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What has been the impact of COVID-19 lockdown on health services in Public facilities?

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The COVID-19 lockdown affected many sectors including the health sector. Many routine healthcare services including maternal & pregnant healthcare, child immunization, emergency services were disrupted. In this story, we look at the extent of this disruption of some of the important services. 

Even before the COVID-19 pandemic hit the world, it was estimated that about half of the world’s population lacked access to essential health services, according to UN. In 2019 alone, around 5.7 million children aged below 9 years died due from preventable and treatable causes such as preterm birth complications, birth asphyxia, pneumonia, diarrhoea, and malaria. It is also estimated that every 11 seconds, a pregnant woman or a new-born dies somewhere around the world, mostly of preventable causes. Effective health interventions such as immunization drives, and health check-ups help in addressing these issues. 

However, in 2020, the COVID-19 pandemic resulted in disruptions in routine and essential health services which has further worsened the accessibility to healthcare. Immunization, non-communicable diseases diagnosis and treatment, mental health services, and family planning & contraception are some of the services that were disrupted. Significant progress made over decades to minimize the effect of diseases including malaria and tuberculosis has also been threatened because of the pandemic in India & other nations. The annual polio vaccination day in India, also known as National Immunization Day, has been rescheduled to 31 January 2021 following the rollout of COVID-19 vaccine that began on 16 January 2021. 

In this story, we take a look at how maternal healthcare, child immunization, and other treatment-related services were affected in India when the nation went into a complete lockdown in the first half of 2020. Data has been collated from the National Health Mission’s Health Management Information System which is a web-based monitoring system of the Health Ministry. It covers data taken from over 2 lakh public health facilities including PHCs and district hospitals, across urban and rural areas in India. The latest data available is up to June 2020.  

Impact on Maternal healthcare services

Antenatal care is vital for pregnant women as it helps them in delivery and ensures improved maternal and child health. A minimum of 4 Antenatal check-ups (ANC) are necessary to check the progress of the pregnancy as per the National Health Mission’s guidelines

  • As a result of the lockdown, the number of women who received at least 4 ANCs had dropped by 7.7% between January to June of 2020, compared to the same period in 2019. In April 2020, the number of women who received at least 4 check-ups was 7.15 lakh less than that in April 2019. Since then, as lockdown regulations were relaxed, the number has gradually increased. However, it is still lesser than the pre-COVID-19 levels. 
  • Pregnant women tested for Haemoglobin is about 9.7 lakhs less in the first half of 2020 than in the first half of 2020. In January and February, the number of women was about 3.39 lakh higher than in 2019. 
  • Similarly, Y-o-Y comparison of number of pregnant women tested for diabetes orally shows that the number had dropped by half in April 2020 from 3.6 lakh to over 1.8 lakh.

It is seen that in March 2020, the number of women who received the check-ups and tests was lower than in March 2019. States started imposing lockdowns towards the latter half of March as COVID-19 cases began increasing. 

Another observation is that the number of institutional deliveries in the first six months of 2020 was about 9.59 lakh less than that during the same period in 2019. This may be due to more women giving birth at home or outside these institutions. 

What about Child immunization?

Child Immunization has also been hit amidst the pandemic lockdown. Delaying or not taking a vaccine has its own risks and even the potential to affect a child’s health for life. 

  • There has been a drop in BCG immunization by nearly 12.8 lakh in the first half of 2020 as compared to the first half of 2019. In the month of April alone, the difference is over 6 lakhs. 
  • The number of infants who got the Pentavalent vaccine’s birth dose was also fewer in 2020 by more than 14 lakhs as compared to 2019. 
  • Children who took Measles and Rubella vaccine have dropped by more than 44%. In April 2020 alone, over 1 lakh children missed the vaccine while in March 2020 there was a drop in number by more than half as compared to 2019. 
  • The number of children who got the birth dose of Hepatitis B vaccine has also dropped. However, the drop is not as significant as in the case of BCG, Pentavalent, and Measles.
  • Between March to June 2020, over 9.6 lakh infants missed the oral polio vaccine as compared to the same period in 2019. 

In the case of the Rotavirus vaccine, contrary to the other vaccinations, it is observed that the number of children who received the vaccine has gone up by over 71% in the first half of 2020 as compared to 2019. This is because of the increase in coverage in Rotavirus vaccination since September 2019. However, the M-o-M comparison reveals that the number of children who received the vaccine dropped by over 3.36 lakh in March 2020 and 14.4 Lakh in April 2020, as compared to February 2020.

Impact on Patient health services

During & immediately after the lockdown in the first half of 2020, there has been a drop not only in routine health services, but also in the number of patients being admitted, treated, and attending surgeries. Outpatient treatment of patients with illnesses such as diabetes, acute heart diseases, cancer, etc. had dropped. Similarly, inpatient health services for communicable diseases such as TB, Malaria, Dengue, etc. were also curtailed by the lockdown. 

  • Those going to hospitals for dental health has dropped considerably. Y-o-Y comparison with 2019 for the months of March, April, May, and June 2020 reveals a drop in patients by 23%, 71%, 68%, and 61% respectively.
  • Dengue patients in hospitals had increased in 2020 to 25,780 as compared to 21,864 in 2019.
  • The overall drop in the number of patients for diabetes in the six months was 14% as against 40% for oncology. The same for acute heart diseases, mental illnesses, TB, and Asthma was between 27% to 30%.

Number of people who availed Emergency services also dropped

During the lockdown, even emergency services were curtailed. There were reports of hospitals hesitating & refusing to admit patients fearing the spread of the virus. Further, hospitals and beds were limited, and available resources were diverted for COVID-19 care. It is seen that the number of patients given emergency service for cerebrovascular diseases, acute cardiac issues had dropped by around 14%, and obstetrics complications by around 11% in the first half of 2020 compared to the same period in 2019.

Besides the above-discussed indicators, even surgeries have declined in the first half of 2020 as compared to 2019. The number of major surgeries involving general or spinal anesthesia reduced by 25% and minor surgeries without anesthesia or with local anesthesia dropped by 28%. 

COVID-19 put the healthcare systems to test

Most countries diverted a large portion of their medical resources including health infrastructure, equipment, and health professionals, towards dealing with the COVID-19 pandemic. Moreover, since hospitals could be hotspots for the coronavirus, people may have avoided visits to hospitals to avert the risk of contracting the virus. Transportation challenges due to lockdowns, disruptions in nutrition programs, and adherence to COVID-19 precautions may have also contributed to the inability of governments to deliver efficient healthcare services during the pandemic. Though the disruption might seem temporary, the effects of such disruption could be felt in the long run if adequate corrective interventions are not made immediately. The government should be prepared to continue with routine health services while dealing with future pandemics simultaneously.

Featured Image: COVID-19 impact on health services

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