Effect of the COVID-19 pandemic preparation and response on essential health services in primary and tertiary healthcare settings of Amhara Region, Ethiopia

American Journal of Tropical Medicine and Hygiene, Volume 105, No. 5, Year 2021

Interpretação

Countries like Ethiopia have had to make difficult decisions to balance between the demands of the COVID-19 pandemic and maintaining the essential health service delivery. We assessed the effect of preventive COVID-19 measures on essential healthcare services in selected health facilities of Ethiopia. In a comparative cross-sectional study, we analyzed and compared data from seven health facilities over two periods: the pre-COVID-19 period before the first reported COVID-19 case in the country and during the COVID-19 period. Data were summarized using descriptive statistics and the independent t test. During the COVID-19 period the average number of monthly patient visits in the emergency department, pediatrics outpatient, and adult outpatient dropped by 27%, 30%, and 27%, respectively compared with the pre-COVID-19 period. Family planning; institutional delivery; childhood immunization; antenatal care-, hypertension- and diabetic patient follow-up, did not vary significantly between pre-COVID-19 and during COVID-19. Moreover, the monthly average number of tuberculosis (TB) and HIV patients who visited health facilities for drug refill and clinical evaluation did not vary significantly during the two periods. In conclusion, the study highlights that the effect of public restrictions to mitigate the COVID-19 pandemic on essential care systems should be considered. A comparative cross-sectional study to assess essential services uptake before and during the COVID-19 pandemic. We used monthly aggregated data from July 7, 2019 to July 6, 2020 (one Ethiopian fiscal year). Amhara, the second most populous Regional State in the nation, is one of the 10 administrative regions in Ethiopia with an estimated 30 million inhabitants.19 Based on the report of the MOH, more than 90% of the population in the region has access to health facility. The three-tier healthcare system ranges from primary healthcare units to higher tertiary level specialized hospitals. Primary healthcare units (PHCU) comprise health posts, health centers, and primary hospitals, serving 4,000 to 100,000 inhabitants. Secondary healthcare comprises general hospitals covering a population of 1–1.5 million people, and the tertiary care system comprise referral and specialized hospitals covering a population of 3.5–5 million people. All three healthcare systems provide essential healthcare services.20 In the Amhara region, there are 98 hospitals and 825 health centers providing essential health services. In this study, we included data from four hospitals and three PHCUs (Table 1). Characteristics of health facilities in Amhara region included in the study These health facilities were selected after considering their location and convenience. Medical records of the visitors of the abovementioned health facilities from July 7, 2019 to July 6, 2020. Data were retrieved from Health Management Information Systems (HMIS). The HMIS data from two periods were analyzed and compared: the pre-COVID-19 period from July 7, 2019 to March 8, 2020 (before the first reported COVID-19 case in Ethiopia); and the during COVID-19 period from March 9, to July 6, 2020 (after the first reported case in Ethiopia). We collected the following data: name and tier of visited healthcare facility, number of patients visits to different essential health services (such as number of patients who visited adult and pediatric emergency; outpatient surgical, medical, and pediatrics departments; the number of newly diagnosed HIV cases; number of visit to antiretroviral therapy (ART) clinic), and maternal and child care indicators (number of deliveries stratified by route, vaccinations, if applicable). Data at district level from health facility and regional registers were entered in Microsoft Excel by two independent persons and cross-checked by the principal investigator. Data were imported in SPSS (Version 20) (Chicago, Illinois) for data quality assessment and analysis. The data were presented using descriptive statistics: frequency and measures of central tendency. The Independent t test was used to compare means before and during the COVID-19 periods.

AI Digest

Study Justification:

This study aimed to assess the effect of COVID-19 pandemic preparation and response on essential health services in primary and tertiary healthcare settings in the Amhara Region of Ethiopia. The study was conducted to understand the impact of preventive measures on healthcare services and to provide evidence for decision-making in balancing the demands of the pandemic and maintaining essential health service delivery.

Highlights:

– The study analyzed data from seven health facilities in the Amhara Region over two periods: the pre-COVID-19 period and the during COVID-19 period.
– During the COVID-19 period, there was a significant drop in the average number of monthly patient visits in the emergency department, pediatrics outpatient, and adult outpatient compared to the pre-COVID-19 period.
– However, essential services such as family planning, institutional delivery, childhood immunization, antenatal care, hypertension and diabetic patient follow-up, tuberculosis (TB) and HIV patient visits for drug refill and clinical evaluation did not vary significantly between the two periods.
– The study highlights the need to consider the effect of public restrictions implemented to mitigate the COVID-19 pandemic on essential care systems.

Recommendations:

– Policy makers should prioritize the maintenance of essential health services during the COVID-19 pandemic and ensure that preventive measures do not hinder access to these services.
– Strategies should be developed to address the drop in patient visits in the emergency department, pediatrics outpatient, and adult outpatient during the pandemic period.
– Efforts should be made to ensure continuity of essential services such as family planning, institutional delivery, childhood immunization, antenatal care, hypertension and diabetic patient follow-up, TB and HIV patient visits for drug refill and clinical evaluation.

Key Role Players:

– Ministry of Health: Responsible for policy development and coordination of healthcare services.
– Regional Health Bureau: Responsible for implementing healthcare policies and programs at the regional level.
– Health Facility Managers: Responsible for managing and coordinating healthcare services at the facility level.
– Healthcare Providers: Responsible for delivering essential health services to patients.

Cost Items for Planning Recommendations:

– Personal Protective Equipment (PPE) for healthcare providers.
– Training and capacity building for healthcare staff on infection prevention and control measures.
– Information, education, and communication materials for public awareness campaigns.
– Equipment and supplies for maintaining essential health services.
– Monitoring and evaluation activities to assess the impact of recommendations and adjust strategies accordingly.

Força da prova

N/A

Resumo

A comparative cross-sectional study to assess essential services uptake before and during the COVID-19 pandemic. We used monthly aggregated data from July 7, 2019 to July 6, 2020 (one Ethiopian fiscal year). Amhara, the second most populous Regional State in the nation, is one of the 10 administrative regions in Ethiopia with an estimated 30 million inhabitants.19 Based on the report of the MOH, more than 90% of the population in the region has access to health facility. The three-tier healthcare system ranges from primary healthcare units to higher tertiary level specialized hospitals. Primary healthcare units (PHCU) comprise health posts, health centers, and primary hospitals, serving 4,000 to 100,000 inhabitants. Secondary healthcare comprises general hospitals covering a population of 1–1.5 million people, and the tertiary care system comprise referral and specialized hospitals covering a population of 3.5–5 million people. All three healthcare systems provide essential healthcare services.20 In the Amhara region, there are 98 hospitals and 825 health centers providing essential health services. In this study, we included data from four hospitals and three PHCUs (Table 1). Characteristics of health facilities in Amhara region included in the study These health facilities were selected after considering their location and convenience. Medical records of the visitors of the abovementioned health facilities from July 7, 2019 to July 6, 2020. Data were retrieved from Health Management Information Systems (HMIS). The HMIS data from two periods were analyzed and compared: the pre-COVID-19 period from July 7, 2019 to March 8, 2020 (before the first reported COVID-19 case in Ethiopia); and the during COVID-19 period from March 9, to July 6, 2020 (after the first reported case in Ethiopia). We collected the following data: name and tier of visited healthcare facility, number of patients visits to different essential health services (such as number of patients who visited adult and pediatric emergency; outpatient surgical, medical, and pediatrics departments; the number of newly diagnosed HIV cases; number of visit to antiretroviral therapy (ART) clinic), and maternal and child care indicators (number of deliveries stratified by route, vaccinations, if applicable). Data at district level from health facility and regional registers were entered in Microsoft Excel by two independent persons and cross-checked by the principal investigator. Data were imported in SPSS (Version 20) (Chicago, Illinois) for data quality assessment and analysis. The data were presented using descriptive statistics: frequency and measures of central tendency. The Independent t test was used to compare means before and during the COVID-19 periods.

Materiais

N/A

Inovações

Based on the information provided, here are some potential innovations that could be used to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women to receive virtual consultations and check-ups from the comfort of their homes, reducing the need for in-person visits and minimizing the risk of exposure to COVID-19.

2. Mobile health (mHealth) applications: Developing mobile applications that provide pregnant women with information, reminders, and access to healthcare professionals can help improve their access to maternal health services and support.

3. Community health workers: Training and deploying community health workers who can provide essential maternal health services, such as antenatal care and postnatal care, in remote or underserved areas can help bridge the gap in access to healthcare facilities.

4. Transportation support: Establishing transportation support systems, such as ambulances or community-based transportation networks, can ensure that pregnant women have access to timely and safe transportation to healthcare facilities for deliveries and emergencies.

5. Remote monitoring devices: Introducing remote monitoring devices, such as wearable sensors or mobile apps, can enable healthcare providers to remotely monitor the health status of pregnant women and intervene when necessary, reducing the need for frequent in-person visits.

6. Strengthening referral systems: Improving the coordination and communication between primary healthcare facilities and higher-level hospitals can ensure that pregnant women receive timely and appropriate care, including emergency obstetric services, when needed.

7. Health education and awareness campaigns: Conducting targeted health education and awareness campaigns to inform pregnant women and their families about the importance of seeking maternal health services, even during the COVID-19 pandemic, can help overcome barriers to access.

It’s important to note that the specific context and resources available in Ethiopia should be considered when implementing these innovations.

AI Innovations Description

Based on the information provided, here is a recommendation that can be developed into an innovation to improve access to maternal health:

Develop a mobile health (mHealth) application that provides essential maternal health services and information to pregnant women and new mothers in Ethiopia. The application should include features such as:

1. Antenatal care reminders: Send regular reminders to pregnant women about their upcoming antenatal care appointments, including the date, time, and location.

2. Educational resources: Provide educational materials and resources on topics such as prenatal care, nutrition, breastfeeding, and postpartum care. This can include articles, videos, and interactive tools.

3. Teleconsultations: Enable pregnant women to have virtual consultations with healthcare providers for non-emergency concerns or follow-up appointments. This can help reduce the need for in-person visits and improve access to healthcare services, especially in remote areas.

4. Emergency assistance: Include a feature that allows pregnant women to quickly access emergency assistance in case of complications during pregnancy or childbirth. This can connect them to nearby healthcare facilities or emergency services.

5. Maternal health records: Allow pregnant women to keep track of their medical records, including prenatal visits, test results, and vaccinations. This can help healthcare providers have access to accurate and up-to-date information during consultations.

6. Community support: Create a platform where pregnant women can connect with other mothers and healthcare professionals for support, advice, and information sharing. This can help create a sense of community and provide a support network for pregnant women.

By developing and implementing this mHealth application, pregnant women in Ethiopia can have improved access to essential maternal health services, receive timely reminders and information, and have the option for virtual consultations when needed. This innovation can help bridge the gap in access to maternal healthcare services, especially in areas with limited healthcare infrastructure or during times of public health emergencies like the COVID-19 pandemic.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Telemedicine and Telehealth Services: Implementing telemedicine and telehealth services can provide remote access to healthcare professionals, allowing pregnant women to receive prenatal care, consultations, and monitoring from the comfort of their homes.

2. Mobile Health Applications: Developing mobile health applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take control of their own health and access necessary maternal health services.

3. Community Health Workers: Expanding the role of community health workers can help bridge the gap between healthcare facilities and pregnant women in remote or underserved areas. These workers can provide education, support, and referrals for maternal health services.

4. Transportation Support: Improving transportation infrastructure and providing transportation support for pregnant women in rural or remote areas can ensure they can access healthcare facilities for prenatal care, delivery, and postnatal care.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the indicators: Identify key indicators that measure access to maternal health, such as the number of prenatal visits, institutional deliveries, postnatal care visits, and maternal mortality rates.

2. Data collection: Gather data on the selected indicators before implementing the recommendations and during or after their implementation. This data can be collected from health facility records, surveys, or other relevant sources.

3. Data analysis: Analyze the collected data using statistical methods to compare the indicators before and after the implementation of the recommendations. This analysis will help determine the impact of the recommendations on improving access to maternal health.

4. Evaluation: Assess the results of the data analysis to evaluate the effectiveness of the recommendations. Consider factors such as changes in the indicators, cost-effectiveness, and user feedback to determine the overall impact.

5. Iterative improvement: Based on the evaluation, refine and improve the recommendations as needed to further enhance access to maternal health services.

By following this methodology, policymakers and healthcare providers can gain insights into the potential impact of these recommendations and make informed decisions to improve access to maternal health.

Autores & Coautores

Statistics:

Citations: 4

Authors: 10

Identifiers:

DOI: 10.4269/ajtmh.21-0354

ISSN: 00029637

Research Areas:

COVID, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Noncommunicable Diseases, Quality of Care, Sexual and Reproductive Health

Study Countries:

Ethiopia

Study Design:

Cohort Study, Cross Sectional Study

Study Approach:

Mixed-methods, Quantitative, Systematic Review

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