Ensuring continuity of essential health services during COVID-19
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This document discusses ensuring continuity of essential health services during the COVID-19 pandemic, which is a critical priority. It outlines the impact of the pandemic on essential health services, including disruptions to services for noncommunicable diseases and declines in immunization rates. It also discusses challenges delivered essential health services during the pandemic, such as limitations in health system capacity and shortages of supplies. The document provides an overview of WHO's guidance and activities to support delivering essential health services during COVID-19, and innovative approaches that have been used. It calls for renewed commitment to achieving universal health coverage and the Sustainable Development Goals.
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Ensuring continuity of essential health services during COVID-19
- 1. Ensuring continuity of essential health services: A critical priority during the COVID-19 pandemic Abridged agenda item 3(b) 67th session of the Regional Committee for the Eastern Mediterranean 12–13 October 2020 1
- 2. 2 Outline 1. Why essential health services (EHS)? Achievements to date 2. Impact of COVID-19 pandemic 3. Challenges delivering EHSs during the pandemic 4. WHO activities & operational guidance 5. Innovative approaches to delivering EHSs 6. Way forward
- 3. Emergency care Neonatal and child health Acute dental problems Reproductive & maternal health Mental health Noncommunicable diseases and nutrition Elderly health Communicable diseases SDG 3.8 calls for “Achieving universal health coverage (UHC), including financial risk protection, access to Quality Essential Health Services, and access to safe, effective, quality, and affordable essential medicines and vaccines for all” Essential Health Services Why essential health services?
- 4. 4 Holistic approach: advancing UHC while ensuring emergency preparedness and response and building systems! Why essential health services (EHS)? Essential public health functions
- 5. 5 Declining maternal mortality ratio (52%) 330 275 220 175 164 0 50 100 150 200 250 300 350 2000 2005 2010 2015 2017 Per100,000livebirths Declining child and neonatal mortality (1990–2018) We have come a long way in the Region… Maternal and child health
- 6. 6 Progress on vaccine preventable diseases (↑ DTP3 coverage); Eliminating measles and rubella… We have come a long way in the Region: Immunization
- 7. Indicator Year EMR Global 2030 numeric target Maternal mortality ratio (per 100 000 live births) 2017 164 211 < 70 Under-5 mortality rate (per 1000 live births) 2019 46 38 25 Neonatal mortality rate (per 1000 live births) 2019 25 17 12 Probability of dying from any NCD: CVD, cancer, diabetes, CRD (30–70 years of age) (%) 2016 16.2 18.3 Reduce 1/3 UHC service coverage index 2017 57 66 100? Density of health care workers (medical doctors, nurses, midwives) (per 10 000 population) 2017 15.2 34.8 44.5 We still need to step up our efforts: SDG 3 indicators
- 8. 8 Impact of the pandemic on EHS: COVID-19 set us back! (n=13)
- 9. 9 11% 16% 21% 16% 42% 26% 42% 42% 47% 37% 26% 32% 0% 10% 20% 30% 40% 50% 60% Hypertension Management Cardiovascular emergencies (including MI, Stroke and cardiac Arrhythmias) Cancer Treatment Diabetes and Diabetic Complications Management Asthma services Urgent dental care Rehabilitation services Palliative care services Completely disrupted Partially disrupted Impact of the pandemic on EHS: NCDs survey
- 10. 10 Average DTP3 and MCV1 month coverage (%) in high priority countries (January–June 2020) Impact of the pandemic on EHS: Immunization
- 11. 11 Limited capacity of health systems to cope with outbreaks, other emergencies Decrease in outpatient/inpatient visits due to facilities closure, fear of infection, lack of PPE, infodemic Re-purposed health workforce Shortage of supplies, medicines Travel/movement restrictions Financial resources diverted to the pandemic Challenges of service delivery during the pandemic
- 12. Impact assessments Country missions/e-consultations Over 30 regional webinars related to EHS (trainings/consultations) Technical guidance/contextualized protocol guidelines Policy briefs (health systems, nutrition, migrant/refugee health) Communication and raising awareness 12 What have we done so far?
- 13. Governance/coordination Health Information Systems Context-relevant essential services Patient flow (screening, triage, targeted referral) Financial barriers Essential medicine & supplies Service delivery platforms Health workforce Strengthen communication and use of information technologies Operational guidance for EHS continuity during COVID-19: Strategies
- 14. 14 Noncommunicable diseases, nutrition and mental health Life-course stages Communicable diseases (including immunization) Operational guidance for EHS continuity during COVID-19: Programmes
- 15. 15 Mental health: 85% countries with online platforms/hotlines A first! Waterpipes banned in 17 countries e-health and applicationsCommunity-based services Tele-medicine/e-clinics Impact on air quality Opportunities and innovations during the pandemic
- 16. Moving forward: Renewing commitment to UHC and SDGs, and building more resilient health systems
- 17. 1. Sustain gains and ensure access to quality essential health services 2. Benefit from opportunity to strengthen primary health care and build integrated delivery platforms 3. Ensure health care workers are adequately trained and protected, and health care facilities are well equipped and prepared 4. Focus on building essential health systems functions to ensure service delivery and monitoring, especially primary health care 5. Invest in alternative methods e-health/telemedicine 6. Strengthen health promotion and self-care 17 Call For Action!
- 18. “A safer world benefits everyone. UHC will benefit everyone” UHC is critical for global health security Peter Salama, Former Executive Director UHC/Life Course at WHO
- 19. Health for All – By All 19
Editor's Notes
- To mention on this slide: Maternal mortality U5 and Neonatal mortality Sin taxes Regional observatory Taxes on sugar-sweetened beverages introduced in Bahrain, Iran, Iraq, Saudia Arabia, Morocco, Oman, Qatar, TunisiaUAE 14 countries remain malaria free in spite massive population movement in the region Morocco certified as malaria free in 2010.
- To mention on this slide: Maternal mortality U5 and Neonatal mortality Sin taxes Regional observatory , measles and rubella eliminated; NTDs eliminated Taxes on sugar-sweetened beverages introduced in Bahrain, Iran, Iraq, Saudia Arabia, Morocco, Oman, Qatar, TunisiaUAE 14 countries remain malaria free in spite massive population movement in the region Morocco certified as malaria free in 2010.
- Source: World Health Statistics 2019 and 2020 reports and UN Child Mortality Report 2020 16 indicators where the Region was flagged to be behind (for the selected indicators with explicit targets) or need to step up more efforts. This is based on comparison with other regions
- 13 (59%) EMRO countries submitted a survey response. 38% of responding countries have defined essential health services to be maintained during the COVID-19 pandemic. The most frequently disrupted services reported by countries included family planning and contraception (92%), dental services (92%), rehabilitation services (92%), palliative services (92%), antenatal care (85%), NCD diagnosis and treatment (85%), and treatment for mental health disorders (85%). Causes of disruption source (Mental Health slides)
- NCD survey: Rapid assessment questionnaire sent to all MOH focal points who answered the NCD country capacity survey (CCS) in 2019. Web-based questionnaire with 13 questions designed to assess NCD staffing and service disruptions during COVID-19 pandemic; services included in country COVID-19 response plans; funding for NCDs in COVID-19 response; level of service disruption for a set of tracer services; main causes of disruption; mitigation strategies, data collection on co-morbidity; and suggestions for WHO technical guidance and tools. Response rate: 86 % for EMR (19 out 22 countries). Partially or completely disrupted services: 53% HTN treatment and urgent dental care, 48% Palliative care, 47% Asthma and rehabilitation. 42% Diabetes and cancer management, 26% Cardiovascular emergencies
- Additional burden of deteriorated on the economy, food security and mental health
- Webinars: Health Workforce, chemical hazards (CEHA), mental health, supply chain, mental health, adolescent health, nutrition, maternal health, breastfeeding, sexual and reproductive health, laboratories, leprosy.
- IPC Health information systems! 12 of 22 EMR countries integrated continuity of EHSs in their CPRP Continuity of services for communicable and noncommunicable disease (Hep, HIV, WASH, IPC) DCP3 Reviewed and tailored guidance with a COVID lens (RMNCAH, Nutrition, NCDs, CDs, MHPSS, etc.) Mental Health (hot topic) 17 countries established MHPSS hotlines and/or platforms for remote MHPSS deliver with WHO support. Developing MHPSS for RO by WHO (50,000 consultations) Impact of economy on countries Governement and MoF injecting $$ into the economy
- Life-course stages: maternal and newborn, child and adolescent, older people, Nutrition, noncommunicable diseases and mental health Communicable diseases (HIV, Hepatitis, TB, immunization, NTDs, Malaria)
- Tele medicine and e-health, Application UAE deliver of medicine Provide only timely, necessary, and life-saving treatment: Palestine (Augusta Victoria Hospital): continue provision of dialysis and cancer patients Housing patients and staff in or near hospital, limit visitors, multiple daily screenings, all-staff IPC training Pakistan (AKU and Indus Hospital Network): OPD closed BUT continued infectious diseases, cancer, immunization and emergencies Spacing appointment, social distance, 100% PPE compliance, converting parking space for services Oman (Khoula and Royal Hospitals): Cancel all elective procedures, reduce hospital load, shifting staff and resources and providing all emergency and urgent operations Using telemedicine (Tele-triage, tele-treatments) and home-visit/care: almost all EMR countries Jordan: MOH used tele-health to prepared and distributed prescriptions home delivered Libya: volunteers arranged home visits, especially in limited-mobility areas Iraq: home-treatment of mild-moderate COVID cases Comments from TFI: There has always been a claim in the region; that a ban on tobacco use in public places is not possible nor doable. COVID-19 proved that it was possible not only in indoors public places but also in out doors as was done by 17 countries in the region. We need to maintain this new normal and make sure that this ban continues as long as possible, and once measures are reduced at least in all indoors public places tobacco use should be stopped and end. Counter the tobacco industry claims to undermine this ban; including the integration of new products in the region. Strengthen cessation services through new modalities that are suitable to COVID-19 such as on line and virtual services. As we ban tobacco use in public places demand on cessation will increase, we need to be ready and support the population in this regard.
- Define ehs PACKAGES AND PUBLICH FINANCING Strengthen PHC Develop integrated delivery platforms Innovative approaches e-health Invest in alternative methods e-health/telemedicine Health promotion and self-care
- publicly financed, evidence-informed, prioritized individual and population-based interventions, defined through a deliberative process, which accounts for people’s health needs, country’s economic reality and societal preferences. The UHC-PBP consists in ‘health services and programs’ and ‘intersectoral actions and fiscal policies’ [7]. ‘Health services and programs’ include promotive, preventive, curative, rehabilitative and palliative interventions that respond to people’s health needs. ‘Intersectoral actions and fiscal policies’ relate to actions in other sectors with impact on health; e.g., promoting physical activity, subsidizing beneficial commodities or taxing harmful products [8].