Measuring unanticipated opportunity costs of South Africa's COVID-19 response for children, mothers, and people living with non-communicable diseases

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.

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.