Measuring unanticipated opportunity costs of South Africa's COVID-19 response for children, mothers, and people living with non-communicable diseases
Lead Research Organisation:
University of the Witwatersrand
Department Name: Priceless SA
Abstract
The SA government introduced a strict lockdown in response to the COVID-19 epidemic, providing extra hospital beds and widespread community testing and tracing. At the same time, SA has high levels of HIV (the highest number globally), Tuberculosis, undernutrition, obesity, Diabetes, and Hypertension as well as excessive levels of violence and trauma. By focusing only on COVID-19, providing the usual preventive and curative health services may have suffered. The fast response has reduced the voice of communities in decision-making. People stop attending health services either because of fear or because of temporary unavailability of services. This may have consequences for the health of women and children and people who live with chronic conditions. Our study aims to measure the impact of redirecting resources from routine health services and seeks to understand the perspective of health workers and communities about this repositioning of services. The project will focus on mother and child health, and on people with hypertension and diabetes, diseases that result in significant sickness and death. These analyses will shift the needle from assumptions to reality and show where the most lives are being lost, many of them not COVID-19 related. This can and will inform policy decisions for current and future epidemics.
Technical Summary
Before the COVID-19 epidemic, SA's life expectancy was on an upward trajectory, with gains towards 2030 SDG targets. In response to the epidemic, the government instituted a lockdown to flatten the curve. Though there have been benefits, there are questions about the impact on non-COVID-19 health outcomes. Rapid decision making has also left community perspectives behind. SAMRC Centre for Health Economics and Decision Science-PRICELESS SA & the MRC/Wits Agincourt Unit have partnered to investigate this. Our hypotheses are firstly, that during COVID-19 epidemic there has been and will continue to be a decrease in supply and demand of routine health services which may impact on morbidity and mortality for individuals with HT, Diabetes, pregnant mothers and children under 5. Secondly, the perspective of health workers and community members regarding provision and access to routine health services during the COVID-19 epidemic will differ from that of public policy makers. The proposal aims to quantitatively measure the impact of diverting a workforce who are managing COVID-19, on routine preventive and curative health services. This will include supply and demand side perspectives. We will also qualitatively evaluate the views of the public and of healthcare workers in rural and urban areas. This will be a mixed-method study with a multi-disciplinary approach that will quantify health service opportunity costs due to the COVID-19 response. We will use a time series analysis of health services headcount data, addressing geographical and equity impacts, and qualitative interviews to understand the perspective of the public and health workers. The results will enable policymakers to make evidence-based decisions regarding resource allocation, between maintaining health services and mitigating the epidemic, that are also responsive to community needs and priorities. Our robust track record of policy action research over a decade in SA predicts a successful outcome.
Publications
Boachie MK
(2023)
The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa.
in Health services insights
Lalla-Edward ST
(2022)
Essential health services delivery in South Africa during COVID-19: Community and healthcare worker perspectives.
in Frontiers in public health
Rwafa-Ponela T
(2022)
"We Were Afraid": Mental Health Effects of the COVID-19 Pandemic in Two South African Districts.
in International journal of environmental research and public health
Thsehla E
(2023)
Indirect effects of COVID-19 on maternal and child health in South Africa.
in Global health action
Description | This research in urban and rural areas showed that COVID -19 severely impacted on health services, particularly mother and child health and chronic conditions. Although after the disruption of standard service there was substantial catch-up critical services such as immunization did not catch up to prior COVID-19 levels. The study found substantial mental health stress (particularly fear and anxiety) during and after COVID -19 both with health workers and community members alike. This was also associated with financial and social stress. Attention needs to be paid in future to cultural issues relating to burials and mourning too. On the positive side there was an increase in a system for providing people with chronic illnesses medication for longer than the standard 1 month, although the impact of this on health is still to be evaluated it made life much easier for poor people as they did not have to travel to the health services as much. However those receiving medications for multiple morbidities did not show an increase in participation in this project. |
Exploitation Route | Looking at the issue of chronic medication being supplied for at least 3 months to stable patients needs to be evaluated. Further research needs to be done to ascertain why people with multiple morbidities were not given extended chronic medicines. Attention to mental health issues in future emergencies is critical. Through better engagement with the public about restrictions will go a long way to improving the levels of anxiety and fear, but mental health support needs to be offered at health services at all levels. Outreach to get standard health services back to pre-covid levels is important and especially for children who have missed essential immunisations. |
Sectors | Communities and Social Services/Policy Healthcare |
Description | Presentations have been made to stakeholders in the National and provincial departments of health to enable them to engage with the findings of our research and to take up our recommendations. |
First Year Of Impact | 2021 |
Sector | Healthcare |
Impact Types | Policy & public services |
Description | MOCCA |
Organisation | Ezintsha |
Country | South Africa |
Sector | Charity/Non Profit |
PI Contribution | As with other MOCCA partners PRICELESS conceptualized, leads and manages the research. |
Collaborator Contribution | Ezintsha brings the research capacity in an urban area in Johannesburg, qualitative expertise and fieldworkers. Ezintsha also participated in the study design and development of instruments. |
Impact | This is multidisciplinary - with clinical trail and qualitative research experts, HIV clinicians and field workers. |
Start Year | 2020 |
Description | MOCCA |
Organisation | Medical Research Council (MRC) |
Department | MRC/Wits Rural Public Health and Health Transitions Research Unit |
Country | South Africa |
Sector | Public |
PI Contribution | This research was a partnership with the Transitions research unit with our contribution being the conceptualization, management and coordination, analysis and writing of the research. |
Collaborator Contribution | The Transitions unit provided a rural perspective to the research using their clinic links to the participants, fieldworkers and demographers to analyze the data relating to the MOCCA project. It has been a good partnership with leadership from all partners. |
Impact | There is a multidisiplinary team at Agincourt- this includes demographers, public health specialists, clinicians, and community based field workers. |
Start Year | 2020 |
Description | MOCCA |
Organisation | South African Medical Research Centre |
Country | South Africa |
Sector | Public |
PI Contribution | PRICELESS is an Extramural unit of the SAMRC so we benefit from a yearly grant of R500 000 for core functioning, capacity building and other research support. A small amount of this went to the MOCCA project. |
Collaborator Contribution | PRICELESS is an Extramural unit of the SAMRC so we benefit from a yearly grant of R500 000 for core functioning, capacity building and other research support. A small amount of this went to the MOCCA project. |
Impact | This is multidisciplinary and involves Health Economists, public health specialists, health lawyers, anthropologists, and occupational therapists. |
Start Year | 2019 |
Description | MOCCA Collaboration |
Organisation | Ezintsha |
Country | South Africa |
Sector | Charity/Non Profit |
PI Contribution | Provided funding for primary data collection for community member and health care worker interviews. |
Collaborator Contribution | Conducted primary data collection for community member and health care worker interviews. |
Impact | None yet |
Start Year | 2020 |
Description | Measuring unanticipated opportunity costs of South Africas COVID-19 response for children, mothers, and people living with non-communicable diseases |
Organisation | Harvard University |
Department | Harvard T.H. Chan School of Public Health |
Country | United States |
Sector | Academic/University |
PI Contribution | The research partnership looking at the opportunity costs of the Covid-19 epidemic and South Africa's response to it in relation to chronic health conditions and mother and child health. our team is analyzing national health system data, and data from a health and demographic surveillance site in Rural Mpumalanga. We use a time series to analyse number of visits to health services before Covid-19, and during the various waves. |
Collaborator Contribution | Prof Verguet is an expert at looking at distributional costs measuring equity in time series analyses. This means understanding which socio-economic group has been most impacted by the disruption of services. |
Impact | A paper entitled: "Socioeconomic status, the COVID-19 crisis, and children's utilization of routine healthcare services in South Africa" is in final draft |
Start Year | 2020 |
Description | Conference presentation |
Form Of Engagement Activity | Participation in an activity, workshop or similar |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Professional Practitioners |
Results and Impact | Poster presentation at the Public Health Association of South Africa Conference in Durban September 2022 |
Year(s) Of Engagement Activity | 2022 |
Description | MOCCA Steering Committee Engagements |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | Local |
Primary Audience | Policymakers/politicians |
Results and Impact | Formulated a steering committee to guide and refine the research activities. The first engagement was an onboarding to familiarise the committee with the research. Subsequent engagements will focus on feeding back research results. |
Year(s) Of Engagement Activity | 2020 |
Description | Steering Committee Interim Results Meeting |
Form Of Engagement Activity | A formal working group, expert panel or dialogue |
Part Of Official Scheme? | No |
Geographic Reach | National |
Primary Audience | Policymakers/politicians |
Results and Impact | The Steering Committee was convened and the presentation of the early results for both the quantitative and qualitative streams of work. The discussion that followed assisted in clarifying some issues and focusing the direction of the final analyses. |
Year(s) Of Engagement Activity | 2021 |