A representative photo of a nurse at work in a hospital in Mumbai, August 2018. Photo: Reuters
- On February 7, the WHO released the results of an assessment of how health services were disrupted in 129 countries during the COVID-19 pandemic.
- India’s health ministry didn’t participate in this exercise (via the WHO’s regional office) and didn’t respond to requests to explain its stand.
- Contrary to popular belief, the WHO found that health services were disrupted in various countries not because governments imposed measures like lockdowns.
New Delhi: COVID-19 has caused untold morbidity and mortality in the last two years. Many experts, policymakers and politicians have acknowledged and discussed it. Yet the setbacks that routine healthcare suffered fail to get centre-stage in these discussions.
The WHO recently released the results of such an assessment that remedies this oversight to some extent. They revealed that essential health services in almost all countries face tough challenges even after two years of the pandemic.
The WHO conducted the assessment in the last quarter of 2021. This is the third round; the first two wrapped up in late 2020 and early 2021. The body tracked the services that the pandemic disrupted and the extent of disruption.
According to the survey report, the essential services are routine immunisation for children, nutrition, mental health, geriatric care, cancer care, child and maternal health, services for neglected tropical diseases, emergency care, elective surgeries and scheduled and unscheduled visits to primary health centres.
As it happens, India is missing from this important exercise. The WHO had sent queries to the health ministries of 223 countries through its regional offices. Of them, 129 responded by January 20, 2022. India didn’t.
The Wire Science reached out to the WHO’s India office to ask why the Union health ministry had refused to participate in this exercise. This article will be updated as and when we receive a response.
Based on the third round’s findings, the WHO has said that the pandemic disrupted at least one essential health service in almost all countries. The WHO had found this in the first two rounds as well – meaning this situation hasn’t changed since the start of the pandemic. Essential health services around the world continue to suffer.
India didn’t participate in the WHO’s exercise but that doesn’t mean India didn’t suffer disruptions.
Childhood vaccination uptake declined because many states halted routine programmes for logistical reasons. Malaria elimination took a hit because the government didn’t distribute nets with insecticides to kill mosquitoes. And the registration of new tuberculosis cases nosedived by 25% compared to the same period in 2019.
Reasons for disruption
People commonly understand that COVID-induced measures like lockdowns led to all this disruption. But the WHO report is clear that this wasn’t the reason. It apparently found no obvious correlation between service disruptions and such restrictions.
Earlier, researchers at the University of Oxford had developed a ‘stringency index’. It is a composite measure of governments’ responses to restrict people’s movement, ostensibly to limit the spread of the disease. These responses included school closures, workplace closures, stay-at-home orders and travel bans.
The WHO’s conclusion about the cause of the disruptions is based on the stringency index. Specifically, it found that governments were underprepared for the pandemic. They compensated by prioritising COVID-19 over other healthcare needs – and then failed to make up for the latter.
The body isolated three major types of problems. The first and most dominant is what it calls “intentional service delivery modifications”. This happened when governments temporarily closed or postponed healthcare services to accommodate COVID-19 patients.
The second cause was lack of resources. There was widespread shortage of essential medicines, diagnostic facilities, vaccines and other health products. A paucity of healthcare workers, either because they had been diverted to the pandemic frontlines or because they were infected themselves, made the problem worse.
The third cause was a slowdown in patients availing services. That is, for the first two reasons, the people themselves sought healthcare services less often. The WHO also pointed to a ‘community fear’: people were wary that visiting hospitals could fan rumours that they had COVID-19. This in turn was rooted in a lack of trust within communities, over who had COVID-19 and whether they would have to be isolated.
Many countries have now decided to take corrective measures. According to the WHO’s assessment itself, more than two-thirds of countries have plans to ensure continuity of essential health services through the pandemic. One-fifth of countries have also updated their plans in the last six months while three-fourths have allocated additional funds.
According to the report:
“Despite the ongoing and persistent health system challenges that have been further exacerbated by the pandemic, countries are adopting short-term strategies and innovations, to not only overcome disruptions and recover services, but also to solve bottlenecks to scale up essential COVID-19 tools.”