EHS-COVID (518) WHO Bulletin: National policy responses to maintain essential health services during the COVID-19 pandemic

8 February, 2022

The February 2022 issue of the WHO Bulletin looks at 'how countries are responding to the pandemic, including the use of data, the role of community health workers, how to build resilient supply chains, lessons learnt in sustaining essential health services for immunization, child nutrition, eye care, tuberculosis, maternal and child health, peritoneal dialysis and more.' https://www.ncbi.nlm.nih.gov/pmc/issues/399608/

CITATION: Bull World Health Organ. 2022 Feb 1; 100(2): 168–170.

Published online 2021 Dec 2. doi: 10.2471/BLT.21.286852

National policy responses to maintain essential health services during the COVID-19 pandemic

Nikki Gurley et al. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8795845/

SELECTED EXTRACTS

'To track policy development at a national level, we launched the COVID-19 Essential Health Services Policy Tracker6 in collaboration with WHO’s Maternal, Adolescent, Child Health and Ageing department with funding from the Bill & Melinda Gates Foundation. The tracker identified and analysed 198 policy documents across 53 countries through September 2020. Our analysis of policies found that most national policies recommended the continuation or adaptation of essential health services. First, 59% (117/198) of policies recommended adapting the delivery of at least one essential health service to ensure continued provision. Second, 58% (115/198) of policies recommended continuation of at least one essential health service with infection prevention control measures. Third, 11% (22/198) of policies recommended pausing or suspending at least one essential health service.

'We also performed content analysis to identify service delivery adaptations recommended in policies in five countries (Burkina Faso, Ethiopia, India, Kenya and Nigeria)... the 11 most common adaptations [were]:

Integration at point of care

Appointment scheduling

Telehealth consultations

Extended service hours

Home or community-based delivery of medicines

Reconfiguration and triage of patient intake

Home-based visits

Multimonth prescribing and dosing

Intensified community outreach to generate demand

Task shifting to lower levels of care

Self-care and self-management of health...

'only 45% (89/198) of policies included guidance on managing the health workforce to maintain essential health services during COVID-19, and 11% (22/198) of policies included guidance on financing the proposed changes...

'only 1% (1/101) of surveyed maternal and newborn health providers from low-income countries began telemedicine during the pandemic. Reasons include low awareness of the recommendations, lack of training and equipment, and provider and client concerns about quality of care.

'Based on our experience from the COVID-19 policy analysis, we recommend two key learning actions to advance current recovery efforts and respond to future outbreaks.

'Future policy development efforts must aim to integrate across essential health service areas, an important step towards integrated, person-centred primary health care...

'Many of the essential health service adaptations identified in the COVID-19 policy guidance serve as promising approaches for strengthening person-centred primary health care in a non-pandemic context...

'Nearly 2 years into the COVID-19 pandemic, the resilience of health systems remains threatened, as does access to and effective coverage of high-quality health care. Health policy presents a lever for change if policies reflect local needs and context, are developed through citizen engagement and are robustly monitored and adapted based on learning.'

COMMENT (NPW): While citizen engagement is widely acknowledged to be desirable, it is unclear how the findings of this study lead to the central recommendation of citizen engagement as recommended in the authors' conclusion. Also, it remains unknown whether and to what extent each of the 11 common adaptations listed above would actually contribute to better health outcomes. It will be interesting to see how this and other current research will be synthesised by WHO and others into practical contribute for national ministries of health.

Neil Pakenham-Walsh, HIFA Coordinator, neil@hifa.org www.hifa.org

Coordinator, WHO-HIFA project on Essential Health Services and COVID-19

https://www.hifa.org/projects/essential-health-services-and-covid-19