The second round of a World Health Organization “pulse survey“ reveals that over one year into the COVID-19 pandemic, substantial disruptions persist, with about 90% of countries still reporting one or more disruptions to essential health services, marking no substantial global change since the first survey conducted in the summer of 2020.
Within countries, however, the magnitude and extent of disruptions has generally decreased. In 2020, countries reported that, on average, about half of essential health services were disrupted. In the first 3 months of 2021, however, they reported progress, with just over one third of services now being disrupted.
Countries have been working to mitigate disruptions. Many have now stepped up communications efforts to inform the public about changes to service delivery and provide advice about ways to safely seek health care. They are also triaging to identify and better meet the most urgent patient needs.
More than half the countries consulted say they have recruited additional staff to boost the health workforce; redirected patients to other care facilities; and switched to alternative methods to delivering care, such as providing more home-based services, multi-month prescriptions for treatments, and increasing the use of telemedicine.
In addition, WHO and its partners have been helping countries to adapt their processes so they can better respond to the challenges being placed on their health systems; strengthen primary health care, and advance universal health coverage.
“It is encouraging to see that countries are beginning to build back their essential health services, but much remains to be done,” says Dr Tedros Adhanom Ghebreyesus, Director General, WHO. “The survey highlights the need to intensify efforts and take additional steps to close gaps and strengthen services. It will be especially important to monitor the situation in countries that were struggling to provide health services before the pandemic.“
Persisting causes of disruptions
Countries are still having to make important decisions when responding to COVID-19 that may negatively affect access to care for other health issues. Redeployment of staff to provide COVID-19 relief and temporary closures of health facilities and services continue.
Although they may have taken on new staff, 66% of countries continue to report health workforce-related reasons as the most common causes of service disruptions. Supply chains are also still disrupted in nearly one third of countries, affecting the availability of essential medicines, diagnostics, and the PPE needed to safely and effectively provide care.
Communications efforts need to be further scaled up: more than half of countries report service disruptions due to patients not seeking care and because of community mistrust and fears of becoming infected.
Meanwhile, 43% of countries cite financial challenges as major causes for disruptions in service utilization.
As a result, millions of people are still missing out on vital health care. In terms of services, the biggest impact reported by nearly half of countries is on provision of day-to-day primary care to prevent and manage some of the most common health problems. Long-term care for chronic conditions, rehabilitation, and palliative end-of-life care, is also still badly disrupted - severely affecting older people and people living with disabilities.
Potentially life-saving emergency, critical and surgical care interventions are still disrupted in about 20% of countries, reflecting the most immediate indirect consequences of the pandemic. Two thirds of countries also report disruptions in elective surgeries, with accumulating consequences as the pandemic is prolonged.
Among the most extensively affected health services (i.e. those for which more than 40% of countries are reporting disruptions) are those for mental, neurological and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; cancer screening, and services for other noncommunicable diseases including hypertension and diabetes; family planning and contraception; urgent dental care; and malnutrition.
Issued ahead of World Immunization Week (which starts 24 April) and World Malaria Day (25 April) the survey reveals that serious gaps also remain in addressing disruptions to services in both these areas.More than one third of countries are still reporting disruptions to immunization services, despite progress in countries reducing disruptions to immunization services in health facilities and “outreach” immunization services by about 20% and 30% respectively compared to 2020. This highlights the need for new and sustained approaches to improving immunization coverage and uptake.
“The COVID-19 pandemic continues to pose serious challenges to global health beyond the impact of the disease itself,” said Henrietta Fore, UNICEF Executive Director. “For children, disruptions to immunization services have serious consequences. As we scale up delivery of COVID-19 vaccines, we have to ensure that this does not come at the cost of essential childhood vaccinations. We cannot allow today’s fight against COVID-19 to undermine our fight against measles, polio or other vaccine preventable illnesses. Prolonged immunization disruptions will have long-term consequences for children’s health. The time to catch up is now.”
Meanwhile, nearly 40% of countries are also reporting disruptions to one or more malaria services. While progress compared to 2020 – with about 10% fewer countries reporting disruptions to malaria diagnosis and treatment and 25-33% fewer countries reporting disruptions to malaria prevention campaigns (including distribution of long-lasting insecticide impregnated bed nets, indoor spraying and seasonal malaria chemoprevention), the reported level of disruption is still significant and needs to be urgently addressed.
WHO will continue to support countries so they can respond to increased strains on health systems and rapidly evolving priorities and needs throughout the course of the pandemic, and to ensure that COVID-19 control strategies are in balance strategies to tackle other health priorities and secure continued access to comprehensive care for everyone, including the most vulnerable.
Key support mechanisms include the ACT-Accelerator, which works to speed up equitable access to COVID-19 vaccines, tests and treatments, and the Strategic Preparedness and Response Plan, which guides actions taken at national, regional, and global levels to tackle COVID-19.
The Organization also remains focused on the delivery of the work it has committed to before the COVID-19 pandemic started. Internally, through the “Boost initiative” and the UHC Partnership, which covers 115 countries, WHO has strengthened its capacity to provide additional support to countries so they can maintain essential health services during the pandemic, and advance progress towards universal health coverage.
The World Health Organization “pulse survey“
This survey looks at 63 core health services across delivery platforms and health areas. It was sent to 216 countries and territories across the six WHO regions. 135 responses were received (63% response rate) from senior ministry of health officials predominantly between January and March 2021. The responses referred to the situation in the country during the 3 months prior to survey submission (in this case predominantly covering periods between October 2020-February 2021).
The purpose of the survey was to gain insights and perspectives on the impact of the COVID-19 pandemic on essential health services and how countries are adapting strategies to maintain essential services. This survey round follows up WHOs previous pulse surveys on continuity of essential health services distributed throughout quarters 2 and 3 of 2020, including: Pulse survey on continuity of essential health services during the COVID-19 pandemic; Rapid assessment on the impact of the COVID-19 pandemic on noncommunicable disease resources and services; Rapid assessment on the impact of COVID-19 on mental, neurological and substance use services; and Round 1 and Round 2 pulse surveys on immunization.
While pulse surveys have limitations such as possible reporting bias and representativeness, the strength of this effort is that it is comprehensive, and delivers information rapidly.