“Many gains have been made in Africa in the last two decades, including in the management of communicable and non-communicable diseases and critical cases, but these have been rapidly lost in just over one year due to the massive repurposing of care and resources towards COVID-19 efforts,” Dr Christian Owoo, Ghana’s COVID-19 case management coordinator and national lead for severe and critically ill patients, told a recent press briefing of the World Health Organization regional office for Africa.
The media event was held to present the global findings of the second round of the National pulse survey carried out by the WHO to assess the extent of disruption of the COVID-19 pandemic to essential health services, the causes of disruptions, and how countries are adapting strategies and approaches to maintain service delivery.
The report revealed the widespread impact of the pandemic across many sectors one year from the onset of the pandemic: of the 40 countries in the African region taking part in the survey, 95% were still reporting one or more disruptions of key health services.
Services hardest hit included primary care and rehabilitative, palliative and long-term care with implications for some of the most vulnerable populations. Disruptions were reported across all service areas but most frequently for mental, neurological services, and substance use disorders (53%), closely followed by immunization services (48%) and NCDs (43%).
One in three countries in the African region related that life-saving emergency, critical and surgical interventions had been affected, highlighting the most immediate indirect consequences.
For most countries, the disruption was mainly caused by shortages of health workers as staff were redeployed to provide COVID-19 relief (76%). This was in spite of an increase in staff recruitment.
Lack of essential medicines and cancellation of elective care also affected services.
Mistrust, stigma and fear among the community were cited as factors that limited access to treatment (64%). Many patients with non-communicable diseases stayed at home in fear of contracting the disease while visiting health facilities. Social media contributed to spreading the fear. Financial difficulties arising from the pandemic were also among factors that led to less recourse to health facilities and a lower demand for services.
During the media event, Kaushik Ramaia, general secretary of the Tanzania diabetes association and NCD alliance, recalled how having to manage patients with co-morbidities during the first wave of COVID-19 posed a great number of challenges and “triggered the need for rapid reaction to contain the situation”.
Steps were taken to provide healthcare workers, paramedical staff and non-medical staff with acute healthcare training so as to ensure enough knowledge, diagnostic skills and protocol of care to handle cases such as acute diabetes or uncontrolled cancer.
IPC training was also a core component of the training, focusing on community sensitization to ensure that people would not be stigmatized but brought to the facility and managed.
The supply chain for primary care had to be ensured so that patients would not go to another facility, which would increase the risks of spreading the virus. Among the measures adopted featured also “strengthening the health system to fit a mobile healthcare service for communities far from the facility to ensure a continuum of care”, he said.
In fact, most countries put in place recommended policies and strategies for maintaining essential health services, which improved access to key services compared to 2020. The guidance, released by WHO to help countries balance the COVID-19 response while ensuring the continuity and mitigating the disruption of services, was detailed under pillar 9 of the Strategic Preparedness and Response Plan (SPRP).
Following WHO recommendations, three in four countries drew up national policies to define which essential health services to maintain during the COVID-19 pandemic and designated national focal points responsible for continuity of essential health services. Over half the reporting countries in the African region allocated additional funding to support maintenance of essential health services. The use of community communication increased as did the availability of PPE, testing and other health products.
However, despite the improvement in service provision, with 41% of services disrupted between January and March 2021 compared with 64% in the last quarter of 2020, and fewer countries reporting disruptions across all tracer service areas, the report shows persistent high levels of disruption to health services.
The COVID-19 pandemic appears to be having a long-term impact on health services even after many countries have eased restrictions. It hits hardest the communities that are already vulnerable and marginalized, especially those with high levels of diseases and with less access to essential health services.
Prioritizing the health and safety of healthcare workers and restoring people’s trust in medical services are the most effective way of fighting the pandemic. Strengthening health systems is a vital step, both to manage an unexpected surge of demand and to maintain continuity of essential care for all throughout a crisis that is likely to endure in a region with persistent fragilities in health systems and gaps in overall service delivery.
“We need to continue to strengthen our existing collaboration between African countries, between African countries and the WHO, and between our health sector and other sectors in our countries, with the aim of maximizing our resources - human, material, financial - while hoping to minimize the impact of a potential third wave” said Dr Owoo in his concluding remarks.
