Two years into the pandemic, health systems are still facing significant challenges in providing essential health services. Ongoing disruptions have been reported in over 90% of countries surveyed in the third round of World Health Organization’s (WHO) Global pulse survey on continuity of essential health services during the COVID-19 pandemic.
Countries reported disruptions across services for all major health areas including sexual, reproductive, maternal, newborn, child and adolescent health, immunization, nutrition, cancer care, mental, neurological and substance use disorders, HIV, hepatitis, TB, malaria, neglected tropical diseases and care for older people. Additionally, even as COVID-19 vaccination has scaled up, increased disruptions were reported in routine immunization services.
Findings from this latest survey, conducted at the end of 2021, suggest that health systems in all regions and in countries of all income levels continue to be severely impacted, with little to no improvement since early 2021, when the previous survey was conducted.
Disruption continues in all health-care settings
Countries reported disruptions in all health-care settings. In more than half of countries surveyed, many people are still unable to access care at the primary care and community care levels. Significant disruptions have also been reported in emergency care, particularly concerning given the impact on people with urgent health needs. Thirty-six per cent of countries reported disruptions to ambulance services; 32% to 24-hour emergency room services; and 23% to emergency surgeries.
Elective surgeries have also been disrupted in 59% of countries, which can have accumulating consequences on health and well-being as the pandemic continues. Disruptions to rehabilitative care and palliative care were also reported in around half of the countries surveyed.
Major barriers to health service recovery include pre-existing health systems issues which have been exacerbated by the pandemic as well as decreased demand for care.
Bottlenecks to scaling up COVID-19 tools
While countries continue to face challenges to maintain essential health services, 92% of countries also reported critical bottlenecks to scaling up access to essential COVID-19 tools, including COVID-19 diagnostics, therapeutics, vaccines and personal protective equipment (PPE).
The survey highlighted health workforce issues as the biggest barriers to access to COVID-19 tools, likely caused by health workers facing exhaustion, being infected with COVID-19 or leaving the workforce. Health workforce challenges were reported by 56% of countries for diagnostics and testing; 64% for COVID-19 therapeutics and treatments, and 36% for PPE distribution and use. Demand-side challenges, such as lack of community acceptance, access and affordability, are the most frequently reported bottlenecks for COVID-19 vaccination. Fifty-eight per cent of countries reported demand-side challenges as a main bottleneck to COVID-19 vaccine access and 35% reported health workforce challenges.
Other obstacles include lack of funding; supply and equipment shortages; and lack of data, information, strategies and guidance.
Plans for recovery underway
All countries surveyed are, however, adopting strategies to overcome disruptions and recover services. These include strengthening health workforce training and capacities, providing home-based or telehealth services, procuring essential medicines and health products, implementing risk communications and community engagement strategies and implementing health financing strategies. They are also looking forward towards longer-term health service resilience, with half of countries surveyed having developed a health service recovery plan to prepare for future health emergencies and 70% of countries having allocated additional government funding to recovery efforts around health workforce capacity strengthening; access to medicines and other health products; digital health; facility infrastructure, and information and misinformation management.
Even moderate disruptions to essential health services lead to negative consequences on health and well-being. The results of this survey highlight the importance of urgent action to address major health system challenges, recover services and mitigate the impact of the COVID-19 pandemic. WHO will continue to support countries to address priority health system needs to transition towards recovery, end the acute phase of the COVID-19 pandemic and prepare for future health emergencies.