WHO and HIFA are collaborating to:

• Promote sharing and learning of experience and expertise around the maintenance of essential health services during and after the pandemic.
• Promote uptake of the WHO guidance (Maintaining Essential Health Services: Operational Guidance for the COVID-19 Context, June 2020).

HIFA is a global human-rights-based movement working in collaboration with the World Health Organization to reduce avoidable death and suffering by improving the availability of reliable healthcare information and protecting people from harmful misinformation. It has 20,000 professional members from 180 countries representing frontline health professionals, patients, general public, policymakers, researchers, journal publishers, systematic reviewers, guideline developers, producers of reference and learning materials, journalists, social scientists, library and information professionals. HIFA members share experience and expertise around how to improve the quality of health care and availability and use of reliable healthcare information on six virtual discussion forums in four languages (English, French, Portuguese and Spanish).

Contributors reported significant disruption to reproductive and maternal health services. This included inadequate access to antenatal care; severe shortage of intensive care units (ICUs) resulting in fatalities during COVID-19-associated delivery and an increase in home births performed by unskilled birth attendants.

Contributors recommended a number of different approaches to combat the disruption of COVID-19 on health services. This included the use of mass communication strategies to inform patients on accessing appropriate care. In addition, it was recommended that COVID-19 positive women receive intensive monitoring and follow up, and provision of adequate oxygen and personal protective equipment.

“What has been the impact in my country? Reduced access to emergency contraceptives, increase in domestic violence, fear to visit health facilities and increase in home delivery by unskilled birth attendants.” (Frontline health worker, Ghana)

Contributors noted an increase in neonatal morbidity, including bilirubin-induced encephalopathy; lack of updated guidelines to address child health during COVID-19; and disruption to immunization schedules. One contributor (an infection control specialist in Ethiopia) noted increased compliance with hand hygiene practices among health workers, potentially reducing hospital-acquired sepsis.

“COVID-19 pandemic has taken a toll on child healthcare services. It may be immunization, hospital care services, public healthcare programs… all are affected. The fear of contagion is widespread, and parents / caregivers don’t want any risk when it comes to children.” (Public Health Professional, India)

Contributors noted that due to disruption in mental health services, prospective care seekers find it difficult to access appropriate care.

Contributors reported an increase in suicide cases. In addition, contributors reported disruption to burial rituals, making it difficult for people to mourn and express their grief. Contributors reported concerns about healthcare worker wellbeing. Healthcare workers have experienced long working hours, burnout syndrome and increased stigma in society; deceased members of the healthcare team were denied burial due to fear of infection. Contributors recommended more investment in mental health services, online counselling, and the efficient involvement of NGOs and other key stakeholders in addressing the gap in mental health services.

“Mental health all over the world has been negatively affected [as a result of the pandemic]… among the highly affected are health care providers; me included.” (Health worker, Egypt)

Contributors noted a shortage of PPE, ventilators, ICU beds, and trained staff; long waiting period for elective surgeries, and delays in surgical intervention for cancer and other critical conditions.

“During the pandemic most of the rural hospitals in India 1) stopped all surgical work; 2) later re-started with only emergency surgical work; 3) when the urban hospitals were overwhelmed, only the rural hospitals were available for elective surgical work.” (Rural surgeon, India)

Contributors highlighted the adverse impact of COVID-19 on oncology services, including a drop in urgent referrals for individuals with suspected cancer. Contributors advocated for initiatives like the “European Cancer Patient Coalition” and the “Time To Act” campaign.

“As the pandemic marches on, there is a dire need for monitoring of service utilization… as well [as] the impact of COVID-19-related disruption on cancer outcomes.” (Healthcare Professional, Croatia)

The full text of the discussion is available here with highlights here, including a list of references cited during the discussion.

Acknowledgments: with thanks to HIFA Essential Health Services and COVID-19 Working Group and Sandra Bearcroft (compiler).