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. 2022 May;7(5):e008069.
doi: 10.1136/bmjgh-2021-008069.

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services

Agbessi Amouzou  1 , Abdoulaye Maïga  2 , Cheikh Mbacké Faye  3   4 , Samuel Chakwera  5 , Dessalegn Y Melesse  6 , Martin Kavao Mutua  7 , Sokhna Thiam  3 , Idrissa Boukary Abdoulaye  8 , Seth Kwaku Afagbedzi  9 , Akory Ag Iknane  10 , Odile Sassor Ake-Tano  11 , Joshua O Akinyemi  12 , Victor Alegana  13   14 , Yakubu Alhassan  9 , Arinaitwe Emma Sam  15 , Dominic Kwabena Atweam  16 , Shraddha Bajaria  17 , Luke Bawo  18 , Mamadou Berthé  10 , Andrea Katryn Blanchard  6 , Hamissou Alaji Bouhari  8 , Ousmane Maimouna Ali Boulhassane  8 , Maio Bulawayo  19 , Ovost Chooye  20 , Amed Coulibaly  11 , Mamatou Diabate  21 , Fatou Diawara  10 , Ousman Esleman  22 , Mulugeta Gajaa  23 , Kamil Halimatou Amadou Garba  8 , Theodros Getachew  23   24 , Choolwe Jacobs  25 , George P Jacobs  18 , Femi James  26 , Ayodele S Jegede  12 , Catherine Joachim  27 , Rornald Muhumuza Kananura  28 , Janette Karimi  29 , Helen Kiarie  29 , Denise Kpebo  11 , Bruno Lankoandé  30 , Akanni Olayinka Lawanson  12 , Yahaha Mahamadou  31 , Masoud Mahundi  32 , Tewabe Manaye  22 , Honorati Masanja  17 , Modeste Roch Millogo  33 , Abdoul Karim Mohamed  31 , Mwiche Musukuma  34 , Rose Muthee  29 , Douba Nabié  33 , Mukome Nyamhagata  27 , Jimmy Ogwal  15 , Adebola Orimadegun  35 , Ajiwohwodoma Ovuoraye  26 , Adama Sanogo Pongathie  36 , Stéphane Parfait Sable  11 , Geetor S Saydee  37 , Josephine Shabini  38 , Brivine Mukombwe Sikapande  20 , Daudi Simba  39 , Ashenif Tadele  23 , Tefera Tadlle  23 , Alfred K Tarway-Twalla  37 , Mahamadi Tassembedo  40 , Bentoe Zoogley Tehoungue  18 , Ibrahim Terera  10 , Soumaïla Traoré  40 , Musu P Twalla  37 , Peter Waiswa  28 , Naod Wondirad  22   41 , Ties Boerma  6
Affiliations

Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services

Agbessi Amouzou et al. BMJ Glob Health. 2022 May.

Abstract

Introduction: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation.

Methods: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020.

Results: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index.

Conclusion: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

Keywords: COVID-19; Child health; Health systems; Immunisation; Maternal health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Stepwise analysis process with country teams.
Figure 2
Figure 2
Per cent change in utilisation of selected health services during March–December 2020, compared to expected utilisation based on the preceding 3 years.
Figure 3
Figure 3
Median change in service utilisation across countries during March–December 2020 by type of service and urban–rural district group. Mixed areas not included. Only five countries reported mixed areas. ANC, antenatal care; C-section, Caesarian section; Penta, Pentavalent vaccination.
Figure 4
Figure 4
Median stringency index for COVID-19 restrictions and median changes (%) in service utilisation during March–December 2020, by type of service. IPD, inpatient admissions; OPD, outpatient consultations.
See this image and copyright information in PMC

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