How the COVID-19 pandemic has affected healthcare around the world
New insights into the disruption caused by COVID-19 could help strengthen health systems ahead of future pandemics.
- 25 July 2022
- 5 min read
- by Linda Geddes
Researchers have urged countries to invest in strategies to improve the resilience of their health systems for future emergencies, as new data sheds light on the extent of disruption to essential services like cancer screening, maternal health and vaccination during the COVID-19 pandemic.
The arrival of COVID-19 disrupted healthcare in various ways. Less urgent services were cancelled or postponed, while barriers imposed by curfews, transport closures and stay-at-home orders prevented some patients from attending appointments. Others avoided health centres and hospitals for fear of becoming infected themselves.
Cancer and TB screening/detection and HIV testing were the most affected services, experiencing a 26 to 96% decline, depending on the country. Breast cancer screening was particularly affected.
So, what effect did this have on routine healthcare? Although some studies have previously tried to answer this, most have been limited in scale and scope, covering only the first few months of the pandemic, small geographic areas or only certain types of healthcare.
To gain a broader perspective, Catherine Arsenault and colleagues at the Harvard T.H. Chan School of Public Health in Boston, US, used data from national health information systems in ten countries – Ethiopia and Haiti (low-income countries); Ghana, Lao People’s Democratic Republic and Nepal (lower-middle-income countries); Mexico, South Africa and Thailand (upper-middle-income countries) and Chile and South Korea (high-income countries) – to assess the effects of the pandemic on 31 types of health service between January 2019 and December 2020, plus trends up until June 2021 in some countries.
They also estimated the number of missed healthcare appointments per 1,000 population and examined factors that may have promoted or resilience or worsened disruption.
Overall trends
The study, published in Nature Medicine, found that no country was spared from disruption, and this continued until at least the end of 2020 in half of the countries analysed.
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Cancer and TB screening/detection and HIV testing were the most affected services, experiencing a 26 to 96% decline, depending on the country. Breast cancer screening was particularly affected.
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Maternal health services were disrupted in approximately half of countries, with declines ranging from 5% to 33%. Family planning visits declined by more than 10% in Chile, Haiti and Mexico, while hospital deliveries and C-sections declined by 5 to 31% in five countries, but were stable elsewhere. Mothers and babies in Haiti and Nepal experienced the greatest reduction in care, with 207 missed visits per 1,000 births in Haiti and 209 missed visits per 1,000 births in Nepal.
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The pandemic also disrupted care for chronic conditions, e.g. diabetes and hypertension (high blood pressure). Mexico was worst affected, with 48 missed diabetes and hypertension appointments per 1,000 people), while 4.6 million fewer people received care for diabetes across Chile, Haiti, Mexico, Nepal, South Africa and Thailand.
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The health systems most affected included those in Chile, Haiti, Mexico, Nepal and South Africa. However, Ethiopia and South Korea – the poorest and richest countries – were among the least affected by disruptions.
Disrupted vaccinations
The researchers observed declines in childhood vaccinations of greater than 10% in Chile, Haiti, Laos, Mexico, Nepal and South Africa. Although vaccinations were disrupted for shorter periods than other services, catch-up campaigns may not have reached all children who missed their appointments, the authors said.
Some vaccination programmes were more affected than others, e.g. Mexico had a 95% decline in BCG vaccination (to prevent tuberculosis), but a 2% increase in measles vaccination.
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Across Chile, Ethiopia, Mexico, Nepal and South Africa, an estimated 131,652 fewer children received their third and final dose of pentavalent vaccine, which provides protection against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type b (Hib).
South Africa experienced the largest number of missed immunisations, with 266 fewer vaccinations per 1,000 births.
Further data on the impact of the pandemic on immunisation in lower-income countries will be released by Gavi, the Vaccine Alliance, later this week.
Boosting resilience
The researchers identified several reasons for reduced health care use that appeared to be common across countries: fear of contagion, inability to pay for health care because of lost employment or wages, intentional suspension of routine care or redeployment of health workers or hospitals to care for COVID-19 patients, and the barriers imposed by COVID-19 lockdowns.
However, some countries’ health systems appeared to be more resilient than others. For instance, in Chile, maternal health services are provided exclusively by midwives. Because they weren’t redeployed to COVID-19 care, they were able to maintain regular service provision.
“Health system resilience must become a central component of national health plans. Given the likelihood of future pandemics and other major shocks, there is an urgent need to design more resilient health systems capable of addressing a crisis while maintaining essential functions.”
In South Korea, the number of hospital beds per capita is about three times higher than the OECD average, so reallocating a large share of these beds to COVID-19 care had less of an impact on other services than in countries with fewer beds per person. South Korea has also invested in building a stronger public health response system, as a result of previous health emergencies such as the 2003 SARS outbreak.
Meanwhile in Mexico, which has a large and expanding private health care system, private facilities were used to provide maternity care for a high percentage of public sector users while public hospitals were repurposed to provide COVID-19 care.
Other countries made efforts to prioritise and adapt certain services once COVID-19 arrived. For instance, Ghana made efforts to maintain continuity of reproductive, maternal, newborn and child health services, and increased outreach and home visits for child vaccination. Possibly as a result, there were more C-sections and an increase in postnatal care and pentavalent vaccinations during the study period.
“Given the widespread disruptions in health services demonstrated in this paper, many of which were unrelated to COVID-19 severity, our results call for rethinking pandemic preparedness and health system response,” the authors wrote. “Health system resilience must become a central component of national health plans. Given the likelihood of future pandemics and other major shocks, there is an urgent need to design more resilient health systems capable of addressing a crisis while maintaining essential functions.”
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