After three years of the COVID-19 pandemic, countries’ health systems have begun to show the first major signs of health system recovery, according to the WHO interim report on the “Fourth round of the global pulse survey on the continuity of essential health services during the COVID-19 pandemic: November 2022 to January 2023”. By early 2023, countries reported experiencing fewer disruptions to routine health service delivery, but highlighted the need to invest in recovery and greater resilience for the future.
Among the 139 countries that responded to the fourth round of the WHO pulse survey, countries reported ongoing interruptions to almost a quarter of services on average. In 84 countries where trend analysis is possible, the percentage of interrupted services decreased on average from 56% in July-September 2020 to 23% in November 2022-January 2023.
Persistent disruptions are due to both demand-side and supply-side factors, including low levels of care-seeking in communities, as well as limited availability of health workers and other healthcare resources, such as open clinics or available stocks of medicines and products.
“It is good news that health systems in most countries are starting to restore essential health services for millions of people who were unable to enjoy them during the pandemic,” said Dr. Rudi Eggers, Director of Integrated Services of Health of the WHO. “But we must ensure that all countries continue to close this gap to recover health services and apply the lessons learned to build more future-proof and resilient health systems.”
First noticeable signs of recovery
In this new survey, fewer countries reported intentionally reducing access across all essential public health service delivery platforms and functions since the 2020-2021 report, showing an important step toward returning to service delivery levels. prior to the pandemic and a broader operation of the system.
By the end of 2022, most countries reported partial signs of recovery of services, including sexual, reproductive, maternal, newborn, child and adolescent health services; nutrition; immunization; communicable diseases (including malaria, HIV, tuberculosis and other sexually transmitted infections); neglected tropical diseases; non-communicable diseases; management of mental, neurological and substance use disorders; care for the elderly; and traditional and/or complementary care.
The number of countries reporting disruptions in their domestic supply chain system dropped from almost half (29 of 59 responding countries) to about a quarter (18 of 66 responding countries) in the past year.
Despite signs of recovery, service disruptions persist in all countries across all regions and income levels, and in most service delivery environments and tracking service areas. Countries are also facing a growing backlog of services, most often in services for the detection, diagnosis and treatment of non-communicable diseases, which can have negative consequences as people delay in accessing timely care .
The recovery of the provision of essential health services is critical because interruptions, including health promotion, disease prevention, diagnosis, treatment, rehabilitation and palliation services, can have even greater adverse health effects at the population level. and individual than the pandemic itself, especially among vulnerable populations.
Integration of COVID-19 services into essential health services
In another important step towards system recovery and transition, most countries have made progress in integrating COVID-19-related services into routine health service delivery. About 80-90% of countries have fully integrated COVID-19 vaccination, diagnostic and case management services, as well as post-COVID-19 services into routine service delivery.
Still, most countries (80% of the 83 responding countries) reported at least one bottleneck to expanding access to essential COVID-19 tools (for example, diagnostics, therapies, vaccines, and protective equipment). (PPE) of COVID-19), with problems of health personnel and the lack of financing represent the most common barriers.
More support is needed for recovery, resilience and preparedness
Most countries have begun to apply what they have learned during the COVID-19 pandemic, including through the institutionalization of a number of innovative service interruption mitigation strategies in routine health service delivery. These include the deployment of telemedicine approaches, the promotion of home care or self-care interventions, approaches to strengthen the availability, capacities and support mechanisms of health workers, innovations in the procurement and delivery of medicines and supplies. , more routine community communications and partnerships with the private sector. providers
Three quarters of countries reported allocating additional funds for longer-term recovery, resilience, and system readiness.
Countries expressed the need for WHO support to address remaining challenges in the context of COVID-19 and beyond, most often related to strengthening the health workforce, building monitoring capacities of health services, the design of models of care oriented to primary health care, governance, policies and planning and financial planning and financing.
Note to editors:
In the fourth round of the WHO global pulse survey, 222 countries, territories and areas were invited to respond to a standardized web-based survey between November 2022 and January 2023. The fourth survey followed surveys from Previous WHO pulses of 2020 and 2021: Round 1 (May-September 2020), Round 2 (January-March 2021)and Round 3 (November-December 2021) which showed to what extent the pandemic was affecting the continuity of essential health services and how countries are taking action. While pulse surveys have limitations, such as reporting bias and representativeness, the strength of this effort is that it is comprehensive and provides information quickly. The term “country” should be understood to include all countries, territories and areas. Trend analyzes were completed based on responses from 84 countries, territories, or areas that responded to at least one section of the survey across all four rounds of the pulse survey.
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