tetano
Editor, Senior Moderator
Nat Med
. 2022 Mar 14.
doi: 10.1038/s41591-022-01750-1. Online ahead of print.
COVID-19 and resilience of healthcare systems in ten countries
Catherine Arsenault[SUP] 1 [/SUP], Anna Gage[SUP] 2 [/SUP], Min Kyung Kim[SUP] 3 [/SUP], Neena R Kapoor[SUP] 2 [/SUP], Patricia Akweongo[SUP] 4 [/SUP], Freddie Amponsah[SUP] 5 [/SUP], Amit Aryal[SUP] 6 [/SUP], Daisuke Asai[SUP] 7 [/SUP], John Koku Awoonor-Williams[SUP] 4 [/SUP], Wondimu Ayele[SUP] 8 [/SUP], Paula Bedregal[SUP] 9 [/SUP], Svetlana V Doubova[SUP] 10 [/SUP], Mahesh Dulal[SUP] 6 [/SUP], Dominic Dormenyo Gadeka[SUP] 4 [/SUP], Georgiana Gordon-Strachan[SUP] 11 [/SUP], Damen Haile Mariam[SUP] 8 [/SUP], Dilipkumar Hensman[SUP] 7 [/SUP], Jean Paul Joseph[SUP] 12 [/SUP], Phanuwich Kaewkamjornchai[SUP] 13 [/SUP], Munir Kassa Eshetu[SUP] 14 [/SUP], Solomon Kassahun Gelaw[SUP] 14 [/SUP], Shogo Kubota[SUP] 7 [/SUP], Borwornsom Leerapan[SUP] 13 [/SUP], Paula Margozzini[SUP] 9 [/SUP], Anagaw Derseh Mebratie[SUP] 8 [/SUP], Suresh Mehata[SUP] 15 [/SUP], Mosa Moshabela[SUP] 16 [/SUP], Londiwe Mthethwa[SUP] 16 [/SUP], Adiam Nega[SUP] 8 [/SUP], Juhwan Oh[SUP] 3 [/SUP], Sookyung Park[SUP] 17 [/SUP], Álvaro Passi-Solar[SUP] 9 [/SUP], Ricardo Pérez-Cuevas[SUP] 18 [/SUP], Alongkhone Phengsavanh[SUP] 19 [/SUP], Tarylee Reddy[SUP] 20 [/SUP], Thanitsara Rittiphairoj[SUP] 13 [/SUP], Jaime C Sapag[SUP] 9 [/SUP], Roody Thermidor[SUP] 21 [/SUP], Boikhutso Tlou[SUP] 16 [/SUP], Francisco Valenzuela Guiñez[SUP] 9 [/SUP], Sebastian Bauhoff[SUP] 2 [/SUP], Margaret E Kruk[SUP] 2 [/SUP]
Affiliations
Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.
. 2022 Mar 14.
doi: 10.1038/s41591-022-01750-1. Online ahead of print.
COVID-19 and resilience of healthcare systems in ten countries
Catherine Arsenault[SUP] 1 [/SUP], Anna Gage[SUP] 2 [/SUP], Min Kyung Kim[SUP] 3 [/SUP], Neena R Kapoor[SUP] 2 [/SUP], Patricia Akweongo[SUP] 4 [/SUP], Freddie Amponsah[SUP] 5 [/SUP], Amit Aryal[SUP] 6 [/SUP], Daisuke Asai[SUP] 7 [/SUP], John Koku Awoonor-Williams[SUP] 4 [/SUP], Wondimu Ayele[SUP] 8 [/SUP], Paula Bedregal[SUP] 9 [/SUP], Svetlana V Doubova[SUP] 10 [/SUP], Mahesh Dulal[SUP] 6 [/SUP], Dominic Dormenyo Gadeka[SUP] 4 [/SUP], Georgiana Gordon-Strachan[SUP] 11 [/SUP], Damen Haile Mariam[SUP] 8 [/SUP], Dilipkumar Hensman[SUP] 7 [/SUP], Jean Paul Joseph[SUP] 12 [/SUP], Phanuwich Kaewkamjornchai[SUP] 13 [/SUP], Munir Kassa Eshetu[SUP] 14 [/SUP], Solomon Kassahun Gelaw[SUP] 14 [/SUP], Shogo Kubota[SUP] 7 [/SUP], Borwornsom Leerapan[SUP] 13 [/SUP], Paula Margozzini[SUP] 9 [/SUP], Anagaw Derseh Mebratie[SUP] 8 [/SUP], Suresh Mehata[SUP] 15 [/SUP], Mosa Moshabela[SUP] 16 [/SUP], Londiwe Mthethwa[SUP] 16 [/SUP], Adiam Nega[SUP] 8 [/SUP], Juhwan Oh[SUP] 3 [/SUP], Sookyung Park[SUP] 17 [/SUP], Álvaro Passi-Solar[SUP] 9 [/SUP], Ricardo Pérez-Cuevas[SUP] 18 [/SUP], Alongkhone Phengsavanh[SUP] 19 [/SUP], Tarylee Reddy[SUP] 20 [/SUP], Thanitsara Rittiphairoj[SUP] 13 [/SUP], Jaime C Sapag[SUP] 9 [/SUP], Roody Thermidor[SUP] 21 [/SUP], Boikhutso Tlou[SUP] 16 [/SUP], Francisco Valenzuela Guiñez[SUP] 9 [/SUP], Sebastian Bauhoff[SUP] 2 [/SUP], Margaret E Kruk[SUP] 2 [/SUP]
Affiliations
- PMID: 35288697
- DOI: 10.1038/s41591-022-01750-1
Abstract
Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People's Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26-96% declines). Total outpatient visits declined by 9-40% at national levels and remained lower than predicted by the end of 2020. Maternal health services were disrupted in approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.