Health service utilization and delivery during the COVID-19 pandemic in Uganda between 2020 and 2022: implications for the future pandemics

Abstract

In 2019, Uganda’s General Service Readiness Index was at 52.7% and the Universal Health Coverage index was only 48%. Consequently, a public health emergency such as the COVID-19 pandemic would leave many cut off from even the most essential health services. We studied the effects of the COVID-19 peak of June 2021 on health service utilization and delivery in Uganda and the magnitude of these effects. Secondary data on outpatient department visits and inpatient department admissions for all conditions were collected from the District Health Information System 2 (DHIS2) and Key Informant Interviews were conducted among health workers in charge at 32 health facilities in selected districts of Uganda between August and September 2022. Using a negative binomial model, we conducted Interrupted Time Series Analysis (ITS) of secondary data over 25 months between May 2020 and May 2022 using STATA and reported results as Incidence Rate Ratios. Using ATLAS.ti software, we identified common themes on health service delivery and utilization in the study period. Following the COVID-19 peak (June 2021), the level of OPD attendances immediately dropped by 40% (IRR = 0.60; 95%CI 0.45,0.80, p < 0.001) compared to pre-peak. Similarly, following the COVID-19 peak, the level of IPD admissions immediately dropped by 55% (IRR = 0.45; 95%CI 0.34,0.60, p < 0.001). However, the rate of IPD admissions during the post-peak period was significantly higher by 4% for every passing month, compared to that of the pre-peak period. (IRR = 1.04; 95%CI 1.02,1.05, p < 0.001). The key informants reported a decline in health care utilization characterised by reduced antenatal and maternal visits, HIV services and chronic illness attendance. During the peak periods, the main contributors to the reduction of service utilization were fears of COVID-19 infection and death associated with visiting the health facility, and lockdown restrictions that limited mobility to access services especially among the vulnerable and rural populations. The COVID-19 peak period brought about challenges in health care access and utilization in Uganda. This exposed people to health emergencies and possibly resulted in poor health outcomes and many losses in the fight against epidemics like HIV/AIDS and Tuberculosis. The Ministry of Health and private health care providers should develop a crisis health care delivery strategy to guarantee access to key outpatient and inpatient health care services for risk groups and tailored to address the needs of rural populations. In addition, a tailored rapid risk communication strategy should be in place to manage miscommunication and stigma around emerging infections.