Area-specific covid-19 effects on health services utilization in the Democratic Republic of the Congo using routine health information system data

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  • Angeles G.
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
  • Silverstein H.
    • Affiliation: Gillings School of Global Public Health, Department of Maternal and Child Health
  • Worges M.
    • Other Affiliation: Tulane University
  • Hotchkiss D.R.
    • Other Affiliation: Tulane University
  • Wisniewski J.M.
    • Other Affiliation: Tulane University
  • Lusamba Dikassa P.S.
    • Other Affiliation: University of Kinshasa
  • Weiss W.
    • Other Affiliation: John Hopkins University
  • Ahsan K.Z.
    • Affiliation: Gillings School of Global Public Health, Public Health Leadership Program
Abstract
  • Background: Since March 2020, the COVID-19 pandemic has shocked health systems worldwide. This analysis investigated the effects of the pandemic on basic health services utilization in the Democratic Republic of the Congo (DRC) and examined the variability of COVID effects in the capital city Kinshasa, in other urban areas, and in rural areas. Methods: We estimated time trends models using national health information system data to replicate pre-COVID-19 (i.e., January 2017–February 2020) trajectories of health service utilization, and then used those models to estimate what the levels would have been in the absence of COVID-19 during the pandemic period, starting in March 2020 through March 2021. We classified the difference between the observed and predicted levels as the effect of COVID-19 on health services. We estimated 95% confidence intervals and p-values to examine if the effect of the pandemic, nationally and within specific geographies, was statistically significant. Results: Our results indicate that COVID-19 negatively impacted health services and subsequent recovery varied by service type and by geographical area. COVID-19 had a lasting impact on overall service utilization as well as on malaria and pneumonia-related visits among young children in the DRC. We also found that the effects of COVID-19 were even more immediate and stronger in the capital city of Kinshasa compared with the national effect. Both nationally and in Kinshasa, most affected services had slow and incomplete recovery to expected levels. Therefore, our analysis indicates that COVID-19 continued to affect health services in the DRC throughout the first year of the pandemic. Conclusions: The methodology used in this article allows for examining the variability in magnitude, timing, and duration of the COVID effects within geographical areas of the DRC and nationally. This analytical procedure based on national health information system data could be applied to surveil health service disruptions and better inform rapid responses from health service managers and policymakers.
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  • Article
License
  • Attribution 4.0 International
Journal title
  • BMC Health Services Research
Journal volume
  • 23
Journal issue
  • 1
Language
  • English
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  • This publication was produced with the support of the United States Agency for International Development (USAID) under the terms of the Data for Impact (D4I) associate award 7200AA18LA00008, which is implemented by the Carolina Population Center at the University of North Carolina at Chapel Hill, in partnership with Palladium International, LLC, John Snow, Inc., ICF Macro, Inc., and Tulane University. WW’s involvement in this work was through an Intergovernmental Personnel Act (IPA) Mobility Program between Johns Hopkins University and USAID. The views expressed in this publication do not necessarily reflect the views of USAID or the United States government. For access to the DRC data, we are grateful to the Ministry of Public Health.
ISSN
  • 1472-6963
Publisher
  • BioMed Central Ltd

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