WHO conducted a key informant survey among ministry of health officials in five WHO regions between May and July 2020 to assess the impact of the COVID-19 pandemic on up to 25 essential health services in countries. Questionnaires were sent to 159 countries and 105 responses were received (66% response rate). 80%of the 105 responding countries had established packages of essential health services prior to the pandemic and 66% of these countries had already identified a core set of services to be maintained during the COVID-19 pandemic.
In general, disruptions of essential health services were reported by nearly all countries, and more so in lower-income than higher-income countries. The great majority of service disruptions were partial, which was defined as a change of 5–50% in service provision or use. Severe/complete disruptions were defined as a change of more than 50% in service provision or use.
All services were affected, including essential services for communicable diseases, noncommunicable diseases, mental health, reproductive, maternal, newborn, child and adolescent health, and nutrition services. Emergency services were the least disrupted, although 16 countries reported disruptions across all emergency services. The most severely affected service delivery platforms were mobile services, often suspended by government, and campaigns, for example as used for malaria prevention or immunization.
The causes of the disruptions were a mix of demand and supply factors. On the demand side, 76% of countries reported reductions in outpatient care attendance. Other factors, such as lockdowns hindering access and financial difficulties during lockdown were also mentioned. On the supply side, the most commonly reported factor was cancellation of elective services (66%). Other factors mentioned included staff redeployment to provide COVID-19 relief, unavailability of services owing to closures of health facilities or health services, and supply-chain difficulties.
Countries have responded to the adverse effects on essential health services in multiple ways, most commonly through triage of health services, telemedicine deployment to replace in-person consultations (more common in high-income countries), and changes in dispensing approaches for medicines. Eighty countries indicated priorities and technical assistance needs, including guidance and support in adapting strategies to maintain essential health services, assuring essential supplies, strengthening the health workforce, implementing adequate infection prevention and control capacities, risk communication, monitoring and telemedicine.