Overcoming disruptions in essential health services during the COVID-19 pandemic in Mexico

Vector mosquito distribution and richness are predicted by socio-economic, and ecological variables

Mosquitoes of vectorial importance represent a ubiquitous and constant threat of potentially devastating arboviral outbreaks. Our ability to predict such outcomes is still restricted. To answer this, we have used an extensive data collection of 23 vector and 233 non-vector mosquito species distributed throughout the Mexican territory and linked them to social and environmental factors. Our aim was to predict vector and non-vector mosquitoes' distribution and species richness based on socioeconomic and environmental data. We found that lack of health services, human population variation, ecological degradation, and urban-rural categorization contributed significantly to explain the distribution of vector mosquitoes. mosquitoes. This phenomenon is probably attributed to the degradation of natural ecosystems as it creates favorable conditions for the proliferation of vector mosquitoes. The richness of vector mosquitoes was similarly explained by most of these variables as well as altitude. As for non-vector mosquitoes, social marginalization, ecological degradation, anthropogenic impact, and altitude explain species richness and distribution. These findings illustrate the complex interaction of environmental and socioeconomic factors behind the distribution of mosquitoes, and the potential for arboviral disease outbreaks. Areas with human populations at highest risk for mosquito-borne diseases should be primary targets for vector control.

Monitoring and evaluation practices and operational research during public health emergencies in southeast Asia region (2012-2022) - a systematic review

This systematic review aimed to explore the monitoring and evaluation (M&E) and operational research (OR) practices during public health emergencies (PHE) in the southeast Asian region (SEAR) over the last decade. We searched electronic databases and grey literature sources for studies published between 2012 and 2022. The studies written in English were included, and a narrative synthesis was undertaken. A total of 29 studies were included in this review. Among these 25 studies documented M&E and four studies documented OR practices. The majority of the studies were from India and Bangladesh, with no evidence found from Sri Lanka, Bhutan, Myanmar, and Timor-Leste. M&E of surveillance programs were identified among which PHE due to COVID-19 was most prevalent. M&E was conducted in response to COVID-19, cholera, Nipah, Ebola, Candida auris, and hepatitis A. OR practice was minimal and reported from India and Indonesia. India conducted OR on COVID-19 and malaria, whereas Indonesia focused on COVID-19 and influenza. While most SEAR countries have mechanisms for conducting M&E, there is a noticeable limitation in OR practices. There is a compelling need to develop a standard framework for M&E. Additionally, enhancing private sector engagement is crucial for strengthening preparedness against PHE. Furthermore, there is a necessity to increase awareness about the importance of conducting M&E and OR during PHE.

Essential healthcare services during the COVID-19 pandemic: a cross-sectional study of community needs and perspectives in West Java, Indonesia

OBJECTIVES

While issues in healthcare facilities during the COVID-19 pandemic have been widely discussed, little is known about health service issues from community (demand) sides. This study aimed to identify community needs in the utilisation of health services and highlight the key roles and barriers that community health workers (CHWs) face in delivering community-based services during the pandemic.

DESIGN

Cross-sectional study.

SETTING

38 randomly selected villages covered by 21 preidentified community health centres in 3 districts in West Java, Indonesia. The survey was conducted from 22 January 2022 to 7 February 2022 (2 years after the pandemic began).

PARTICIPANTS

118 respondents, consisting of community leaders, vulnerable group representatives and CHWs.

RESULTS

Laboratory examination (55.1%), emergency care (52.5%), non-communicable disease screening (50%) and routine treatment (49.2%) were perceived as the highest unmet needs of essential healthcare services. Fear of infection (90.3%) became one main barrier to access healthcare services. Vulnerable populations including lower socioeconomic groups (61.2%), households with elderly (25.4%), persons with disabilities (25.4%), pregnant women, people with mental illness and people with lower education (26.9%) were reported facing difficulties in accessing healthcare services. Further, the pandemic was deemed to have significantly impacted the community economic situation (91.5%). CHWs were actively engaged in community-based services and were mentioned as the first contact when the community needed help (57.6%). CHWs reported essential needs on financial support (45.2%), logistics (54.8%) and protective equipment (22.6%).

CONCLUSIONS

Essential health services for the community, including those belonging to vulnerable groups, were highly impacted during the pandemic. CHWs appear to have significant roles in delivering health services during this health crisis, hence, adequate support is needed to equip them in strengthening pandemic response.

The COVID-19 pandemic and non-COVID-19 healthcare utilization in Mexico

OBJECTIVES

This study aimed to analyze the effects of the COVID-19 pandemic on non-COVID-19 healthcare utilization in Mexico, including oral health, mental health, communicable disease visits, health checkups, chronic degenerative disease visits, postpartum care, prenatal care, and family planning visits.

STUDY DESIGN

This was a retrospective ecological analysis during the COVID-19 pandemic. During the pandemic, the Mexican government recommended non-essential consultations be suspended or rescheduled to accommodate the new demand for healthcare services from COVID-19 patients.

METHODS

This study uses administrative data from Mexico's Ministry of Health from January 2017 to December 2022. These data cover 14,299 consultation units and 775 hospitals from the 32 Mexican States, all of which are public institutions. A difference-in-differences strategy and an event study specification are used to study the impacts of the pandemic on non-COVID-19 healthcare utilization.

RESULTS

The findings reveal a decrease in the utilization of all healthcare services: oral health (69%), mental health (27%), communicable diseases (46%), chronic degenerative diseases (36%), health checkups (62%), family planning (45%), prenatal care (36%), and postpartum care (44%). Furthermore, the event study indicates that most services follow a U-shaped trend, although only mental health services clearly return to prepandemic levels. The remainder of services remain below prepandemic levels at the end of 2022.

CONCLUSIONS

The 2020 pandemic had detrimental effects on non-COVID-19 healthcare utilization. The healthcare interruptions will likely impact short- and long-term morbidity and mortality. Programs intended to remediate these negative consequences may be of interest to public health policymakers.

Effect of COVID-19 on Routine Childhood Vaccination in Bahir Dar City, Northwestern, Ethiopia

Despite free vaccinations for all children, Ethiopia is one of the ten countries where most children do not receive all of their basic vaccines. The COVID-19 pandemic has disrupted service delivery and utilization worldwide. In this study, we assessed the effect of the pandemic on routine childhood vaccinations in Bahir Dar, Ethiopia. The data were collected from immunization records, health system monthly reports, and interviews with vaccination professionals. The data were analyzed using interrupted time series and thematic analyses. In 6940 records covering 2018-2022, the number of vaccine doses that were delivered steadily increased except for 2021/22. Vaccine delivery consistently increased prior to the pandemic. Immediately after the first case was reported, there were some disruptions, but they were not statistically significant compared to the pre-pandemic period. In-depth interviews also confirmed this finding, showing early pandemic fear and protective measures had an impact but were not sustained. These results show that COVID-19 has had a transient but non-significant effect on childhood vaccination. Although the interruption was statistically insignificant, it could reverse decades of progress toward safeguarding children from vaccine-preventable diseases. Therefore, we must intensify our initiatives to boost childhood vaccination rates and restore pre-pandemic services to regain momentum and avoid future setbacks.

What is the NCD service capacity and disruptions due to COVID-19? Results from the WHO non-communicable disease country capacity survey in the Americas region

OBJECTIVE

This article presents the Americas regional results of the WHO non-communicable diseases (NCDs) Country Capacity Survey from 2019 to 2021, on NCD service capacity and disruptions from the COVID-19 pandemic.

SETTING

Information on public sector primary care services for NCDs, and related technical inputs from 35 countries in the Americas region are provided.

PARTICIPANTS

All Ministry of Health officials managing a national NCD programme, from a WHO Member State in the Americas region, were included throughout this study. Government health officials from countries that are not WHO Member States were excluded.

OUTCOME MEASURES

The availability of evidence-based NCD guidelines, essential NCD medicines and basic technologies in primary care, cardiovascular disease risk stratification, cancer screening and palliative care services were measured in 2019, 2020 and 2021. NCD service interruptions, reassignments of NCD staff during the COVID-19 pandemic and mitigation strategies to reduce disruptions for NCD services were measured in 2020 and 2021.

RESULTS

More than 50% of countries reported a lack of comprehensive package of NCD guidelines, essential medicines and related service inputs. Extensive disruptions in NCD services resulted from the pandemic, with only 12/35 countries (34%), reporting that outpatient NCD services were functioning normally. Ministry of Health staff were largely redirected to work on the COVID-19 response, either full time or partially, reducing the human resources available for NCD services. Six of 24 countries (25%) reported stock out of essential NCD medicines and/or diagnostics at health facilities which affected service continuity. Mitigation strategies to ensure continuity of care for people with NCDs were deployed in many countries and included triaging patients, telemedicine and teleconsultations, and electronic prescriptions and other novel prescribing practices.

CONCLUSIONS

The findings from this regional survey suggest significant and sustained disruptions, affecting all countries regardless of the country's level of investments in healthcare or NCD burden.

Tracking health system performance in times of crisis using routine health data: lessons learned from a multicountry consortium

COVID-19 has prompted the use of readily available administrative data to track health system performance in times of crisis and to monitor disruptions in essential healthcare services. In this commentary we describe our experience working with these data and lessons learned across countries. Since April 2020, the Quality Evidence for Health System Transformation (QuEST) network has used administrative data and routine health information systems (RHIS) to assess health system performance during COVID-19 in Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, Republic of Korea and Thailand. We compiled a large set of indicators related to common health conditions for the purpose of multicountry comparisons. The study compiled 73 indicators. A total of 43% of the indicators compiled pertained to reproductive, maternal, newborn and child health (RMNCH). Only 12% of the indicators were related to hypertension, diabetes or cancer care. We also found few indicators related to mental health services and outcomes within these data systems. Moreover, 72% of the indicators compiled were related to volume of services delivered, 18% to health outcomes and only 10% to the quality of processes of care. While several datasets were complete or near-complete censuses of all health facilities in the country, others excluded some facility types or population groups. In some countries, RHIS did not capture services delivered through non-visit or nonconventional care during COVID-19, such as telemedicine. We propose the following recommendations to improve the analysis of administrative and RHIS data to track health system performance in times of crisis: ensure the scope of health conditions covered is aligned with the burden of disease, increase the number of indicators related to quality of care and health outcomes; incorporate data on nonconventional care such as telehealth; continue improving data quality and expand reporting from private sector facilities; move towards collecting patient-level data through electronic health records to facilitate quality-of-care assessment and equity analyses; implement more resilient and standardized health information technologies; reduce delays and loosen restrictions for researchers to access the data; complement routine data with patient-reported data; and employ mixed methods to better understand the underlying causes of service disruptions.

[PRIISMA Project: Transformation into a more preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS]

Two years after the onset of the COVID-19 pandemic, the Mexican Institute for Social Security (IMSS, according to its initials in Spanish) rethought new projects focused on the new needs of the population and social security organizations and institutions. The Institute, as a cornerstone in the search for the wellbeing of Mexicans, aligned with the National Development Plan and the Strategic Health for Wellbeing Program, sought to direct its transformation towards a preventive, resilient, comprehensive, innovative, sustainable, modern and accessible IMSS. For this reason, the Medical Services Director designed the PRIISMA Project, as the one that over the next three years could make possible to innovate and improve its medical care processes, starting with the recovery of medical services and identifying those groups of beneficiaries who experience the most vulnerable circumstances. The PRIISMA project consisted of five sub-projects: 1. Vulnerable groups; 2. Efficient and effective care; 3. Prevent IMSS plus; 4 IMSS University and 5. Recovery of medical services. The strategies of each project seek to improve medical care for all IMSS beneficiaries and users with a human rights perspective and by priority groups; the goal is reducing the gaps in access to health care, leaving no one behind and leaving no one out; and to surpass the goals for medical services provided before the pandemic. This document provides an overview of strategies and progress of the PRIISMA sub-projects achieved during 2022.

The road to recovery: an interrupted time series analysis of policy intervention to restore essential health services in Mexico during the COVID-19 pandemic

Background

Recovery of health services disrupted by the COVID-19 pandemic represents a significant challenge in low- and middle-income countries. In April 2021, the Mexican Institute of Social Security (IMSS), which provides health care to 68.5 million people, launched the National Strategy for Health Services Recovery (Recovery policy). The study objective was to evaluate whether the Recovery policy addressed COVID-related declines in maternal, child health, and non-communicable diseases (NCDs) services.

Methods

We analysed the data of 35 IMSS delegations from January 2019 to November 2021 on contraceptive visits, antenatal care consultations, deliveries, caesarean sections, sick children’s consultations, child vaccination, breast and cervical cancer screening, diabetes and hypertension consultations, and control. We focused on the period before (April 2020 – March 2021) and during (April 2021 – November 2021) the Recovery policy and used an interrupted time series design and Poisson Generalized Estimating Equation models to estimate the association of this policy with service use and outcomes and change in their trends.

Results

Despite the third wave of the pandemic in 2021, service utilization increased in the Recovery period, reaching (at minimum) 49% of pre-pandemic levels for sick children’s consultations and (at maximum) 106% of pre-pandemic levels for breast cancer screenings. Evidence for the Recovery policy role was mixed: the policy was associated with increased facility deliveries (IRR = 1.15, 95%CI = 1.11-1.19) with a growing trend over time (IRR = 1.04, 95%CI = 1.03-1.05); antenatal care and child health services saw strong level effects but decrease over time. Additionally, the Recovery policy was associated with diabetes and hypertension control. Services recovery varied across delegations.

Conclusions

Health service utilization and NCDs control demonstrated important gains in 2021, but evidence suggests the policy had inconsistent effects across services and decreasing impact over time. Further efforts to strengthen essential health services and ensure consistent recovery across delegations are warranted.