After three years of the COVID-19 pandemic, health systems in countries have started showing the first major signs of health system recovery, according to the WHO interim report on the “Fourth round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic: November 2022–January 2023”. By early 2023, countries reported experiencing reduced disruptions in the delivery of routine health services, but highlighted the need to invest in recovery and stronger resilience for the future.
Among the 139 countries that responded to the fourth round of WHO’s pulse survey, countries reported continued disruptions in almost one-quarter of services on average. In 84 countries where trend analysis is possible, the percentage of disrupted services declined on average from 56% in July-September 2020 to 23% in November 2022- January 2023.
Persisting disruptions are due to both demand- and supply-side factors, including low levels of health care-seeking in communities as well as limited availability of health workers and other health-care resources such as open clinics or available stocks of medicines and products.
“It is welcome news that health systems in the majority of countries are starting to restore essential health services for millions of people who missed them during the pandemic,” said Dr Rudi Eggers, WHO Director for Integrated Health Services. “But we need to ensure that all countries continue to close this gap to recover health services, and apply lessons learnt to build more prepared and resilient health systems for the future”.
First notable signs of recovery
In this new survey, fewer countries reported intentionally scaling back access across all service delivery platforms and essential public health functions since 2020-2021 reporting, showing an important step to return to pre-pandemic levels of service delivery and broader system functioning.
By the end of 2022, most countries reported partial signs of service recovery, including in services for sexual, reproductive, maternal, newborn, child and adolescent health; nutrition; immunization; communicable diseases (including malaria, HIV, TB, and other sexually-transmitted infections); neglected tropical diseases; noncommunicable diseases; management of mental, neurological and substance use disorders; care for older people; and traditional and/or complementary care.
The number of countries reporting disruption to their national supply chain system reduced from nearly half (29 of 59 responding countries) to about a quarter (18 of 66 responding countries) within the last year.
Despite signs of recovery, service disruptions persist across countries in all regions and income levels, and across most service delivery settings and tracer service areas. Countries are also dealing with increasing service backlogs – most frequently in services for screening, diagnosis and treatment of noncommunicable diseases – which can lead to negative consequences as people are delayed access to timely care.
Recovering essential health service delivery is critical because disruptions – including to services for health promotion, disease prevention, diagnosis, treatment, rehabilitation and palliation – may have even greater adverse health effects at population and individual level than the pandemic itself, especially among vulnerable populations.
Integrating COVID-19 services into essential health services
In another important step towards system recovery and transition, most countries have made progress in integrating COVID-19 services into routine health service delivery. About 80-90% of countries have fully integrated COVID-19 vaccination, diagnostic and case management services as well as services for post COVID-19 condition into routine service delivery.
Still, most countries (80% of 83 responding countries) reported at least one bottleneck to scaling up access to essential COVID-19 tools (e.g. COVID-19 diagnostics, therapeutics, vaccines and personal protective equipment - PPE), with health workforce issues and lack of funding representing the most common barriers.
Further support needed for recovery, resilience and preparedness
Most countries have started to apply what they have learnt during the COVID-19 pandemic, including through the institutionalization of a number of innovative service disruption mitigation strategies into routine health service delivery. These include deployment of telemedicine approaches, promotion of home-based care or self-care interventions, approaches for strengthening health workers availability, capacities and support mechanisms, innovations in procuring and delivering medicines and supplies, more routine community communications, and partnerships with private sector providers.
Three quarters of countries reported additional funding allocation towards longer term system recovery, resilience and preparedness.
Countries expressed need for WHO support to address remaining challenges in the COVID-19 context and beyond, most frequently related to health workforce strengthening, building the monitoring capacities of health services, designing primary health care -- oriented models of care, governance, policy and planning and financial planning and funding.
Note to editors:
In the fourth round of WHO’s global pulse survey, 222 countries, territories and areas were invited to respond to a standardized web-based survey between November 2022 and January 2023. The fourth survey followed up on WHO’s previous 2020 and 2021 pulse surveys: Round 1 (May-September 2020), Round 2 (January-March 2021), and Round 3 (November-December 2021) which showed the extent to which the pandemic was affecting the continuity of essential health services and how countries are taking action. While pulse surveys have limitations such as reporting bias and representativeness, the strength of this effort is that it is comprehensive and delivers information rapidly. The term “country” should be understood to include all countries, territories and areas. Trend analyses was completed based on responses from 84 countries, territories, or areas that responded to at least one survey section in all four pulse survey rounds.
