Using administrative and RHIS data from ten countries, we assessed the effect of the COVID-19 pandemic on a spectrum of health services. We estimated the immediate effect after the declaration of the pandemic on 11 March 2020 and assessed whether services had returned to pre-pandemic levels by the last quarter of 2020. We found declines of varying magnitude and duration in every country. Effects were heterogeneous across countries, and we found no clear patterns in disruptions by country income group or according to the severity of COVID-19 epidemics. The health systems most affected included those in Chile, Haiti, Mexico, Nepal and South Africa. By contrast, Ethiopia and South Korea, which represent the poorest and richest countries, respectively, in our analysis, were among the least affected by health service disruptions.
The magnitude of health service disruptions at national levels also did not appear to be directly driven by COVID-19 severity. Of the ten countries included, six reported fewer than 2,000 cumulative cases per million in 2020 and even fewer deaths (Supplementary Table 3). Only 41 total cases were reported in Laos in 2020. Chile, Mexico, Nepal and South Africa faced higher COVID-19 caseloads, with peaks in June or July (or late October in Nepal). However, health service disruptions were largest in April and May 2020 in all countries, suggesting that they were not caused by overburdened health systems but rather by a combination of policy responses and demand-side factors. Several reasons for reduced healthcare use appeared common across countries: fear of contagion, inability to pay for healthcare due to loss of employment or remuneration, intentional suspension of routine care to leave room for patients with COVID-19, the redeployment of health workers or hospitals to COVID-19 care and prevention and the barriers imposed by COVID-19 lockdowns. Whether the type of COVID-19 response (for example, elimination versus steady-state strategies) or the stringency and length of COVID-19-related lockdowns were associated with the magnitude of disruptions remains unclear and should be investigated further.
On the other hand, we found patterns in disruptions according to the type of health service. Outpatient visits and hospital-based services (including emergency room visits, inpatient admissions, trauma care, accidents and surgeries) declined in every country reporting them, and these disruptions often persisted throughout the period analyzed. Other studies also reported declining inpatient admissions during the COVID-19 pandemic16,24. These declines may be explained, in part, by a reduction in need.