Nearly every country, or 90 percent, have experienced disruptions to healthcare services during the COVID-19 pandemic, with low- and middle-income countries reporting the greatest difficulties, according to the results of a survey from the World Health Organization (WHO).
In a survey of 105 countries in five regions, conducted from March to June 2020, the WHO found that most countries reported that many routine and elective services have been suspended, while critical care - such as cancer screening and treatment and HIV therapy – has seen high-risk interruptions in low-income countries.
"The survey shines a light on the cracks in our health systems, but it also serves to inform new strategies to improve healthcare provision during the pandemic and beyond,” said Tedros Adhanom Ghebreyesus, PhD, WHO Director-General. "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."
Based on reports from key informants, countries on average experienced disruptions in 50 percent of a set of 25 services. The most frequently disrupted areas reported included routine immunization – outreach services (70 percent) and facility-based services (61 percent), non-communicable diseases diagnosis and treatment (69 percent), family planning and contraception (68percent), treatment for mental health disorders (61 percent), cancer diagnosis and treatment (55 percent).
Countries also reported disruptions in malaria diagnosis and treatment (46 percent), tuberculosis case detection and treatment (42 percent) and antiretroviral treatment (32 percent).
Potentially life-saving emergency services were disrupted in almost a quarter of responding countries. Disruptions to 24-hour emergency room services for example were affected in 22 percent of countries, urgent blood transfusions were disrupted in 23 percent of countries, emergency surgery was affected in 19 percent of the countries.
The WHO said that while some areas of healthcare, such as dental care and rehabilitation, may have been deliberately suspended in line with government protocols, the disruption of many of the other services is expected to have harmful effects on population health in the short- medium- and long-term.
When asked about the reasons behind the service disruptions, 76 percent of countries reported reductions in outpatient care due to lower demand and other factors such as lockdowns and financial difficulties, while 66 percent mentioned the cancellation of elective services. Other factors reported by countries 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.
Many countries have started to implement some of the WHO recommended strategies to mitigate service disruptions, such as triaging to identify priorities, shifting to online patient consultations, changes to prescribing practices and supply chain and public health information strategies. However, only 14 percent of countries reported removal of user fees, which WHO has recommended as a strategy to offset potential financial difficulties for patients.
