Disruptions in maternal health service use during the COVID-19 pandemic in 2020: experiences from 37 health facilities in low-income and middle-income countries

Abstract

The COVID-19 pandemic has heterogeneously affected use of basic health services worldwide, with disruptions in some countries beginning in the early stages of the emergency in March 2020. These disruptions have occurred on both the supply and demand sides of healthcare, and have often been related to resource shortages to provide care and lower patient turnout associated with mobility restrictions and fear of contracting COVID-19 at facilities. In this paper, we assess the impact of the COVID-19 pandemic on the use of maternal health services using a time series modelling approach developed to monitor health service use during the pandemic using routinely collected health information systems data. We focus on data from 37 non-governmental organisation-supported health facilities in Haiti, Lesotho, Liberia, Malawi, Mexico and Sierra Leone. Overall, our analyses indicate significant declines in first antenatal care visits in Haiti (18% drop) and Sierra Leone (32% drop) and facility-based deliveries in all countries except Malawi from March to December 2020. Different strategies were adopted to maintain continuity of maternal health services, including communication campaigns, continuity of community health worker services, human resource capacity building to ensure compliance with international and national guidelines for front-line health workers, adapting spaces for safe distancing and ensuring the availability of personal protective equipment. We employ a local lens, providing prepandemic context and reporting results and strategies by country, to highlight the importance of developing context-specific interventions to design effective mitigation strategies.

Keywords: COVID-19; health services research; health systems; maternal health; public health.

Figure 2

Time series plots detailing deviations from expected counts (black) during March–December 2020 for first antenatal care visits (histograms on the left) and facility-based deliveries (histograms on the right). Data are from (A) Haiti, (B) Lesotho and (C) Liberia. The grey area indicates the 95% prediction interval. The red asterisk indicates the date on which the first case of COVID-19 was reported in the country (data retrieved from Our World in Data (https://ourworldindata.org/).

Figure 1

Time series plots detailing the observed (black) and predicted counts (grey) from 2016 to 2020 for first antenatal care visits (histograms on the left) and facility-based deliveries (histograms on the right). Data are from (A) Haiti, (B) Lesotho and (C) Liberia. The grey area indicates the 95% prediction interval. The red asterisk indicates the date on which the first case of COVID-19 was reported in the country (data retrieved from Our World in Data (https://ourworldindata.org/).

Figure 3

Time series plots detailing the observed (black) and predicted counts (grey) from 2016 to 2020 for first antenatal care visits (histograms on the left) and facility-based deliveries (histograms on the right). Data are from (A) Malawi, (B) Mexico and (C) Sierra Leone. The grey area indicates the 95% prediction interval. The red asterisk indicates the date on which the first case of COVID-19 was reported in the country (data retrieved from Our World in Data (https://ourworldindata.org/).

Figure 4

Time series plots detailing deviations from expected counts (black) during March–December 2020 for first antenatal care visits (histograms on the left) and facility-based deliveries (histograms on the right). Data are from (A) Malawi, (B) Mexico and (C) Sierra Leone. The grey area indicates the 95% prediction interval. The red asterisk indicates the date on which the first case of COVID-19 was reported in the country (data retrieved from Our World in Data (https://ourworldindata.org/).