Impact of COVID-19 containment policies on health service delivery and mortality in ten countries.

Overview

The DP-REHCORD project was part of the International COVID-19 Data Alliance (ICODA) initiative, and sought to assess the impact of COVID-19 containment approaches, including curfews and lockdowns, on health service provision for other diseases, such as HIV and cancer. The team produced rapid insights to inform priorities for resuming essential health service provision following the COVID-19 pandemic in each of the ten participating low- middle- and high-income countries from different continents. These insights also informed future planning to modernise healthcare services and strengthen health system resilience. Overall, the study found the pandemic resulted in healthcare service disruption in every country, with no patterns associated with country income or pandemic intensity. Healthcare services most affected in all countries were cancer screenings, TB screening and HIV testing, with outpatient visits to hospitals significantly reduced. 

The challenge 

The DP-REHCORD project ran from July 2021 to July 2022. It sought to assess the impact of the COVID-19 pandemic and associated lockdowns and curfews on access to, and provision of, critical health services for other diseases, including cancer screening and HIV testing, and to inform approaches to restoring and improving service provision post-pandemic.  The research team measured the effect of the COVID-19 pandemic and associated containment policies on the quality of health care and mortality rates from non-COVID conditions in 31 health services in 10 countries. To do this, they extracted and prepared data from health management information systems spanning Jan 2019 – Dec 2020 from Chile, Ethiopia, Ghana, Haiti, Laos, Mexico, Nepal, South Africa and South Korea. The team used statistical techniques to assess the effect of the pandemic on health service delivery, and the effect of containment policies on healthcare demand, such as patient appointments.  

The solution 

The multi-country research team took an equitable and highly collaborative approach to the design, delivery and governance of the study, and engaged with key stakeholders in each country. To ensure trustworthy, consistent and standardised approaches for analysing data across the ten countries, the team developed shared approaches, such as common code books, shared tools for harmonisation of data, and a version control system for statistical code. This enabled them to analyse and compare data from 31 health facilities and produce rapid insights, whilst demonstrating a strong research culture.   

The impact 

The equitable approach taken to governance and collaboration between researchers from low-, middle- and high-income countries in this study was exemplary. The approach taken enabled the team to generate rapid and rich research insights in each country, as well as comparative research across multiple countries during the pandemic, with strong engagement with policy makers ensuring research insights were used to inform healthcare policy and practice. This included restoring and/or reforming essential health services in participating countries. Insights have also been used to strengthen healthcare system resilience to future global health challenges, such as the National Strategy for Health Systems Recovery in Mexico.  

More details can be found on the ICODA website.