interviews at 41 health facilities, 80% reported disruption in routine health services. From January to June 2020, scheduled routine immunization outreaches conducted decreased by 47%. Using a relative percentage change, outpatient attendance decreased by 32% in May, inpatient admission by 30% in April, malaria diagnosis and treatment by 40% in April, and routine antenatal obstetric care by 28% in April. The fear of contacting COVID-19 infection, redeployment of healthcare workers to COVID-19 response, restriction of movement due to lockdown, inadequate or lack of PPE for healthcare workers, lack of drugs and vaccine supplies for clients, and partial closure of routine healthcare services were common perceived reasons for disruptions. Massive community health education and strict compliance with COVID-19 nonpharmacological measures were some of the health facility recovery strategies. Conclusions The COVID-19 outbreak in Liberia caused a disruption in routine healthcare services, and strategies to redirect the restoration of routine healthcare services were implemented. During epidemics or global health emergencies, countries should sustain routine health services and plan for them.

Impact of COVID-19 on routine childhood immunisations in low- and middle-income countries: A scoping review

“…Several studies reported on the reduction of fixed services, outreach services and service utilisation. Four studies reported a decline in fixed services provided during the study period [ 18 , 37 , 38 , 59 ]. Another four studies also reported a decline in or limited outreach services provided [ 18 , 37 , 38 , 58 ].…”

“…Four studies reported a decline in fixed services provided during the study period [ 18 , 37 , 38 , 59 ]. Another four studies also reported a decline in or limited outreach services provided [ 18 , 37 , 38 , 58 ]. For example, Babalola et al found that fixed services were offered by 92% of facilities included in the Liberian study, but there was a 47% decline in outreach services [ 18 ].…”

“…Another four studies also reported a decline in or limited outreach services provided [ 18 , 37 , 38 , 58 ]. For example, Babalola et al found that fixed services were offered by 92% of facilities included in the Liberian study, but there was a 47% decline in outreach services [ 18 ]. Similarly, Babatunde et al reported that no clinic completed all of their planned fixed or outreach sessions [ 37 ].…”

“…Few papers in this review studied the impact of COVID-19 on EPI outreach services highlighting an evidence gap in this area. It is evident from these papers that outreach services have been impacted due to COVID-19 [ 18 , 22 , 37 , 38 ]. Outreach services are critical to vaccinate hard-to-reach populations.…”

A review of the John F. Kennedy Medical Center's response to the COVID-19 pandemic in Liberia

“…The COVID-19 epidemic reached Liberia in 2020 ( 25 ), ~6 years after EVD devastated the country's health system and created the first opportunity to test health facility readiness capacities to respond to a large-scale epidemic while retaining routine health services. Despite the national response to the epidemic, COVID-19 rapidly spread across the country and is believed to have affected a large proportion of the population, but the exact extent is unknown due to low testing capacity and mild symptoms in the majority of cases ( 26 ).…”