Increased access to high-quality essential services is vital: at least half the world’s population still lacks coverage of essential health services.

World leaders reconfirmed commitment to universal health coverage in a landmark political declaration in 2019. But, just months later, the COVID-19 pandemic arrived and threatened to undo decades of progress. A WHO survey of the continuity of essential services during COVID-19 indicated that the pandemic is testing all national health systems. Between March and June 2020, health services were disrupted in almost all the 105 countries that responded in the five regions surveyed, with routine and elective services suspended in most countries.

The pandemic also exacerbated systemic deficiencies, such as lack of investment in essential public health functions and surveillance and shortages of health workers.

WHO

In response, WHO rapidly developed operational guidance on maintaining essential health services during an outbreak, recommending practical actions to maintain access, community-based health care, online courses and disease- and condition-specific guidance during different life-course stages, immunization, long-term care, health workforce, supply chains and blood supply.

A dynamic new web platform, the WHO COVID-19 Health Services Learning Hub, supports countries in implementing operational guidance and in innovation by rapidly collecting, synthesizing, curating and sharing the experiences and knowledge of front-line workers.

To help countries advance towards universal health coverage, WHO’s UHC Compendium of Health Interventions offers new tools for decision-makers to develop service packages. The Compendium’s database of 3500 health actions is supported by evidence, guidance, resource inputs and cost analyses.

To maximize the impact and health outcomes in countries, WHO has intensified support for implementation of guidance and tools and worked globally to harness political will and coordinate action among agencies.

By June, many countries had started to implement WHO-recommended strategies to mitigate disruptions to services, such as triaging according to priorities, use of online patient consultations, changes to prescribing practices and supply-chain strategies and refocusing public health communications.

Huge efforts to sustain essential services at all three levels of WHO and by national governments helped to mitigate the impact of COVID-19 and to avoid health system collapse in 2020.

• An estimated 6017 facilities were providing early essential newborn care in nine countries in the Western Pacific Region, an increase of 79% from 2017.
• Consideration of benefit–risk ratios minimized the disruption of essential services for sexual and reproductive health, as did measures such as increased use of digital and telehealth and task-shifting to community health workers.
• Initial estimates suggest that a third of the 119 immunization campaigns that had been postponed were reinstated by the end of 2020.
• The numbers of cases of both human African trypanosomiasis and dracunculiasis were reduced by 50%.
• The number of cases of animal infection with Guinea worm was reduced by 20%.
• Myanmar eliminated trachoma, Malawi eliminated lymphatic filariasis, and Togo eliminated human African trypanosomiasis.
• Home care with adequate drug stocks and expanded use of digital technologies for remote advice and support have helped to mitigate the potential increase in the number of deaths from tuberculosis.
• The prevalence of hepatitis B virus in children < 5 years is < 1.0%, achieving the first indicator of SDG target 3.3.
• 26 million people living with HIV received
• 3 million people in 18 countries were on protocol-based management of hypertension, with increasing use of WHO HEARTS.
• 31 countries have integrated mental health into primary health care, a 34% increase since 2017 and a 100% increase since 2014.

There were, however, some significant setbacks during 2020, such as suspension of routine immunization campaigns. Surveys on COVID-19-related disruption of essential health services indicate that they threaten years of progress in reducing mortality from causes such as HIV, hepatitis, sexually transmitted infections, tuberculosis, malaria, neglected tropical diseases, noncommunicable diseases and mental health conditions. Programmes for reproductive, maternal, newborn, child and adolescent health and ageing were also disrupted.

WHO used its technical expertise and leadership to optimize responses, to help strengthen health systems and to continue to drive progress in achieving universal health coverage. In some countries, innovative adaptations and reorganization strengthened service delivery, and, in others, a comprehensive COVID-19 response helped to advance universal health coverage. Progress was also seen in terms of quality and safety, particularly in infection prevention and control and the safety of care and of health workers.

How Ethiopia prepared its health workforce for the COVID-19 response

Ethiopia invested in emergency care systems by nationwide training with the WHO/ICRC Basic Emergency Care course, after initial training of trainers from several countries in Addis Ababa. By the end of 2019, over 2500 health workers in more than 700 health centres had been trained and certified in basic emergency care, and 100 health care facilities had introduced the extended WHO Emergency Care toolkit, which includes triage, checklists and designation of resuscitation areas.

WHO operational guidance on maintaining essential health services during an outbreak emphasizes maintenance of emergency care as priority for population health in countries that are forced to make strategic shifts in the context of the pandemic. Standardized triage and staff competence in basic emergency care strengthened the capacity for early recognition of serious illness and allowed provision of life-saving treatment for people with COVID-19 and other acute conditions, such as injury, heart attacks, mental health crises, pregnancy-related bleeding and serious childhood infections.

Even after onset of the COVID-19 pandemic, local trainers ensured certification of many additional providers, even as borders closed and international travel was limited. Nearly 300 more providers have been trained and certified in basic emergency care this year, and 100 more health centres are implementing key emergency care by using the WHO toolkit.

WHO/Loza Tesfaye

Health for all is Somalia’s answer to COVID-19 and to future threats to health

Guided by a pilot version of the WHO UHC Compendium of Health Interventions, Somalia revised its national package of essential health services in early 2020, after a high-level WHO mission. The new package includes integrated, first-contact primary and emergency care services, which are often lacking from service packages but which are fundamental to meeting population health needs and maintaining essential health services during a crisis.

After systematic prioritization, Somalia was able to identify and engage in targeted strengthening of key health areas relevant to the COVID-19 response and in maintaining the continuity of essential health services.

WHO continued to provide support at all three levels of the Organization through remote consultations to implement the package, targeted training and applying WHO operational guidance on maintaining essential health services during an outbreak and guidance on case management for COVID-19.  Training focused on emergency and critical care, infection prevention and control and mass casualty management.  In several rounds of training, over 100 health workers were trained and certified in WHO/ICRC Basic Emergency Care; 16 became certified facilitators recognized by the International Federation for Emergency Medicine, who will conduct training both nationally and regionally in association with the African Federation for Emergency Medicine.

WHO, Blink Media/Mustafa Saeed

To find progress on health outcome indicators, visit the World health statistics