Coronavirus: WHO survey reveals widespread disruptions to essential health services

The World Health Organisation (WHO), has published the first indicative survey on the impact of COVID-19 on health systems based on 105 countries’ report.

A press statement issued by the Organisation, said data collected from five regions over the period from March to June 2020, illustrated that almost every country, (representing 90 per cent), experienced disruptions to health services, with low-and middle-income countries reporting the greatest difficulties.

It said most countries reported that many routine and elective services had been suspended, while critical care, such as cancer screening and treatment, and HIV therapy, had also seen high-risk interruptions in low-income countries.

Dr Tedros Adhanom Gyebreyesus, Director-General of the WHO, said “the survey shines a light on the cracks in our health systems, but it also serves to inform new strategies to improve health care provision during the pandemic and beyond.”

He said "COVID-19 should be a lesson to all countries that health is not an 'either-or' equation. We must better prepare for emergencies but also keep investing in health systems that fully respond to people's needs throughout the life course."

He said the WHO would continue to work with countries, and to provide supportive tools to address the fallout from COVID-19.

Dr Gyebreyesus stated that given countries' urgent demand for assistance during the pandemic response, the WHO was developing the COVID-19 Health Services Learning Hub, which was a web-based platform that would allow sharing of experiences and learning from innovative practices that could inform the collective global response.

The Organisation, he said, was devising additional surveys at the sub-national level in health facilities, to gauge the longer-term impact of disruptions, and help countries weigh the benefits and risks of pursuing different mitigation strategies.

The statement however explained that based on reports from key informants, countries on average experienced disruptions on 50 per cent of a set of 25 tracer services.

The most frequently disrupted areas reported included routine immunisation outreach (70 per cent) and facility-based services (61 per cent) respectively, non-communicable disease diagnosis and treatment (69 per cent), family planning and contraception (68 per cent), treatment for mental disorders (61 per cent), and cancer diagnosis and treatment (55 per cent).

Again, the survey showed that countries also reported disruptions in malaria diagnosis and treatment by 46 per cent, and in tuberculosis case detection and treatment also by 42 per cent, while antiretroviral treatment suffered by 32 per cent.

The WHO survey further showed that while some areas of health care, such as dental care and rehabilitation may have been deliberately suspended in line with government protocols, the disruption of many other services were expected to have harmful effects on populations health in the short-medium and long-term.

It also said potentially life-saving emergency services were disrupted in almost a quarter of responding countries.

Again, disruptions to 24-hour emergency room services for example, affected in 22 per cent of countries, with 23 per cent of others suffering from access to urgent blood transfusions, and 19 per cent, emergency surgery.

There were also disruptions due to a mix of supply and demand side factors, where 76 per cent of countries reported reductions in outpatient case attendance to lower demand and other factors such as lockdowns and financial difficulties, it said.

The WHO noted that the commonly reported factors on the supply side, was the 66 per cent cancellation of elective services, while other factors included staff redeployment to provide COVID-19 relief, unavailability of services due to closings, and interruptions in the supply of medical equipment and health products.

However, the study, found out that many countries had started to implement some of the WHO recommended strategies to mitigate service disruptions such as, triaging, to identify priorities, shifting to on-line patient consultations, changes to prescribing practices and supply chain and public health information strategies.

The Survey however indicated that only 14 per cent of counties reported removal of user fees, which the WHO recommended, to offset potential financial difficulties for patients.

According to the statement, the pulse survey also provided an indication of countries' experiences in adapting strategies to mitigate the impact on service provision.

It said despite the limitations of such a survey, it highlighted the need to improve real-time monitoring of changes in service delivery and utilisation as the outbreak was likely wax and wane over the next months, and to adapt solutions accordingly.