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90% nations report 1 or more disruptions in essential health services: WHO survey

Geneva, Apr 23 (MNN) The WHO has said that a ‘pulse survey’ has revealed that over one year into the COVID-19 pandemic, substantial disruptions persist, with about 90 per cent of the countries still reporting one or more disruptions to essential health services, marking no substantial global change since the first survey was conducted in the summer of 2020.

The World Health Organisation said that within countries, however, the magnitude and extent of disruptions has generally decreased.
In 2020, the countries reported that, on an average, about half of essential health services were disrupted.

In the first 3 months of 2021, however, they reported progress, with just over one third of services now being disrupted, the world health body said.

Overcoming disruptions

“Countries have been working to mitigate disruptions. Many have now stepped up communications efforts to inform the public about changes to service delivery and provide advice about ways to safely seek health care. They are also triaging to identify and better meet the most urgent patient needs,” The WHO noted.

More than half the countries consulted say they have recruited additional staff to boost the health workforce; redirected patients to other care facilities; and switched to alternative methods to delivering care, such as providing more home-based services, multi-month prescriptions for treatments, and increasing the use of telemedicine.

In addition, WHO and its partners have been helping countries to adapt their processes so they can better respond to the challenges being placed on their health systems; strengthen primary health care, and advance universal health coverage.

“It is encouraging to see that countries are beginning to build back their essential health services, but much remains to be done,” says Dr Tedros Adhanom Ghebreyesus, Director General, WHO.

“The survey highlights the need to intensify efforts and take additional steps to close gaps and strengthen services. It will be especially important to monitor the situation in countries that were struggling to provide health services before the pandemic.”

Persisting causes of disruptions

Countries are still having to make important decisions when responding to COVID-19 that may negatively affect access to care for other health issues. Redeployment of staff to provide COVID-19 relief and temporary closures of health facilities and services continue.

Although they may have taken on new staff, 66 per cent of the countries continue to report health workforce-related reasons as the most common causes of service disruptions. Supply chains are also still disrupted in nearly one third of countries, affecting the availability of essential medicines, diagnostics, and the PPE needed to safely and effectively provide care.

Communications efforts need to be further scaled up: more than half of countries report service disruptions due to patients not seeking care and because of community mistrust and fears of becoming infected.

Meanwhile, 43 per cent of countries cite financial challenges as major causes for disruptions in service utilisation.

As a result, millions of people are still missing out on vital health care.

In terms of services, the biggest impact reported by nearly half of countries is on provision of day-to-day primary care to prevent and manage some of the most common health problems.

Long-term care for chronic conditions, rehabilitation, and palliative end-of-life care, is also still badly disrupted – severely affecting older people and people living with disabilities.

Potentially life-saving emergency, critical and surgical care interventions are still disrupted in about 20 per cent of countries, reflecting the most immediate indirect consequences of the pandemic.

Two thirds of countries also report disruptions in elective surgeries, with accumulating consequences as the pandemic is prolonged.

Among the most extensively affected health services (i.e. those for which more than 40 per cent of countries are reporting disruptions) are those for mental, neurological and substance use disorders; neglected tropical diseases; tuberculosis; HIV and hepatitis B and C; cancer screening, and services for other noncommunicable diseases including hypertension and diabetes; family planning and contraception; urgent dental care; and malnutrition.The survey revealed that serious gaps also remain in addressing disruptions to services in both these areas.

More than one third of countries are still reporting disruptions to immunisation services, despite progress in countries reducing disruptions to immunisation services in health facilities and “outreach” immunisation services by about 20 per cent and 30 per cent respectively compared with 2020.

This highlights the need for new and sustained approaches to improving immunisation coverage and uptake.

“The COVID-19 pandemic continues to pose serious challenges to global health beyond the impact of the disease itself,” said Henrietta Fore, UNICEF Executive Director.

“For children, disruptions to immunization services have serious consequences. As we scale up delivery of COVID-19 vaccines, we have to ensure that this does not come at the cost of essential childhood vaccinations. We cannot allow today’s fight against COVID-19 to undermine our fight against measles, polio or other vaccine preventable illnesses. Prolonged immunisation disruptions will have long-term consequences for children’s health. The time to catch up is now.”

This survey looked at 63 core health services across delivery platforms and health areas. It was sent to 216 countries and territories across six WHO regions. As many as 135 responses were received (63 per cent response rate) from senior ministry of health officials predominantly between January and March 2021.

The responses referred to the situation in the country during the 3 months prior to survey submission (in this case predominantly covering periods between October 2020-February 2021).

The purpose of the survey was to gain insights and perspectives on the impact of the COVID-19 pandemic on essential health services and how countries are adapting strategies to maintain essential services.

This survey round follows the WHO’s previous pulse surveys on continuity of essential health services distributed throughout quarters 2 and 3 of 2020.

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