COVID-19 outbreak control strategies and their impact on the provision of essential health services in Ghana: An exploratory-sequential study

• DOI: 10.1371/journal.pone.0279528
• Publication Date: 2023-11-16T18:37:51Z
• Authors: Duah Dwomoh; Isaac Yeboah; Rawlance Ndejjo; Steven Ndugwa Kab...; Justice Moses Aheto; Anne Liu; Siobhan Lazenby; Fidelia Ohemeng; Sylvia Akpene Takyi; Ibrahim Issah; Serwaa Akoto Bawuah; Rhoda K. Wanyenze; Julius Fobil
• Keywords: Economics; Social Sciences; Infection control; Infectious disease (medical specialty); FOS: Health sciences; Ghana; Disease Outbreaks; 0302 clinical medicine; Isolation (microbiology); Pregnancy; Psychological intervention; Pathology; Business; Disease; Public health; Modeling the Dynamics of COVID-19 Pandemic; Q; Vaccination; R; Public Health Interventions; 3. Good health; Economics, Econometrics and Finance; Environmental health; Health; Modeling and Simulation; Physical Sciences; Medicine; Female; Research Article; Economics and Econometrics; Family medicine; Science; Nursing; Microbiology; 03 medical and health sciences; Impacts of COVID-19 on Global Economy and Markets; Virology; FOS: Mathematics; Humans; Maternal Health Services; Intensive care medicine; Pandemics; Biology; Economic growth; Infection Control; Pandemic; Health care; COVID-19; Outbreak; Coronavirus disease 2019 (COVID-19); 13. Climate action; FOS: Biological sciences; Factors Affecting Vaccine Hesitancy and Acceptance; Mathematics

Background The COVID-19 pandemic has led to substantial interruptions in critical health services, with 90% of countries reporting interruptions in routine vaccinations, maternal health care and chronic disease management. The use of non-pharmaceutical interventions (NPIs) such as lockdowns and self-isolation had implications on the provision of essential health services (EHS). We investigated exemplary COVID-19 outbreak control strategies and explored the extent to which the adoption of these NPIs affected the provision of EHS including immunization coverage and facility-based deliveries. Finally, we document core health system strategies and practices adopted to maintain EHS during the early phase of the pandemic.

Methods This study used an explanatory sequential study design. First, we utilized data from routine health management information systems to quantify the impact of the pandemic on the provision of EHS using interrupted time series models. Second, we explored exemplary strategies and health system initiatives that were adopted to prevent the spread of COVID-19 infections while maintaining the provision of EHS using in-depth interviews with key informants including policymakers and healthcare providers.

Results The COVID-19 pandemic and the interventions that were implemented disrupted the provision of EHS. In the first month of the COVID-19 pandemic, Oral Polio and pentavalent vaccination coverage reduced by 15.2% [95% CI = -22.61, -7.87, p<0.001] and 12.4% [95% CI = 17.68, -7.13; p<0.001] respectively. The exemplary strategies adopted in maintaining the provision of EHS while also responding to the spread of infections include the development of new policy guidelines that were disseminated with modified service delivery models, new treatment and prevention guidelines, the use of telemedicine and medical drones to provide EHS and facilitate rapid testing of suspected cases.

Conclusion The implementation of different NPIs during the peak phase of the pandemic disrupted the provision of EHS. However, the Ministry of Health leveraged the resilient health system and deployed efficient, all-inclusive, and integrated infectious disease management and infection prevention control strategies to maintain the provision of EHS while responding to the spread of infections.