Covid-19 and the restrictions imposed by the government had a devastating effect on the provision of routine public health services in SA during the first two waves, according to a study published in the SA Medical Journal (SAMJ).
The study raises the spectre of a further hit to the health system as SA enters its third wave of coronavirus infections, unless provincial health departments manage to maintain routine services in parallel with their response to a surge in Covid-19 cases.
“We need to better manage the availability of healthcare workers, inform communities that it safe to go to clinics, and keep primary healthcare services open,” said the study’s lead author Yogan Pillay, SA director for the Clinton Health Access Initiative. It was also vital to speed up the vaccination of healthcare workers and the elderly, he said.
The SAMJ study was based on data routinely collected by the district health information system.
It found patient visits to primary healthcare facilities fell 18%, HIV testing plunged 22.3%, and tuberculosis testing plummeted by 26% between March and December 2020, compared to the corresponding period in 2019.
SA’s first coronavirus case was detected on March 5 2020, and the government imposed one of the world’s most stringent lockdowns three weeks later. The first wave peaked in July 2020, the second in early January 2021.
The study found SA’s institutional maternal mortality ratio soared 18% to 106.8 per 100,000 live births compared to 90.5 per 100,000 live births the year before, reflecting the direct and indirect effects of the pandemic. The institutional maternal mortality ratio (iMMR) reflects women who give birth in hospital, and is routinely used to gauge the strength of a health system. The sharp rise in the iMMR stands in stark contrast to the pre-pandemic trend, which had seen a steady decline since 2010, said Pillay.
Covid-19 increases the mortality risk for pregnant women, but they were also affected by the government’s response to the crisis, he said. During the early stages of SA’s lockdown, people were confined to their homes except to purchase food, perform essential services, or seek medical care. During this period, transport was limited, some healthcare facilities were shut, and many people were unsure if they were permitted to leave home to obtain healthcare. People also stayed away from clinics and hospitals for fear of infection.
At the same time, provincial health departments scaled back on routine care and diverted resources to manage Covid-19 patients.
Immunisation coverage fell 4.3%, but antenatal visits before 20 weeks’ pregnancy remained largely unchanged. “It is clear that for some things people felt they had to get care, but where they could, they put it off,” said Pillay.
The researchers found access to routine public care was limited throughout SA, but there were wide provincial variations, ranging from a drop of 31.1% in the Western Cape to a drop of just 8.7% in the Free State. The variation was due to a range in the severity of the first and second waves, and the varied response of the provincial health departments to the crisis, said Pillay.
Further research published in the SAMJ shows similar trends in the provision of health services in the Western Cape. Cancer diagnosis at one of the two provincial anatomical pathology labs fell 36% in the first three months of the lockdown. A separate study found six public hospitals had built up a collective backlog of more than 1,000 elective procedures during the first four months of the lockdown.
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