Protecting essential health services in low-income and middle-income countries and humanitarian settings while responding to the COVID-19 pandemic

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Abstract

In health outcomes terms, the poorest countries stand to lose the most from these disruptions. In this paper, we make the case for a rational approach to public sector health spending and decision making during and in the early recovery phase of the COVID-19 pandemic. Based on ethics and equity principles, it is crucial to ensure that patients not infected by COVID-19 continue to get access to healthcare and that the services they need continue to be resourced. We present a list of 120 essential non-COVID-19 health interventions that were adapted from the model health benefit packages developed by the Disease Control Priorities project.

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Most cited references 11

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Fair Allocation of Scarce Medical Resources in the Time of Covid-19

Ezekiel J. Emanuel, Govind Persad, Ross Upshur … (2020)

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Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Timothy Roberton, Emily Carter, Victoria Chou … (2020)

Summary Background While the COVID-19 pandemic will increase mortality due to the virus, it is also likely to increase mortality indirectly. In this study, we estimate the additional maternal and under-5 child deaths resulting from the potential disruption of health systems and decreased access to food. Methods We modelled three scenarios in which the coverage of essential maternal and child health interventions is reduced by 9·8–51·9% and the prevalence of wasting is increased by 10–50%. Although our scenarios are hypothetical, we sought to reflect real-world possibilities, given emerging reports of the supply-side and demand-side effects of the pandemic. We used the Lives Saved Tool to estimate the additional maternal and under-5 child deaths under each scenario, in 118 low-income and middle-income countries. We estimated additional deaths for a single month and extrapolated for 3 months, 6 months, and 12 months. Findings Our least severe scenario (coverage reductions of 9·8–18·5% and wasting increase of 10%) over 6 months would result in 253 500 additional child deaths and 12 200 additional maternal deaths. Our most severe scenario (coverage reductions of 39·3–51·9% and wasting increase of 50%) over 6 months would result in 1 157 000 additional child deaths and 56 700 additional maternal deaths. These additional deaths would represent an increase of 9·8–44·7% in under-5 child deaths per month, and an 8·3–38·6% increase in maternal deaths per month, across the 118 countries. Across our three scenarios, the reduced coverage of four childbirth interventions (parenteral administration of uterotonics, antibiotics, and anticonvulsants, and clean birth environments) would account for approximately 60% of additional maternal deaths. The increase in wasting prevalence would account for 18–23% of additional child deaths and reduced coverage of antibiotics for pneumonia and neonatal sepsis and of oral rehydration solution for diarrhoea would together account for around 41% of additional child deaths. Interpretation Our estimates are based on tentative assumptions and represent a wide range of outcomes. Nonetheless, they show that, if routine health care is disrupted and access to food is decreased (as a result of unavoidable shocks, health system collapse, or intentional choices made in responding to the pandemic), the increase in child and maternal deaths will be devastating. We hope these numbers add context as policy makers establish guidelines and allocate resources in the days and months to come. Funding Bill & Melinda Gates Foundation, Global Affairs Canada.

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Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa

Alyssa S. Parpia, Martial Ndeffo-Mbah, Natasha S Wenzel … (2016)

Reduced access to healthcare during the outbreak substantially increased mortality rates from other diseases.

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Journal

Journal ID (nlm-ta): BMJ Glob Health

Journal ID (iso-abbrev): BMJ Glob Health

Journal ID (hwp): bmjgh

Journal ID (publisher-id): bmjgh

Title: BMJ Global Health

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2059-7908

Publication date Collection: 2020

Publication date (Electronic): 7 October 2020

Publication date PMC-release: 7 October 2020

Volume: 5

Issue: 10

Electronic Location Identifier: e003675

Affiliations

[1 ]departmentGeneva Centre of Humanitarian Studies , University of Geneva Faculty of Medicine , Geneve, Switzerland

[2 ]departmentFaculty of Public Health and Policy , London School of Hygiene & Tropical Medicine , London, UK

[3 ]University of Washington , Seattle, Washington, USA

[4 ]Action Contre la Faim , Paris, France

[5 ]Global Financing Facility/World Bank , Addis Ababa, Ethiopia

[6 ]Ministry of Public Health , Kabul, Afghanistan

[7 ]Global Financing Facility/World Bank , Addis Abab, Ethiopia

[8 ]departmentDepartment of Global Public Health and Primary Care , University of Bergen , Bergen, Norway

[9 ]departmentHealth Policy and Management , University of Zambia , Lusaka, Zambia

[10 ]departmentGlobal Health Sciences , University of California , San Francisco, California, USA

[11 ]departmentDepartment of Global Public Health and Primary Care , Universitetet i Bergen , Bergen, Norway

[12 ]departmentDepartment of Global Health and Population , Harvard T.H. Chan School of Public Health , Cambridge, Massachusetts, USA

[13 ]departmentDepartment of Global Health and Primary Health Care , University of Bergen Faculty of Medicine and Dentistry , Bergen, Norway

[14 ]departmentDepartment of Research and Development , Haukeland University Hospital , Bergen, Norway

[15 ]Options Consultancy Services Ltd , London, UK

[16 ]departmentGlobal Health and Population , Harvard University T H Chan School of Public Health , Boston, Massachusetts, USA

[17 ]departmentDepartment of Global Public Health and Primary care , University of Bergen Faculty of Medicine and Dentistry , Bergen, Norway

Author notes

[Correspondence to ] Dr Karl Blanchet; karl.blanchet@ 123456unige.ch

Author information

Karl Blanchet http://orcid.org/0000-0003-0498-8020

Alemayehu Hailu http://orcid.org/0000-0003-4872-8036

Peter Hangoma http://orcid.org/0000-0002-6573-5628

Ingrid Miljeteig http://orcid.org/0000-0001-5738-017X

Stéphane Verguet http://orcid.org/0000-0003-4128-0849

David Watkins http://orcid.org/0000-0001-6341-9595

Kjell Arne Johansson http://orcid.org/0000-0001-8912-8710

Article

Publisher ID: bmjgh-2020-003675

DOI: 10.1136/bmjgh-2020-003675

PMC ID: 7542611

PubMed ID: 33028701

SO-VID: 3844768f-8c0f-4a86-a892-97cd168e05ea

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This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 10 August 2020

Date revision received : 14 September 2020

Date accepted : 16 September 2020

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Keywords: public health,health policies and all other topics,control strategies,health economics,health systems

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Keywords: public health, health policies and all other topics, control strategies, health economics, health systems

Protecting essential health services in low-income and middle-income countries and humanitarian settings while responding to the COVID-19 pandemic

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Novel Coronavirus Disease COVID-19

Most cited references 11

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

Early estimates of the indirect effects of the COVID-19 pandemic on maternal and child mortality in low-income and middle-income countries: a modelling study

Effects of Response to 2014–2015 Ebola Outbreak on Deaths from Malaria, HIV/AIDS, and Tuberculosis, West Africa

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