Scoping review of interventions to maintain essential services for maternal, newborn, child and adolescent health and older people during disruptive events – Global

ABSTRACT

For maternal, newborn, child, adolescent and elderly health (MNCAAH), the most significant effects of the COVID-19 pandemic will be indirect. Recent modeling of indirect effects in low- and middle-income countries has shown that, under certain service reduction scenarios, reduced coverage of essential maternal and child health interventions can lead to additional maternal and child deaths. Assist governments and other actors in making difficult decisions to balance the demands of a direct response to the COVID-19 pandemic, while simultaneously maintaining essential services for the MNCAAH, Department of Maternal, Newborn, Child Health World Health Organization (WHO) and Adolescent and Aging commissioned this scoping review of the literature to draw lessons from actions taken in response to past disruptive events.

The objective was to review published and gray literature to identify interventions to maintain the provision and use of essential MNCAAH services during disruptive events and to summarize lessons learned from the implementation of these interventions. The scope of the review included outbreaks of Ebola Virus Disease (EVD), Severe Acute Respiratory Syndrome (SARS), Zika Virus Disease (ZVD), the ongoing COVID-19 pandemic, natural disasters and humanitarian emergencies that have disrupted health, transport and other service delivery.

Between July and December 2020, we searched peer-reviewed journal article databases and gray literature repositories. We included primary research, reports, and any papers describing an intervention carried out. We identified 29,810 references, of which 115 articles describing 120 interventions were included in the review (11 for EVD, 40 for natural disasters, 13 for humanitarian emergencies, three for SARS and 53 for COVID-19). Evaluations were identified for 65 of these interventions. Quality assessment of primary studies was not performed. We have summarized the issues that typically lead to disruption in the provision and use of essential health services. We linked the interventions described in the articles to these problems, according to the time elapsed since the disruptive event (immediate, medium or long term). Lessons learned from the implementation of interventions and evaluations have been synthesized narratively based on their relevance to the COVID-19 pandemic.

The four main issues identified were: declining health service provision, declining health service utilization, increased and emerging health care needs, and the need to adapt health service delivery. health to challenges, for example to minimize face-to-face contact. Although not all types of issues occurred to the same extent in all disruptive events, it appears that all four issues affected MNCAAH services during COVID-19. The disruptions and increased needs appeared to be largely due to the health and social measures imposed to curb the spread of the virus. The inability to provide face-to-face care (to protect providers and care users from infection) was much more extreme and longer lasting than in other disruptive events. However, given the dates of the searches carried out for this review, all of the problems described for COVID-19 were immediate problems: persistent or slow-onset problems had not yet been captured in the literature. In pre-COVID-19 events, relatively few interventions addressing medium- and long-term issues related to declining MNCAAH service provision and emerging care needs, as well as the increase in socio-economic vulnerability, could be useful in limiting the disruptions caused by COVID-19. 19 and to “build back better”.

The table on page viii summarizes the distribution of interventions according to the target populations, the health service(s) involved and whether an evaluation has been reported. Some interventions targeted more than one population group and involved more than one health service area. Of the interventions identified under the disruptive events examined, children were the most common target population with 41 interventions in total. About half of them came from the COVID-19 literature. The health of the elderly was the least mentioned population group with a total of 16 interventions, including 14 related to COVID-19. Interventions related to disruptions in health services for the general population were mostly present in studies of natural disasters. In terms of health services covered by interventions, the most commonly described areas were mental health, maternal and newborn health, and child health.

A variety of interventions have been described across the disruptive events, ranging from adaptations to service delivery in a clinic or hospital to national-level policy changes on service delivery.

Seven categories of intervention have been identified:

  1. maintaining access to health services or finding alternatives to bring care closer to the populations;

  2. maintaining, strengthening and/or adapting the health workforce;

  3. ensure collaboration between different health services, institutions and health workers;

  4. adapt interventions to the local context;

  5. involve stakeholders and local communities;

  6. use digital health; and

  7. maintaining access to essential supplies and products (medicines, vaccines, nutrition, etc.)

Interventions during COVID-19 were different from other events in that they were informal and organic adaptations to service delivery with very few interventions implemented from the outside. However, the interventions described were mainly from high-resource settings: they yield little on the coordination of adaptations, from which few lessons have been learned. This may be partly due to the need for quick adaptations. Overall, COVID-19 was the only disruptive event for which studies primarily report digital health interventions. Given that 47 of the 53 included articles featured interventions that relied wholly or partially on the use of digital health, this scoping review provides a summary of relevant considerations.

The lack of articles on interventions implemented by health authorities (district, regional, national) during the first months of the COVID-19 pandemic is an important gap, and contrasts with the literature on other disruptive events. , where this response item is clearly critical to removing barriers to accessing MNCAAH services. Additionally, COVID-19-related interventions in low-resource settings were rare, so it was not possible to compare issues and interventions across a wide range of settings. It is likely that many other context-appropriate, innovative and promising interventions have been implemented in low-resource settings that were not considered in this review.

Several key lessons can be learned from interventions to address disruptions in the provision and use of MNCAAH services in relation to COVID-19. Governance, coordination and open communication channels between health care providers and regional/national health authorities are critical during disruptive events, when the situation is changing rapidly and guidelines for care delivery need to be updated. adapted and disseminated quickly. Such a coordination infrastructure should also include referral and coordination among providers within local areas, to coordinate closures and reopenings of services and health facilities, inter-facility transfers, and provision of information. to service users.

In addition, communication between health authorities and health care providers should be two-way, so that providers are able to give early signals to health authorities about factors that affect the delivery and use of health services. , and what is necessary to ensure the continued delivery of services. (eg the ability of health personnel to get to work), accessibility for populations and the evolution of health needs.

We also identified several gaps in the documentation of interventions to address MNCAAH disruptions that could help improve learning and future preparedness. Areas for which there were very few articles include interventions to communicate with populations about ongoing changes in health services (such as facility closures or new guidelines) and interventions by health authorities regional and national levels and governments, especially in low-resource settings. Correcting this last shortcoming should be a priority: such interventions should be scaled up and supported as a matter of urgency.

We note that the included primary studies use different methods, reveal many different types of learning, and do not all contain formal assessments. Notably, most of the articles included do not provide enough detail on the interventions. It would be useful for international organizations to develop and apply standard criteria for reporting interventions and evaluations in the literature. Improved reports could be used to compile a publicly available database of interventions. We also recognize that it is difficult to conduct high-quality research on interventions implemented during disruptive events, and here we highlight the suggestion of having pre-prepared protocols and rapid reviews in place.

Michelle J. Kelley