Covid-19 and resilience of healthcare systems in ten countries

Bibliographic Data

ID23331033
AuthorsCatherine Arsenault (0000-0003-2410-3015, Harvard University, corresponding author), Anna D Gage (0000-0002-4422-0545, Harvard Global Health Institute), Min Kyung Kim (0000-0003-2996-0198, Seoul National University), Neena Kapoor (0000-0001-9406-1442, Harvard Global Health Institute), Neena R Kapoor, Patricia Akweongo (0000-0001-6728-3365, University of Ghana), Freddie Amponsah (Ghana Health Service), Amit Aryal (0000-0001-9899-5226, Government of Nepal), Daisuke Asai, John Koku Awoonor‐Williams (0000-0002-1094-8212, University of Ghana), John Koku Awoonor-Williams, Wondimu Ayele (0000-0001-5899-347X, Addis Ababa University), Paula Bedregal (0000-0003-3550-9117, Pontificia Universidad Católica de Chile), SVETLANA V DOUBOVA (0000-0002-0521-7095, Mexican Social Security Institute), Mahesh Dulal (Government of Nepal), Dominic Dormenyo Gadeka (0000-0002-1583-4572, University of Ghana), Georgiana Gordon‐Strachan (0000-0001-5712-9575, University of the West Indies), Damen Haile Mariam (0000-0002-3229-5259, Addis Ababa University), Dilipkumar Hensman, Jean Paul Joseph, Phanuwich Kaewkamjornchai (0000-0003-3591-7401, Ramathibodi Hospital), Munir Kassa Eshetu (Government of Ethiopia), Solomon Kassahun Gelaw (Government of Ethiopia), Sachiko Kubota (0000-0003-1770-4381), Shogo Kubota, Borwornsom Leerapan (0000-0001-9381-1045, Ramathibodi Hospital), Paula Margozzini (0000-0002-3919-0070, Pontificia Universidad Católica de Chile), Anagaw Derseh Mebratie (0000-0002-6489-335X, Addis Ababa University), Suresh Mehata (0000-0003-3426-2108, Government of Nepal), Mosa Moshabela (0000-0002-9438-7095, University of KwaZulu-Natal), Londiwe Mthethwa (University of KwaZulu-Natal), Adiam Nega (0000-0001-7648-6332, Addis Ababa University), Juhwan Oh (0000-0003-0983-4872, Seoul National University), Sookyung Park (0000-0002-8972-8473, National Health Insurance Service), Alvaro Passi-Solar, Álvaro Passi‐Solar (0000-0002-1744-1705, Pontificia Universidad Católica de Chile), Ricardo Pérez-Cuevas (0000-0002-5564-5821, Inter-American Development Bank), Alongkhone Phengsavanh (University of Health Sciences Vientiane), Tarylee Reddy (0000-0002-9521-2692, South African Medical Research Council), Thanitsara Rittiphairoj (0000-0002-5460-0808, Ramathibodi Hospital), Jaime C Sapag (0000-0003-2227-8233, Pontificia Universidad Católica de Chile), Roody Thermidor, Boikhutso Tlou (0000-0003-1732-1903, University of KwaZulu-Natal), Francisco Valenzuela Guiñez (0000-0002-3501-2066, Pontificia Universidad Católica de Chile), Sebastian Bauhoff (0000-0001-6017-4991, Harvard Global Health Institute), Margaret E Kruk (0000-0002-9549-8432, Harvard Global Health Institute)
Year2022
Volume28
Issue6
Pages1314-1324
Publication date2022-06-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueNature Medicine (JOURNAL)
Journal identifiersISSN: 1078-8956 • E-ISSN: 1546-170X
PublisherSpringer Science and Business Media LLC (PUBLISHER)
DOI10.1038/s41591-022-01750-1
PMID35288697
OpenAlexW4220656655
LanguageEN
Citations received77
References cited60

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.

Coronavirus disease 2019 (COVID-19) · Developing country · Disease · Economic growth · Economics · Environmental health · Health care · Infectious disease (medical specialty) · Pandemic · Population · Psychological resilience · Socioeconomics · COVID-19 and healthcare impacts · Demography · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Psychology