Our analysis confirms what we feared all along: everywhere we look, the uptake of essential, lifesaving health services has suffered from the COVID-19 pandemic and the social distancing measures.
This piece compiles data from a selection of six Save the Children health projects in five countries, which vary in size, scope and thematic focus, but all have a mandate to help provide quality essential health services to underserved communities.
By looking at HMIS data, we’re able to track the use of services month by month in primary healthcare centres, which in turn provides a proxy for how disruptive the COVID-19 pandemic has been on access to routine, lifesaving health. While we cannot strictly attribute reductions in service use to the pandemic, contextual information gathered from our teams in the field confirm the significant impact the COVID-19 response is inflicting on basic health service delivery.
Overall findings
The impact of COVID-19 on the provision and/or use of essential health services is real and significant in all countries looked at in this analysis.
However, the overall picture is complex and the impact far from consistent. The scale of reduction in service utilisation varies significantly:
- Between countries: for instance, service use seems to have dropped to a far greater degree in Yemen than in Senegal.
- Within countries: for instance, the two districts of focus in Sierra Leone (Kailahun and Pujehun) display markedly different situations in service use.
- Between services: for instance, in Bungoma district, Kenya, vaccination services have held up well so far despite the COVID-19 crisis whereas services for the integrated management of childhood illness seem to have been more severely affected.
Kenya (HIV)
This is data from our only HIV project, which is funded by the Elton John Foundation (EJAF) and designed to improve access to HIV testing and treatment for adolescent girls and young women in Turkana County. The data compares April 2020 data with April 2019 data on the number of individuals tested.
Kenya (BORESHA programme)
The BORESHA programme is a GSK and DFID funded programme in the Bungoma and Busia counties of Kenya. The thematic focus of the programme since its inception has been maternal and newborn care, and BORESHA has been an incubator (or a “centre of excellence”) to introduce Kangaroo Mother Care and the Chlorhexidine gel for umbilical cord care. The chart below uses HMIS data to plot changes in service utilisation levels between May 2019 and May 2020. The data presented in this chart covers 88 health facilities across the two counties of Bungoma and Busia.
It shows a mixed picture: the take-up of immunisation services seems to have held up rather well despite the spread of COVID-19 and the severe lockdown measures imposed. However, maternal and newborn health services – safe deliveries and postnatal care in particular – are experiencing a significant decline in utilisation. The most spectacular decline in utilisation relates to case management services for childhood malaria, pneumonia and diarrhoea, which suggests families are avoiding health facilities when children fall ill and may be seeking healthcare elsewhere or not at all.
Myanmar
This project is designed to strengthen access to quality services across the continuum of care in two states (Northern Shan and Chin states). The chart below compares utilisation data from May 2020 with May 2019 across a range of routine services including obstetric care, vaccination and child health, in a total of 18 health facilities. As expected, we’re seeing significant drops across most routine services in 2020 as compared to 2019. We’re noting a sharp increase in the number of children diagnosed with pneumonia compared with the same time last year. The reasons for this are unclear: they could relate to issues in data quality, or to an actual increase in the diagnosis of acute respiratory infections due to a combination of COVID-19 and non-COVID-19 related causes.
Senegal
Our GSK-funded project in Senegal has worked on strengthening access to quality, integrated community case management in the Kaffrine Health Zone since 2018. This chart below describes the percentage change in service utilisation across four individual interventions, as well as in the total number of consultations in primary healthcare centres. between May 2019 and May 2020 in Kaffrine. The picture is mixed: whilst family planning and vaccination services seem to have held up well – and even increased somewhat – antenatal care and safe deliveries have gone down substantially. The total number of consultations has decreased by 36% which certainly indicates significant avoidance of the health system by communities in the Kaffrine health zone.
Sierra Leone
Save the Children UK’s health programming work in Sierra Leone is focused on the districts of Kailahun and Pujehun and is designed to expand the coverage of integrated community case management services in underserved populations. It is a GSK-funded project ending in 2020. The chart below describes health services uptake in Kailahun and Pujehun districts in May of 2018 2019 and 2020 to compare the trend before COVID-19 and since the outbreak. The data were sourced from the DHIS2 which is used by the Ministry of Health and Sanitation.
Reproductive health services
Vaccination
The data shows a very contrasted picture between Kailahun and Pujehun districts. Whilst service uptake has held up well in Pujehun despite the COVID-19 outbreak – and even increased on specific interventions – Kailahun district has experienced a very sharp drop in utilisation of reproductive and child health services.
Yemen
This data is from our GSK-funded project in the Aden / Lahj governorates of Yemen, which helps improve access to quality health and nutrition services at the community level through integrated community case management as well as in primary healthcare centres and referral hospitals. The data presented below relates to a total of 4 primary and 2 secondary health centres.
By comparing average frequentation from January to April 2020, with data from May which is when the pandemic really started to affect Yemen, we’ve noted:
- 46% reduction in children attending outpatient services
- 68% reduction in number of children identified and treated with severe acute malnutrition
- 58% reduction in number of children identified and treated with moderate acute malnutrition
- 81% reduction in number of pregnant and lactating women identified and treated for malnutrition
- 65% reduction in number of children getting vaccinated
- 40% overall reduction in use of reproductive health services – including:
- 45% reduction in family planning
- 65% reduction in attendances for antenatal care
Covid-19 hits wider health