Pulse survey on continuity of essential health services
during the COVID-19 pandemic
Key informant findings from 135 countries, territories and areas Quarter 1 2021
Reporting period: 3 months preceding date of survey submission
Global results – as of 16 April 2021
Round 2: National pulse survey on continuity of EHS during the COVID-19 pandemic
Q1 2021: January – March
Use:
Gain rapid snapshot of changes and challenges in service delivery/utilization
Modular approach:
integrates all WHO pulse surveys into comprehensive approach targeting different key informants in Ministry of Health
Timeline:
Q1 2021 (Jan- March 2021).
Results reflect situation
3 months preceding submission.
Contributes to quarterly WHO SPRP monitoring 2021:
indicators for Pillar 9: Maintaining essential health services and systems (Proportion of countries reporting disruption to essential health services during COVID-19 pandemic) and Pillar 2: Risk communication, community engagement and
infodemic management (Proportion of countries with capacities to track and address infodemic and health misinformation)
Results should be used at country level to
support policy and planning
dialogue to identify critical
bottlenecks and priorities,
recommend mitigation
approaches/solutions, and
guide resource investments as
pandemic progresses.
Round 2: National pulse survey on continuity of EHS during the COVID-19 pandemic
Q1 2021: January – March
Limitations:
• Reporting bias (self-reported key informant data)
• Type/mix of key informants across multiple survey sections
• Process of completion (individual survey section submissions vs. coordinated and validated responses across survey sections)
• National level data does not reflect subnational variability within countries
• Response rates varied across regions, limiting extent of possible regional comparisons
• Different quantity and combination of participating countries introduces potential bias into survey
round 1 and round 2 global comparisons
Key questions the national pulse survey helps to answer
Policies and planning
• Have countries identified a core set of EHS to be maintained during the pandemic?
• Have countries designated a national focal point for maintaining EHS?
• Have countries allocated additional funding for maintaining EHS?
Strategic changes to service delivery and public health activities
• Have countries limited or suspended access to service delivery platforms (e.g. outpatient, inpatient, emergency, community-based, etc.)?
• Have countries limited or suspended essential public health functions/activities (e.g. surveillance, emergency preparedness, research, etc.)?
Disruptions to tracer services
• Have countries limited or suspended access to service delivery platforms (e.g. outpatient, inpatient, emergency, community-based, etc.)?
• Have countries limited or suspended essential public health functions/activities
(e.g. surveillance, emergency preparedness, research, etc.)?
Reasons for disruptions
• What are the main supply-side reasons for service disruptions?
• What are the main demand-side reasons for service disruptions?
Mitigation strategies
• What approaches are being used by countries to overcome service disruptions?
• What approaches are being used to ensure access to care for vulnerable groups?
• How are digital technologies being used to mitigate service disruptions?
Information tracking
• Are countries regularly monitoring and tracking continuity of EHS and the implementation of mitigation strategies?
• Are countries tracking the infodemic and misinformation?
Country priorities and needs
• What are countries’ most urgent priority needs and TA requirements for
maintaining EHS?
National pulse survey on disruptions to essential health services: 2 nd round response rates
Key informant responses from 135 countries/territories between January-March 2021
Note: The survey was sent to 216 countries, territories and areas. Response rates are calculated based on contexts where services are relevant.
Malaria section is considered relevant in 92 contexts and NTDs section is considered relevant in 104 contexts. Responses were tracked only in these settings.
Overall response rates Survey section response rates
Complete survey submission (submission of all relevant sections)
N (%)
Complete + partial survey submissions (submission of at
least 1 section) N (%)
Section 1.
Health system functions and cross-cutting
services N (%)
Section 2.
Reproductive, maternal, newborn, child and adolescent
health and nutrition
N (%)
Section 3.
Immunization N (%)
Section 4.
HIV and hepatitis
N (%)
Section 5.
TB N (%)
Section 6.
Malaria N (%)
Section 7.
Neglected tropical diseases
N (%)
Section 8.
Non- communicable
diseases N (%)
Section 9.
Mental, neurological, and substance
use disorders N (%)
AFR 30 (65%) 40 (85%) 36 (77%) 38 (81%) 33 (70%) 35 (74%) 35 (74%) 32 (74%) 33 (75%) 38 (81%) 37 (79%)
AMR 16 (30%) 29 (54%) 25 (46%) 29 (54%) 23 (43%) 22 (41%) 23 (43%) 11 (65%) 11 (52%) 28 (50%) 27 (50%)
EMR 15 (68%) 21 (95%) 17 (77%) 19 (86%) 19 (86%) 17 (77%) 16 (73%) 8 (100%) 10 (83%) 19 (86%) 20 (91%)
EUR 12 (23%) 23 (43%) 16 (30%) 18 (34%) 21 (40%) 19 (36%) 19 (36%) 1 (20%) 1 (25%) 18 (34%) 18 (34%)
SEAR 8 (73%) 9 (82%) 9 (82%) 8 (73%) 9 (82%) 9 (82%) 8 (73%) 7 (78%) 6 (75%) 9 (82%) 8 (73%)
WPR 7 (24%) 13 (45%) 9 (31%) 9 (31%) 7 (24%) 10 (34%) 11 (38%) 8 (80%) 9 (60%) 9 (31%) 11 (38%)
Global 88 (41%) 135 (63%) 112 (52%) 121 (56%) 112 (52%) 112 (52%) 112 (52%) 67 (73%) 70 (67%) 121 (56%) 121 (56%)
Despite some evidence of service restoration, over one year into the COVID-19 pandemic, substantial disruptions to essential health
services persist across the globe.
Disruptions to essential health services are still geographically widespread across the globe
Denominator: represents responses from countries/territories that responded to at least one survey section and consented to data sharing agreement. Percentage of countries reporting disruptions may not add up to exactly 100% due to rounding. Services include: primary care, emergency and critical care, surgical care, rehabilitation, palliative care, long-term care, auxiliary services, and tracer services for reproductive, maternal, newborn, child and adolescent health and nutrition, immunization, communicable diseases, noncommunicable diseases, neglected tropical diseases, and mental, neurological and substance use disorders
9% of countries reported disruptions in 75-100% of services
25% of countries reported disruptions in 50-74% of services
29% of countries reported disruptions in 25-49% of services
32% of countries reported disruptions in less than 25% of services
Only 6% of countries reported no disruptions
94% of responding countries (n= 135) experienced a disruption to some extent
94%
t
On average, countries reported disruptions to more than one third of services
1/3
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
GNB PHL PER TLS IDN UGA PNG MEX SDN SWZ TCD ITA BOL AGO ALB SSD DOMBRA LBN HND SLB BLZ SLV UKR CMR PAN BHS ARG GBRMDG PRY MOZ PRT LCA IRQ HTI CIV LSO MRT WLS JOR SUR COM SEN MWI CHL MYS KEN STP THA TGO COG YEM GHAMAR ZAF ZMB GTM LKA PYF SYC BWAGEO IRN GIN BGR PAK ERI GMB CZE SCT GRD VCT AUT NER GAB ECU FRA DMA PSE LAO SYR TUN CRI LBR CPV JAM ETH VUT MDA URY BGDOMN BEN BMU FIN QAT VGB EGY AUS NAM LVA MDV BRN FJI NPL SOM HRV ARE AFG KAZ CYM HUN ARM BTN SAU KWT COD BDI EST RWADNK CAF DJI NIC BHR KOR MUS TKM CUB CHN BFA PRK
Percentage of services
Country/territory
Percentage of services disrupted per country (number of tracer services = 63)
50% or more disrupted 26-50% disrupted 5-25% disrupted
Global average: 38%
Denominator: represents responses from countries/territories that responded to at least one survey section and consented to data sharing agreement. Percentage of countries reporting disruptions may not add up to exactly 100% due to rounding. Services include: primary care, emergency and critical care, surgical care, rehabilitation, palliative care, long-term care, auxiliary services, and tracer services for reproductive, maternal, newborn, child and adolescent health and nutrition, immunization, communicable diseases, noncommunicable diseases, neglected tropical diseases, and mental, neurological and substance use disorders
Overall, primary care and rehabilitative, palliative and long-term care are more predominantly affected
t
of countries reported disruptions to essential
primary care services
t
of countries reported disruptions to rehabilitative, palliative and long-term care
41%
48% …with likely implications
for the most vulnerable populations, such as older
persons and people living with chronic conditions
and disabilities
Overall, primary care and rehabilitative, palliative and long-term care are more predominantly affected
Denominator: excludes “Not applicable” or “Do not know” responses.
19%
24%
14%
29%
22%
6%
9%
4%
13%
9%
3%
8%
3%
6%
5%
27%
41%
22%
48%
35%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Auxiliary services Rehabilitative, palliative and long-term care Emergency, critical, and operative care Primary care AVERAGE DISRUPTION
Percentage of countries
Average percentage of disruptions across integrated service delivery channels (n=112)
5-25% disrupted 26-50% disrupted More than 50% disrupted
Potentially life-saving emergency, critical and operative care
interventions disrupted in about 20% of countries, likely resulting in substantial near-term impact on health outcomes
Denominator: excludes “Not applicable” or “Do not know” responses.
29%
32%
30%
35%
24%
26%
14%
27%
21%
12%
15%
14%
15%
11%
8%
7%
24%
29%
22%
22%
19%
20%
18%
13%
16%
15%
9%
17%
8%
4%
13%
4%
5%
2%
3%
2%
1%
4%
2%
9%
13%
8%
5%
6%
5%
6%
6%
6%
8%
4%
7%
2%
3%
25%
2%
2%
1%
0%
1%
0%
0%
0%
8%
10%
7%
8%
3%
3%
3%
48%
54%
53%
48%
48%
36%
22%
65%
27%
19%
18%
18%
19%
13%
12%
9%
41%
53%
36%
35%
27%
28%
27%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
AVERAGE DISRUPTION OF PRIMARY CARE Routine scheduled visits (n=98) Health promotion services (n=96) Referrals to specialty care (n=91) Visits for undifferentiated symptoms (n=90) Prescription renewals for chronic medications (n=97) AVERAGE DISRUPTION OF EMERGENCY, CRITICAL, AND OPERATIVE CARE Elective surgeries (n=100) Emergency referrals for time-sensitive conditions (n=95) Inpatient critical care services (n=94) Emergency surgeries (excluding obstetric) (n=93) Acuity-based triage in emergency units (n=95) Ambulance services at the scene (n=100) Emergency obstetric surgeries (n=96) 24-hour emergency room/unit services (n=94) Urgent blood transfusion services (n=93) AVERAGE DISRUPTION OF REHABILITATIVE, PALLIATIVE, AND LONG-TERM CARE Rehabilitation services (n=89) Palliative services (n=74) Long-term care services (n=74) AVERAGE DISRUPTION OF AUXILIARY SERVICES Radiology services (n=97) Laboratory services (n=97)
Primary careEmergency, critical, and operative care
Rehabilitative, palliative and long-term careAuxiliary services
Percentage of countries
Service disruptions across integrated service delivery channels (n=112)
5-25% disrupted
26-50% disrupted
More than 50% disrupted
65% also reporting disruptions in elective surgeries, with accumulating consequences as the pandemic is prolonged
Substantial disruptions span across all major health areas
Most frequently disrupted services are for mental, neurological, and
substance use disorders and neglected tropical diseases
(reported in more than 40% of countries)
Services across other health areas are also disrupted in more than 1/3
of countries
>1/3
>40%
Substantial disruptions span across all major health areas
Denominator: excludes “Not applicable” or “Do not know” responses.
24%
22%
23%
19%
15%
23%
21%
9%
7%
8%
8%
11%
13%
9%
3%
8%
5%
9%
19%
10%
9%
35%
36%
37%
37%
44%
45%
39%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Reproductive, maternal, newborn, child and adolescent health and nutrition (n=121) Communicable diseases (n=128) Immunization (n=112) Noncommunicable diseases (n=121) Neglected tropical diseases (n=109) Mental, neurological and substance use disorders (n=121) AVERAGE DISRUPTION OF PROGRAMME SPECIFIC AREAS
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions across tracer service areas
5-25% disrupted 26-50% disrupted More than 50% disrupted
Countries in high income group reported fewer service
disruptions compared to countries in other income groups
Denominator: excludes “Not applicable” or “Do not know” responses.
24%
11%
18%
36%
27%
9%
3%
13%
7%
13%
3%
3%
5%
3%
0%
35%
17%
36%
46%
40%
0% 10% 20% 30% 40% 50% 60%
Global (n=121) High income (n=30) Upper middle income (n=34) Lower middle income (n=32) Low income (n=25)
Percent of countries Average percentage of countries reporting disruptions
to reproductive, maternal, newborn, child and adolescent health and nutrition services by income
group
5-25% disrupted 26-50% disrupted More than 50% disrupted
23%
11%
35%
23%
20%
8%
7%
14%
6%
8%
5%
5%
8%
2%
8%
37%
23%
56%
31%
35%
0% 10% 20% 30% 40% 50% 60%
Global (n=112) High income (n=32) Upper middle income (n=30) Lower middle income (n=28) Low income (n=22)
Percent of countries Average percentage of countries reporting disruptions to immunization services by income
group
5-25% disrupted 26-50% disrupted More than 50% disrupted
19%
5%
24%
21%
28%
8%
6%
8%
14%
3%
9%
8%
13%
10%
3%
37%
20%
45%
45%
33%
0% 10% 20% 30% 40% 50% 60%
Global (n=121) High income (n=35) Upper middle income (n=35) Lower middle income (n=33) Low income (n=25)
Percent of countries Average percentage of countries reporting disruptions to noncommunicable disease services by income group
5-25% disrupted 26-50% disrupted More than 50% disrupted
15%
3%
9%
22%
20%
11%
14%
10%
14%
1%
19%
5%
25%
17%
25%
44%
22%
44%
54%
46%
0% 20% 40% 60% 80% 100% 120%
Global (n=109) High income (n=27) Upper middle income (n=32) Lower middle income (n=29) Low income (n=21)
Percent of countries Average percentage of countries reporting disruptions to neglected tropical disease services by
income group
5-25% disrupted 26-50% disrupted More than 50% disrupted
22%
15%
28%
24%
23%
9%
5%
11%
11%
8%
7%
6%
9%
8%
5%
38%
26%
48%
42%
36%
0% 50% 100%
Global (n=135)
High income (n=35)
Upper middle income (n=37)
Lower middle income (n=37)
Low income (n=26)
Percent of countries
Percentage of countries reporting disruptions across
tracer service areas by income group
5-25% disrupted 26-50% disrupted More than 50% disrupted
23%
18%
36%
18%
17%
13%
6%
12%
22%
13%
10%
7%
11%
10%
10%
45%
31%
59%
50%
39%
0% 10% 20% 30% 40% 50% 60%
Global (n=121) High income (n=29) Upper middle income (n=34) Lower middle income (n=34) Low income (n=24)
Percent of countries Average percentage of countries reporting disruptions to mental, neurological, and substance
use disorder services by income group
5-25% disrupted 26-50% disrupted More than 50% disrupted
21%
29%
27%
20%
22%
7%
5%
9%
6%
5%
8%
6%
7%
12%
4%
36%
40%
44%
37%
31%
0% 10% 20% 30% 40% 50% 60%
Global (n=129) High income (n=35) Upper middle income (n=36) Lower middle income (n=35) Low income (n=23)
Percent of countries Average percentage of countries reporting disruptions to communicable disease services by
income group
5-25% disrupted 26-50% disrupted More than 50% disrupted
Disruptions to mental, neurological and substance use disorders (MNS) span the full continuum of care
From prevention and promotion: school mental
health programmes and suicide prevention
programmes
To diagnostics and treatments neuroimaging
and neurophysiology, psychotherapy, counselling
and psychosocial interventions, and
prescriptions
For life-saving emergency care:
management of emergency MNS manifestations, critical harm reduction services, overdose prevention and management programmes
For the most vulnerable populations: older adults, children, and adolescents
with mental health
conditions or disabilities
Denominator: excludes “Not applicable” or “Do not know” responses.
Disruptions to mental, neurological and substance use disorders (MNS) span the full continuum of care
School mental health programmes (66%) and psychotherapy, counselling and psychosocial
intervention (54%) are among the most predominantly disrupted services across all service areas
23%
23%
16%
21%
20%
31%
22%
26%
15%
29%
7%
11%
13%
16%
15%
14%
15%
13%
11%
17%
5%
5%
2%
7%
4%
9%
8%
9%
40%
7%
34%
39%
32%
44%
39%
53%
45%
48%
66%
54%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Overdose prevention and management programmes (n=44) Critical harm reduction services (n=44) Prescriptions for MNS disorder medicines (n=91) Suicide prevention programmes (n=57) Management of emergency MNS manifestations (n=94) Neuroimaging and neurophysiology (n=58) Services for children/adolescents with mental health conditions or disabilities (n=86) Services for older adults with mental health conditions or disabilities (n=85) School mental health programmes (n=53) Psychotherapy interventions for MNS disorders (n=95)
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in services for mental, neurological and substance use disorders
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
Nearly half of countries reported disruptions to one of more services for noncommunicable diseases
Cancer screening and treatment services are
among the most disrupted services
t
1/3 of more countries also reporting disruptions to
hypertension management, diabetes management, and
asthma services
Time-sensitive services for urgent dental care and cardiovascular emergencies
are also affected
1/3
Nearly half of countries reported disruptions to one of more services for noncommunicable diseases
Denominator: excludes “Not applicable” or “Do not know” responses.
11%
15%
18%
21%
24%
27%
20%
19%
7%
8%
6%
7%
11%
9%
10%
8%
2%
7%
9%
14%
7%
8%
19%
9%
20%
30%
32%
42%
42%
45%
49%
37%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Cardiovascular emergencies (n=91) Asthma services (n=87) Cancer Treatment (n=90) Urgent dental care (n=85) Diabetes and Diabetic Complications Management (n=97) Hypertension Management (n=95) Cancer screening (n=86) AVERAGE DISRUPTION IN SERVICE GROUP
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in noncommunicable disease services
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
Disruptions in immunization services
Denominator: excludes “Not applicable” or “Do not know” responses.
24%
21%
23%
7%
10%
8%
3%
8%
5%
34%
39%
37%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Routine facility-based immunization services (n=103) Routine outreach immunization services (n=89) AVERAGE DISRUPTION IN SERVICE GROUP
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in immunization services
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
t
More than one third of countries reported disruptions to both routine facility-based
and outreach immunization services
1/3
Disruptions in services for reproductive, maternal, newborn, child and adolescent health and nutrition
Over 40% of countries report disruptions to family planning
and contraception and malnutrition services
t
Over a third report disruptions to antenatal care and postnatal care, critical health services to ensure that
pregnant women and newborns survive and remain healthy
Although a third of countries report reductions in sick child visits,
further information is needed to understand if this reflects actual disruptions or if children are less likely
to become ill due to measures put in place to prevent the spread of COVID-19
?
>1/3
>40%
Denominator: excludes “Not applicable” or “Do not know” responses.
Disruptions in services for reproductive, maternal, newborn, child and adolescent health and nutrition
18%
17%
24%
23%
32%
26%
24%
25%
24%
6%
9%
7%
7%
5%
10%
13%
14%
9%
1%
1%
2%
4%
2%
3%
4%
5%
3%
25%
28%
33%
34%
39%
39%
41%
44%
35%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Facility-based births (n = 104) Safe abortion and post-abortion care (n=75) Postnatal care for women and newborns (n=101) Sick child services (n=101) Antenatal care (n=110) Intimate partner and sexual violence prevention and response (n=61) Management of moderate and severe malnutrition (n=92) Family planning and contraception (n=104) AVERAGE DISRUPTION IN SERVICE GROUP
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in reproductive, maternal, newborn, child and adolescent health and nutrition services
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
Disruptions in services for communicable disease services
Over half of countries report disruptions to TB diagnosis and treatment.
HIV testing and prevention services also disrupted in nearly half of countries
40%
Nearly 40% of countries are reporting disruptions to one or more malaria services (including diagnosis and treatment services
and prevention campaigns)
1/2
Disruptions in services for communicable disease services
Denominator: excludes “Not applicable” or “Do not know” responses.
13%
18%
13%
10%
19%
27%
22%
25%
29%
30%
29%
21%
1%
2%
10%
10%
7%
2%
4%
4%
9%
12%
16%
7%
3%
4%
2%
10%
7%
10%
12%
13%
9%
7%
6%
8%
17%
25%
25%
30%
33%
39%
39%
43%
46%
49%
51%
36%
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Continuation of established ARV treatment (n=98) Initiation of new ARV treatment (n=93) Outbreak detection and control (for non-COVID diseases) (n=91) Seasonal malaria chemoprevention (n=10) Indoor residual spraying (n=43) Malaria diagnosis and treatment (n=59) Insecticide-treated-mosquito nets (n=49) Hepatitis B and C diagnosis and treatment (n=75) HIV prevention services (n=93) HIV testing services (n=99) TB diagnosis and treatment (n=98) AVERAGE DISRUPTION IN SERVICE GROUP
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in communicable disease services
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
Disruptions in services for neglected tropical diseases (NTDs)
Denominator: excludes “Not applicable” or “Do not know” responses.
t
The most predominant disruptions were to large scale preventive chemotherapy campaigns, community
awareness/health education campaigns, and support for self-care,
rehabilitation and psychosocial services for patients with chronic NTDs
14%
13%
15%
19%
16%
13%
15%
6%
8%
15%
13%
13%
10%
11%
8%
10%
12%
21%
23%
37%
19%
28%
30%
42%
52%
52%
60%
44%
0% 20% 40% 60% 80% 100%
Prescriptions for NTD medicines (n=64) Surgical procedures for NTDs (n=40) Diagnosis, treatment and care for NTDs (n=74) Support for self-care, rehabilitation and psychosocial services for
patients with chronic NTDs (n=48)
Community awareness and health education campaigns for NTDs (n=69)
Large scale preventive chemotherapy campaigns for NTDs (n=62) AVERAGE DISRUPTION IN SERVICE GROUP
Percentage of countries
Es se nt ia l he alth se rv ic e
Percentage of countries reporting disruptions in neglected tropical disease services
5% to 25% disrupted 26% to 50% disrupted More than 50% disrupted
Service disruptions are perceived to be caused by a mix of supply and demand side factors
Health workforce-related issues are among the most commonly reported supply- side reasons linked to staff deployment to COVID-19 relief and insufficient staff availability. Cancellation of elective care and changes to treatment policies are also reported as reasons for disruptions.
Most common demand-side reasons included: community fear/mistrust, decreases in OPD volume due to patients not presenting, travel restrictions and financial difficulties during the pandemic.
In some countries, measures for COVID-19 control may be contributing to increased barriers to accessing care (e.g. fear of getting infected, limited personal protective equipment or access, limitations in movement, loss of income, increased financial burden).
Supply chain systems are also disrupted in nearly 1/3 of countries.
1/3
Denominator: excludes “Not applicable” or “Do not know” responses.
Service disruptions are perceived to be caused by a mix of supply and demand side factors
12%
14%
16%
19%
22%
26%
35%
47%
66%
36%
43%
57%
57%
0% 10% 20% 30% 40% 50% 60% 70%
Closure of outpatient services as per government directive (n=112) Closure of population level screening programmes (n=111) Closure of outpatient clinics (n=112) Inpatient services/hospital beds not available (n=111) Unavailability/Stock out of essential medicines (n=111) Insufficient Personal Protective Equipment (PPE) available (n=111) Changes in treatment policies for care seeking behaviour (n=111) Travel restrictions hindering access to the health facilities (n=112) Financial difficulties during outbreak/lock down (n=112) Decrease in inpatient volume due to cancellation of elective care (n=112) Decrease in outpatient volume due to patients not presenting (n=111) Community fear/mistrust in seeking health care (n=112) Insufficient staff availability (due to deployment to provide COVID-19 relief or other) (n=112)
Percent of countries
Reasons for service disruptions (n=112)
Demand side factor Supply side factor
To some extent, disruptions may be attributed to intentional scaling back or modifications to service delivery in the context of COVID-19
One-third or more countries have limited or suspended community-based, mobile care, outpatient, inpatient and delivery platforms
15%
>1/3
Emergency and pre-emergency platforms
also limited in 15% of countries
To some extent, disruptions may be attributed to intentional scaling back or modifications to service delivery in the context of COVID-19
Denominator: excludes “Not applicable” or “Do not know” responses.
38% 41% 38% 35%
15% 16%
7% 4%
0% 1%
1% 0%
45% 45%
38% 36%
16% 16%
0%
10%
20%
30%
40%
50%
60%
70%
Mobile clinics (n=86) Community based care
(n=103) Outpatient services (n=108) Inpatient services (n=107) Prehospital emergency care
services (n=105) Emergency unit services (n=106)
Pe rc ent age of c oun trie s
Service delivery platform
Government policies in relation to service delivery platforms (n=112)
Limited access Suspended
In high income countries, disruptions are more frequently the result of strategic suspensions or modifications as
compared to countries in other income groups
51% 62% 55%
47% 43%
43% 26% 41%
46% 52%
6% 12% 4% 7% 4%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Global (n=132) High income (n=32) Upper middle income (n=38) Lower middle income (n=36) Low income (n=26)
Pe rc ent age of di srupt ed se rv ic es
Percent of disruptions to tracer services due to intentional modifications by income group
Disruptions due to intentional service modifications Disruptions due to other causes Unknown cause
Services included for: emergency and critical care, rehabilitative and palliative care, reproductive, maternal, newborn, child and adolescent health and nutrition, immunization, communicable diseases, noncommunicable diseases, neglected tropical diseases, and mental, neurological and substance use disorders
Nearly half of countries have scaled back at least one essential public health function or activity, including population-based services
of countries have scaled back population-based disease prevention, health promotion and health protection activities
t
of countries have scaled back
research activities of countries have scaled back communications and social
mobilization activities
>40% 43% 27%
Denominator: excludes “Not applicable” or “Do not know” responses.
Nearly half of countries have scaled back at least one essential public health function or activity, including population-based services
45% 39% 41% 38%
25%
14% 12%
2%
4% 2%
2%
2%
0% 0%
47% 43% 43%
40%
27%
14% 12%
0%
10%
20%
30%
40%
50%
60%
70%
Disease prevention population-based activities
(n=109)
Health promotion-based
activities (n=109) Public health research
(n=96) Health protection (n=100) Communications and social mobilization activities for
health (n=105)
Surveillance and response
(n=105) Emergency preparedness and response (n=106)
Pe rc ent age of c oun trie s
Essential public health function
Government policies in relation to essential public health functions and activities
Limited Suspended
Notwithstanding the sustained global disruptions, the
magnitude and extent of
disruptions within countries
has decreased
Note: represents global findings from all countries that responded to either round 1 or 2 of survey. Round 1 data sourced from 2020 WHO surveys on disruptions to Essential health services, Noncommunicable diseases, and Mental, neurological and substance use disorder during the COVID-19 pandemic.
Denominator: excludes “Not applicable” or “Do not know” responses. 35 tracer services included in both survey rounds include services for: emergency and critical care, rehabilitative and palliative care, reproductive, maternal, newborn, child and adolescent health and nutrition, immunization, communicable diseases, noncommunicable diseases, neglected tropical diseases, and mental, neurological and substance use disorders.
Decrease in reported disruptions in countries
participating in either survey round: just over a third of services are currently affected, compared to half in 2020
Moreover, fewer countries are reporting complete disruptions to 75-100% of services
95% of countries reported some level of disruption to services
• 24% of countries reported disruptions in 75–100% of services
• 27% of countries reported disruptions in 50–74% of services
• 28% of countries reported disruptions in 25–49% of services
• 16% of countries reported disruptions in less than 25% of services 5% of countries reported no service disruptions
89% of countries reported some level of disruption to services
• 8% of countries reported disruptions in 75–100% of services
• 21% of countries reported disruptions in 50–74% of services
• 32% of countries reported disruptions in 25–49% of services
• 27% of countries reported disruptions in less than 25% of services 11% of countries reported no service disruptions
0%
20%
40%
60%
80%
100%
ITAGNBTLSPERIDNUGAPHLTCD SWZ MEXBOLSDNMRT LBNBRABLZARG PNGIRQAGOSLBUKR DOMSLVHNDALBSSD COM CMR MOZ MDG BHSCIVLCAHTISENPANZMBCHL BWA PYF GT M STPLAOWLSLSOECUPRYMWIJOR GMB THAKENGINZAFBGR TGO YEM MAR SYCGAB NERMYSCZESCTJAMFRAPSEGHAERIIRNLKASYR GRD GBR TUN COG VCTAUTPAK GEO VUTNAM SUR OMNFINAFGCRIVGB SOM MDA AUSLBREGY CPVETHQATFJIHRVNPLCOD URY BMU SAU BGD BRNKAZHUN BEN KWT DMA CYM ARMLVACAFAREBTNNICBDIMDV PRTKORDJIBFA CHN MUS ESTPRK RWA DNK BHRTKM CUB
Pe rc ent age of s erv ic es dis rupt ed
Country/territory
Round 2 (Q1 2021)
Percentage of 35 tracer services disrupted per country (n=135)
Global: 36%
0%
20%
40%
60%
80%
100%
IND LBY USA GNB UGA COM MDG LSO GMB TUN GEO GIN NPL DJI CMR ZWE GNQ SEN PAK SWZ STP MLI HTI BLZ SLE PHL TCD TGO KAZ POL BGD SDN JAM ETH YEM PER IRL MNE NAM MKD NGA GUY PLW FRA MMR CIV CHN BRB KGZ UKR THA COG BFA HND IRQ IDN EGY KEN MDA MAR HUN NLD ITA GAB OMN MUS ROU NER HRV BRA ARE JOR MCO LTU BGR DMA EST BEN VEN ZAF MEX ECU GRD BOL SVK LBR NZL LBN DOM SSD AGO PNG ALB CZE TUR GRC GT M JPN QAT SUR MRT LKA TLS MOZ SLB SWE CHL KWT NOR MLT CPV FIN FJI ARM SGP UZB MWI RUS SVN BLR PSE BIH LAO IRN AUT WSM MHL SOM PRK ZMB VUT KHM TZA CYP DZA BHS COK LCA BRN LVA MNG SYC GHA NRU AUS PAN ESP TON KIR COL SAU NIU VNM TTO VCT RWA ARG ISL MYS KNA PRY URY ATG DEU DNK FSM BEL CRI AND SYR BWA SMR ERI MDV ISR TUV AZE CHE COD BTN NIC BHR TKM CUB
Pe rc ent age of s erv ic es dis rupt ed
Country/territory
Round 1 (Q2-Q3 2020)
Percentage of 35 tracer services disrupted per country (n=187)
Global: 50%
Note: represents findings from all countries that responded to both rounds 1 and 2 of survey. Round 1 data sourced from 2020 WHO surveys on disruptions to Essential health services, Noncommunicable diseases, and Mental, neurological and substance use disorder during the COVID-19 pandemic.
Denominator: excludes “Not applicable” or “Do not know” responses. 35 tracer services included in both survey rounds include services for: emergency and critical care, rehabilitative and palliative care, reproductive, maternal, newborn, child and adolescent health and nutrition, immunization, communicable diseases, noncommunicable diseases, neglected tropical diseases, and mental, neurological and substance use disorders.
Comparing service disruptions in countries that
participated in both survey rounds, a drop in disrupted services is still seen from 54% in 2020 to 37% in 2021
Quantity of disruptions reported in countries has also decreased.
96% of countries reported some level of disruption to services
• 25% of countries reported disruptions in 75–100% of services
• 33% of countries reported disruptions in 50–74% of services
• 27% of countries reported disruptions in 25–49% of services
• 11% of countries reported disruptions in less than 25% of services 4% of countries reported no service disruptions
89% of countries reported some level of disruption to services
• 9% of countries reported disruptions in 75–100% of services
• 22% of countries reported disruptions in 50–74% of services
• 32% of countries reported disruptions in 25–49% of services
• 25% of countries reported disruptions in less than 25% of services 11% of countries reported no service disruptions
0%
20%
40%
60%
80%
100%
KORGNBUGACOMMDGLSOGMBTUNGEOGINNPLDJICMRSENPAKSWZSTPHTIBLZPHLTCDTGOKAZBGDSDNJAMETHYEMPERNAMFRACIVCHNUKRTHACOGBFAHNDIRQIDNEGYKENMDAMARHUNITAGABOMNMUSNERHRVBRAAREJORBGRDMAESTBENZAFMEXECUGRDBOLLBRLBNDOMSSDAGOPNGALBCZEGT MJPNQATSURMRTLKATLSMOZSLBSWECHLKWTCPVFINFJIARMMWIBDIPSELAOIRNAUTSOMPRKZMBVUTBHSLCABRNLVASYCGHAAUSPANSAUVCTRWAARGMYSPRYURYDNKCRISYRBWAERIMDVCODBTNNICBHRCUBTKM
Pe rc ent age of s erv ic es dis rupt ed
Country/territory
Round 1 (Q2-Q3 2020)
Percentage of 35 tracer services disrupted per country (n=125)
Global: 54%
0%
20%
40%
60%
80%
100%
ITAGNBTLSPERIDNUGAPHLTCDSWZMEXBOLSDNMRTLBNBRABLZARGPNGIRQAGOSLBUKRDOMHNDALBSSDCOMCMRMOZMDGBHSCIVLCAHTISENPANZMBCHLBWAGT MSTPLAOLSOECUPRYMWIJORGMBTHAKENGINZAFBGRTGOYEMMARSYCGABNERMYSCZEJAMFRAPSEGHAERIIRNLKASYRGRDTUNCOGVCTAUTPAKGEOVUTNAMSUROMNFINCRISOMMDAAUSLBREGYCPVETHQATFJIHRVNPLCODURYSAUBGDBRNKAZHUNBENKWTDMAARMLVAAREBTNNICKORBDIMDVDJIBFACHNMUSESTPRKRWADNKBHRCUBTKM
Pe rc ent age of s erv ic es dis rupt ed
Country/territory
Round 2 (Q1 2021)
Percentage of 35 tracer services at least partially disrupted per country (n=125)
Global: 37%
Note: represents global findings from all countries that responded to either round 1 or 2 of survey. Round 1 data sourced from 2020 WHO surveys on disruptions to Essential health services, Noncommunicable diseases, and Mental, neurological and substance use disorder during the COVID-19 pandemic.
Denominator: excludes “Not applicable” or “Do not know” responses.
Emergency and critical care services include: 24-hour emergency room/unit services; urgent blood transfusion services; inpatient critical care services; and emergency surgery.
Reproductive, maternal, newborn, child and adolescent health and nutrition services include: family planning and contraception; antenatal care; facility-based births; sick child services; and management of malnutrition.
Immunization services include: facility-based routine immunization; and outreach routine immunization.
Communicable disease services include: Outbreak detection and control (non-COVID); continuation of established antiretroviral treatment; malaria diagnosis and treatment; ITN malaria prevention campaigns; IRS malaria prevention campaigns; and SMC malaria prevention campaigns.
Noncommunicable disease services include: cancer diagnosis and treatment; hypertension management; diabetes management; and asthma services.
mental, neurological, and substance use disorders (MNS) services include: MNS emergency services; counselling for MNS disorders; medicines for MNS disorders; services for children and adolescents; services for older adults; school mental health programmes; suicide prevention programmes; overdose prevention programmes; and critical harm reduction services.
Rehabilitative and palliative care services include: rehabilitation services; palliative services.
Average percentage of countries reporting disruptions dropped across all tracer service areas
Countries participating in either survey round
*view report to see changes in disruptions to individual tracer services.
17% 14%
47%
33%
50%
31%
46%
26%
45%
27%
39% 35%
54%
3% 36%
1%
3%
3%
12%
5%
9%
7%
3%
8%
20%
10%
12%
8%
20%
15%
51%
37%
62%
37%
55%
33%
48%
35%
59%
45%
65%
45%
0%
10%
20%
30%
40%
50%
60%
70%
Round 1 (n=129)
Round 2 (n=112)
Round 1 (n=129)
Round 2 (n=121)
Round 1 (n=129)
Round 2 (n=112)
Round 1 (n=129)
Round 2 (n=124)
Round 1 (n=164)
Round 2 (n=121)
Round 1 (n=130)
Round 2 (n=121)
Round 1 (n=164)
Round 2 (n=121) Emergency, critical
and operative care
RMNCAH and nutrition
Immunization Communicable
diseases
Noncommunicable diseases
Mental, neurological and
substance use disorders
Rehabilitative and palliative care
P e rc e nt a ge of c ount rie s
Round 1 vs. Round 2 comparison:
Service disruptions by tracer service area
5-50% disrupted More than 50% disrupted
Note: represents findings from all countries that responded to both rounds 1 and 2 of survey. Round 1 data sourced from 2020 WHO surveys on disruptions to Essential health services, Noncommunicable diseases, and Mental, neurological and substance use disorder during the COVID-19 pandemic.
Denominator: excludes “Not applicable” or “Do not know” responses.
Emergency and critical care services include: 24-hour emergency room/unit services; urgent blood transfusion services; inpatient critical care services; and emergency surgery.
Reproductive, maternal, newborn, child and adolescent health and nutrition services include: family planning and contraception; antenatal care; facility-based births; sick child services; and management of malnutrition.
Immunization services include: facility-based routine immunization; and outreach routine immunization.
Communicable disease services include: Outbreak detection and control (non-COVID); continuation of established antiretroviral treatment; malaria diagnosis and treatment; ITN malaria prevention campaigns; IRS malaria prevention campaigns; and SMC malaria prevention campaigns.
Noncommunicable disease services include: cancer diagnosis and treatment; hypertension management; diabetes management; and asthma services.
mental, neurological, and substance use disorders (MNS) services include: MNS emergency services; counselling for MNS disorders; medicines for MNS disorders; services for children and adolescents; services for older adults; school mental health programmes; suicide prevention programmes; overdose prevention programmes; and critical harm reduction services.
Rehabilitative and palliative care services include: rehabilitation services; palliative services.
Average percentage of countries reporting disruptions dropped across all tracer service areas
Countries participating in both survey rounds
*view report to see changes in disruptions to individual tracer services.
19% 11%
49%
36% 46%
30%
43%
30%
48%
29% 38% 36%
50%
4% 37%
1%
3%
2%
11%
5%
9%
7%
3%
7%
23%
8%
15%
7%
23%
13%
53%
38%
57%
35%
52%
38%
51%
36%
61%
44%
66%
44%
0%
10%
20%
30%
40%
50%
60%
70%
Round 1 (n=75)
Round 2 (n=75)
Round 1 (n=79)
Round 2 (n=79)
Round 1 (n=75)
Round 2 (n=75)
Round 1 (n=75)
Round 2 (n=75)
Round 1 (n=101)
Round 2 (n=101)
Round 1 (n=82)
Round 2 (n=82)
Round 1 (n=101)
Round 2 (n=101) Emergency, critical
and operative care
RMNCAH and nutrition
Immunization Communicable
diseases
Noncommunicable diseases
Mental, neurological and
substance use disorders
Rehabilitative and palliative care
P e rc e nt a ge of c ount rie s
Round 1 vs. Round 2 comparison:
Service disruptions by tracer service area
5-50% disrupted More than 50% disrupted
t
Disruptions due to insufficient PPE and other health products availability have decreased since 2020
Note: represents findings from all countries that responded to either round 1 or 2 of survey.
Denominator: excludes “Not applicable” or “Do not know” responses.
78%
69%
61%
53%
43%
40%
36%
36%
34%
31%
30%
14%
57%
47%
66%
36%
26%
14%
35%
16%
43%
12%
22%
19%
0% 20% 40% 60% 80% 100%
Decrease in outpatient volume due to patients not presenting Decrease in inpatient volume due to cancellation of elective care Insufficient staff availability (due to staff deployment to provide COVID-19 relief or other) Government or public transport lockdowns hindering access Insufficient PPE available for health care providers Closure of population level screening programs Changes in treatment policies Closure of outpatient disease specific consultation clinics Financial difficulties during outbreak/lock down Closure of outpatient services as per government directive Unavailability/Stock out of health products at health facilities Inpatient services/hospital beds not available
Percentage of countries
Round 1 vs. Round 2 comparison:
Reasons for service disruptions
Round 1 (n=129) Round 2 (n=112)
