BOOK: THE IMPACT OF COVID-19 ON HIV, TB AND MALARIA SERVICES AND SYSTEMS FOR HEALTH: A SNAPSHOT FROM 502 HEALTH FACILITIES ACROSS AFRICA AND ASIA
THE IMPACT OF COVID-19 ON HIV, TB AND MALARIA SERVICES AND SYSTEMS FOR HEALTH: A SNAPSHOT FROM 502 HEALTH FACILITIES ACROSS AFRICA AND ASIA
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Access to services
As COVID-19 rapidly spread in 2020, outpatient
consultations at health facilities declined considerably
compared to 2019. All health facilities surveyed in the
spot-checks describe changes in attendance, highlighting
the widespread reach of COVID-19 and its impact. The
main reason patients were no longer coming to health
facilities was due to their fear of catching COVID-19,
according to 85% of facilities surveyed. Patients were
also no longer able to reach health facilities because of
disruption to public transportation services, as well as
lockdown and stay-at-home orders. These trends were
slightly more acute in urban settings. Some patients
also delayed seeking care, while others no longer visited
clinics due to changes in recommendations for mild
illness and elective care.
Overall, facilities appear to have put considerable effort
into keeping services open, despite the challenging
circumstances. Where this was not possible, facilities
redirected patients to and from other facilities, and some
specific services were reduced or no longer offered, which
affected patient attendance. Other factors influencing
patient access to services included more patients
presenting with respiratory infection symptoms and other
services being disrupted. In addition, as everyone’s focus
became consumed by COVID-19, there was a reduction in
general health communication campaigns to encourage
people to seek out health care.
The change in attendance and access to services is
particularly dangerous for mothers and children. Early
childhood is a particularly vulnerable time for health
issues, and the impact of COVID-19 is not sparing the
young. Antenatal care first visits (ANC1) fell by 5% across
Africa, and by a staggering 66% across facilities surveyed
in seven countries across Asia. Services for children
under 5 were also badly impacted by the pandemic.
Facilities across Africa experienced a decrease of 23%
in consultations for under-5 services in 2020 relative to
2019, while in seven countries across Asia these services
fell 74%, resulting in significantly fewer children being
seen by health care workers and receiving lifesaving
care. If mothers and children’s access to essential health
services is reduced, mortality among children under 5
could be expected to rise.
HIV
Access to services
As COVID-19 rapidly spread in 2020, outpatient
consultations at health facilities declined considerably
compared to 2019. All health facilities surveyed in the
spot-checks describe changes in attendance, highlighting
the widespread reach of COVID-19 and its impact. The
main reason patients were no longer coming to health
facilities was due to their fear of catching COVID-19,
according to 85% of facilities surveyed. Patients were
also no longer able to reach health facilities because of
disruption to public transportation services, as well as
lockdown and stay-at-home orders. These trends were
slightly more acute in urban settings. Some patients
also delayed seeking care, while others no longer visited
clinics due to changes in recommendations for mild
illness and elective care.
Overall, facilities appear to have put considerable effort
into keeping services open, despite the challenging
circumstances. Where this was not possible, facilities
redirected patients to and from other facilities, and some
specific services were reduced or no longer offered, which
affected patient attendance. Other factors influencing
patient access to services included more patients
presenting with respiratory infection symptoms and other
services being disrupted. In addition, as everyone’s focus
became consumed by COVID-19, there was a reduction in
general health communication campaigns to encourage
people to seek out health care.
The change in attendance and access to services is
particularly dangerous for mothers and children. Early
childhood is a particularly vulnerable time for health
issues, and the impact of COVID-19 is not sparing the
young. Antenatal care first visits (ANC1) fell by 5% across
Africa, and by a staggering 66% across facilities surveyed
in seven countries across Asia. Services for children
under 5 were also badly impacted by the pandemic.
Facilities across Africa experienced a decrease of 23%
in consultations for under-5 services in 2020 relative to
2019, while in seven countries across Asia these services
fell 74%, resulting in significantly fewer children being
seen by health care workers and receiving lifesaving
care. If mothers and children’s access to essential health
services is reduced, mortality among children under 5
could be expected to rise.
Page 6
Facilities also noted that prevention of mother-tochild
transmission (PMTCT) services and deliveries of
prevention packages through outreach or drop-in visits
were also lower between April to September 2020
compared to the same period in 2019. These disruption
patterns caused by COVID-19 risk reversing the progress
made in the fight against HIV. Fewer mothers being
referred and fewer people being tested means that they
will not be diagnosed or treated, and without treatment,
they could get sick or die. Moreover, more babies will be
born with HIV when PMTCT services are disrupted, which
could wipe out years of progress in making sure that
babies are born HIV-free.
Disruption to HIV prevention services, including referrals,
testing, and PMTCT, means that people are running a
higher risk of not knowing their HIV status, and therefore
of not accessing the treatment they need, as well as
running the risk of unknowingly infecting others. Trends
indicate that services are progressively resuming, but we
must significantly increase our efforts to regain progress
lost in 2020 and get back on track to ending HIV as an
epidemic by 2030.
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