The impact of COVID-19 on primary health care service provision and utilisation in Tanzania, Sierra Leone and the Democratic Republic of Congo

Lead Research Organisation: London Sch of Hygiene and Trop Medicine
Department Name: Epidemiology and Population Health

Abstract

Initial reports suggest the COVID-19 pandemic response has had an impact on the number of people seen for routine healthcare needs worldwide. Potential reasons suggested include the fact that the general public are not attending healthcare centres because they fear that they will contract COVID-19 and that it is difficult for people to travel for healthcare during lockdown. This project will look at whether the attendance of routine services, like antenatal care, immunisations and HIV treatment services, have been affected by the COVID-19 pandemic in 3 countries in East, West and Central Africa. If attendance has been affected, this could have a substantial detrimental effect on health problems that are unrelated to COVID-19, such as pregnancy outcomes, children's risk of contracting other infectious diseases and HIV outcomes. It will be important for the Ministries of Health of the respective countries to have this information in order to plan appropriate responses to ensure services are delivered and to encourage the population to resume seeking care. Recommendations resulting from this project will be useful to inform the response to the present COVID-19 crisis and future large outbreaks.

Technical Summary

The impact and implications of the COVID-19 pandemic on routine primary health care provision and utilisation in resource-poor settings is unknown. Initial reports suggest that as health care workers with comorbidities or pre-existing conditions are taken off the 'frontline', others are transferred to COVID-19 response activities, fear of COVID exposure increases absenteeism, and social distancing measures are put in place in health facilities, the capacity to provide services has been reduced. Utilisation has also been affected, potentially by users' fear of catching SARS-CoV-2 infection at health care facilities, misconceptions that services are shut, barriers to accessing health care due to fewer transport options and less disposable income during lockdowns. A reduction in primary healthcare provision could be particularly devastating in low income settings. This multidisciplinary project aims to investigate the impact that the COVID-19 pandemic is having on primary healthcare providers and users in three distinct settings in Central (Democratic Republic of the Congo), East (Tanzania) and West (Sierra Leone) Africa, by building on existing collaborative partnerships. We will conduct the following activities:
1. Data will be collected from healthcare facilities to estimate the change in the number of people seen for essential services e.g. antenatal care, outpatients, routine immunisations, family planning and HIV comprehensive care visits.
2. Qualitative interviews will be conducted with primary healthcare workers to understand barriers and facilitators for effective care provision during the COVID-19 outbreak.
3. Healthcare workers' exposure to SARS-CoV-2 will be estimated in a repeated sero-survey, using a validated serological assay.
4. Qualitative interviews will be conducted with a selection of healthcare users to understand barriers and facilitators of utilisation.
5. A set of recommendations/ key findings will be formulated together with stakeholder

Publications

10 25 50
 
Description Partnership with COMAHS 
Organisation University of Sierra Leone
Country Sierra Leone 
Sector Academic/University 
PI Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Collaborator Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Impact n/a
Start Year 2020
 
Description Partnership with INRB 
Organisation Congo National Institute of Biomedical Research
Country Congo, the Democratic Republic of the 
Sector Academic/University 
PI Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Collaborator Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Impact N/a
Start Year 2020
 
Description Partnership with MITU 
Organisation National Institute for Medical Research, Tanzania
Department Mwanza Intervention Trials Unit (MITU)
Country Tanzania, United Republic of 
Sector Public 
PI Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context. Unfortunately it became clear that ethical approval from Tanzanian regulatory authorities was not possible as the project is related to COVID; however our Tanzanian partners will stay involved to input into the analysis of data from other countries.
Collaborator Contribution After co-development of the proposal with our partners, our team won the funding for the research. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context.
Impact N/A
Start Year 2020
 
Description Partnership with MRC/UVRI 
Organisation Medical Research Council (MRC)
Department Medical Research Council (MRC), MRC/UVRI Unit, Uganda
Country Uganda 
Sector Academic/University 
PI Contribution Our team won the funding for the research with MITU as a partner in Tanzania, when it became clear the Tanzanian regulatory authority was not going to approve any research on COVID-19 we approached UVRI as an alternative. We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Collaborator Contribution We supplied epidemiological, statistical and laboratory expertise during co-development of the protocol; our partners contributed key inputs to ensure the research protocol was feasible and relevant to their context, and currently lead community engagement and oversight of data collection.
Impact n/a
Start Year 2020
 
Description District Medical Officer engagement on the results of the HWI study 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact 2 District Medical Officers (1 in Masaka, Uganda, 1 in Kambia, Sierra Leone) and three health Zone Heads in Goma, DRC attended a workshop to talk through the results of the HWI study and co-develop interpretations and conclusions.
Year(s) Of Engagement Activity 2022