Browsing by Author "Passi-Solar Á."

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    Associations between the stringency of COVID-19 containment policies and health service disruptions in 10 countries
    (2023-12-01) Reddy T.; Kapoor N.R.; Kubota S.; Doubova S.V.; Asai D.; Mariam D.H.; Ayele W.; Mebratie A.D.; Thermidor R.; Sapag J.C.; Bedregal P.; Passi-Solar Á.; Gordon-Strachan G.; Dulal M.; Gadeka D.D.; Mehata S.; Margozzini P.; Leerapan B.; Rittiphairoj T.; Kaewkamjornchai P.; Nega A.; Awoonor-Williams J.K.; Kruk M.E.; Arsenault C.; Mahidol University
    Background: Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020. Methods: Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People’s Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors. Findings: Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model. Conclusions: Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.
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    COVID-19 and resilience of healthcare systems in ten countries
    (2022-06-01) Arsenault C.; Gage A.; Kim M.K.; Kapoor N.R.; Akweongo P.; Amponsah F.; Aryal A.; Asai D.; Awoonor-Williams J.K.; Ayele W.; Bedregal P.; Doubova S.V.; Dulal M.; Gadeka D.D.; Gordon-Strachan G.; Mariam D.H.; Hensman D.; Joseph J.P.; Kaewkamjornchai P.; Eshetu M.K.; Gelaw S.K.; Kubota S.; Leerapan B.; Margozzini P.; Mebratie A.D.; Mehata S.; Moshabela M.; Mthethwa L.; Nega A.; Oh J.; Park S.; Passi-Solar Á.; Pérez-Cuevas R.; Phengsavanh A.; Reddy T.; Rittiphairoj T.; Sapag J.C.; Thermidor R.; Tlou B.; Valenzuela Guiñez F.; Bauhoff S.; Kruk M.E.; Mahidol University
    Declines in health service use during the Coronavirus Disease 2019 (COVID-19) pandemic could have important effects on population health. In this study, we used an interrupted time series design to assess the immediate effect of the pandemic on 31 health services in two low-income (Ethiopia and Haiti), six middle-income (Ghana, Lao People’s Democratic Republic, Mexico, Nepal, South Africa and Thailand) and high-income (Chile and South Korea) countries. Despite efforts to maintain health services, disruptions of varying magnitude and duration were found in every country, with no clear patterns by country income group or pandemic intensity. Disruptions in health services often preceded COVID-19 waves. Cancer screenings, TB screening and detection and HIV testing were most affected (26–96% declines). Total 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 approximately half of the countries, with declines ranging from 5% to 33%. Child vaccinations were disrupted for shorter periods, but we estimate that catch-up campaigns might not have reached all children missed. By contrast, provision of antiretrovirals for HIV was not affected. By the end of 2020, substantial disruptions remained in half of the countries. Preliminary data for 2021 indicate that disruptions likely persisted. Although a portion of the declines observed might result from decreased needs during lockdowns (from fewer infectious illnesses or injuries), a larger share likely reflects a shortfall of health system resilience. Countries must plan to compensate for missed healthcare during the current pandemic and invest in strategies for better health system resilience for future emergencies.