Both rich and poor countries saw essential health services decline during COVID

March 24, 2022 – Many essential health services—including cancer and tuberculosis screenings, HIV testing, maternal health services, and child vaccinations—declined during the COVID-19 pandemic in poor and rich countries alike around the globe, according to a new study co-authored by researchers at Harvard T.H. Chan School of Public Health.

The study, published March 14, 2022 in Nature Medicine, looked at the effect of the pandemic on 31 health services in two low-income countries (Ethiopia and Haiti), six middle-income countries (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand), and two high-income countries (Chile and South Korea). The researchers found disruptions in health services of varying magnitude and duration in every country, with no clear patterns by country income group of pandemic intensity.

Findings included:

  • Cancer screenings, tuberculosis screening and detection, and HIV testing were most affected, declining by 26%–96%.
  • Outpatient visits declined by 9%–40% at national levels and remained lower than predicted by the end of 2020.
  • Maternal health services were disrupted in roughly half of the countries, with declines ranging from 5% to 33%.
  • Routine childhood vaccinations were disrupted at least six of the countries studied, and while several countries were able to resume vaccinations, catch-up campaigns may not have reached all the children missed.

Some of the declines in health services may have been due to decreased needs during lockdowns, because there were fewer infectious illnesses or injuries, or because people feared becoming infected with COVID-19 if they visited health facilities, according to the authors. But they added that a larger share of the declines is likely due to a failure of health system resilience.

The authors wrote, “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.”

Harvard Chan School co-authors of the study included several researchers from the Department of Global Health and Population: lead author Catherine Arsenault, research scientist; senior author Margaret Kruk, professor of health systems; as well as PhD student Anna Gage, visiting scientist Neena Kapoor, and Sebastian Bauhoff, assistant professor of global health and economics.

Read the Nature Medicine study: COVID-19 and resilience of healthcare systems in ten countries