EHS-COVID (419) Maternal and child health services in Africa

23 June, 2021

What has been the impact of COVID-19 on the delivery of essential maternal and child health services in Africa? This paper notes that outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. Citation, abstract and a comment from me below.

CITATION: Disruptions in maternal and child health service utilization during COVID-19: analysis from eight sub-Saharan African countries

Gil Shapira et al. Health Policy and Planning,

Published: 19 June 2021


The coronavirus-19 pandemic and its secondary effects threaten the continuity of essential health services delivery, which may lead to worsened population health and a protracted public health crisis. We quantify such disruptions, focusing on maternal and child health, in eight sub-Saharan countries. Service volumes are extracted from administrative systems for 63 954 facilities in eight countries: Cameroon, Democratic Republic of Congo, Liberia, Malawi, Mali, Nigeria, Sierra Leone and Somalia. Using an interrupted time series design and an ordinary least squares regression model with facility-level fixed effects, we analyze data from January 2018 to February 2020 to predict what service utilization levels would have been in March–July 2020 in the absence of the pandemic, accounting for both secular trends and seasonality. Estimates of disruption are derived by comparing the predicted and observed service utilization levels during the pandemic period. All countries experienced service disruptions for at least 1 month, but the magnitude and duration of the disruptions vary. Outpatient consultations and child vaccinations were the most commonly affected services and fell by the largest margins. We estimate a cumulative shortfall of 5 149 491 outpatient consultations and 328 961 third-dose pentavalent vaccinations during the 5 months in these eight countries. Decreases in maternal health service utilization are less generalized, although significant declines in institutional deliveries, antenatal care and postnatal care were detected in some countries. There is a need to better understand the factors determining the magnitude and duration of such disruptions in order to design interventions that would respond to the shortfall in care. Service delivery modifications need to be both highly contextualized and integrated as a core component of future epidemic response and planning.


The COVID-19 pandemic and its secondary effects caused significant disruptions in the delivery of essential health services across sub-Saharan Africa and may produce substantial increases in morbidity and mortality.

The largest disruptions were observed in outpatient care and vaccinations, but disruptions were also identified in reproductive and maternal health services with significant cross-country variation in the timing and magnitude.

The ability of health systems to maintain continuity of essential services must be protected as the global community responds to the pandemic and the ensuing economic crises.

Dedicated catch-up campaigns may minimize the adverse consequences of missed care, especially for children.

COMMENT (NPW): These data are now already 1 year old. Can HIFA members comment on the situation more recently? To date, Africa has seen relatively few cases of COVID as compared with Europe and the Americas, but there are continuing concerns about the disporportionate impact that future waves of infection might bring.

Best wishes, Neil

Neil Pakenham-Walsh, HIFA Coordinator,