Health service utilization during the COVID-19 pandemic in sub-Saharan Africa in 2020

The COVID-19 pandemic led to 2%–6%, reductions in use of maternal, newborn and child health services and 7%–17% reductions in outpatient consultations and hospitalizations in 12 African countries during March to December 2020, according to a  Countdown study published in BMJ Global Health. The months immediately following the start of the global pandemic showing larger reductions.

Routine health facility data was the data source for the study, and the main indicators examined were first antenatal care visit, four or more antenatal care visits, facility birth, cesarean section, pentavalent and measles vaccination, outpatient consultations and admissions. The magnitude of decline varied by country, and not all countries showed a decline for all indicators. Greater declines were measured in East Africa than in West Africa.  In some setting, the pandemic was not the only factor affecting service utilization; for example security concerns likely had an impact in Mali and Niger.

Stronger government response at the beginning of the pandemic, as measured through a “stringency index” was associated with larger reduction in general service utilization but had limited effects on maternal, newborn and child health services.

Analysts from the 13 African countries that have ongoing country collaborations  were invited to participate in the study, and 12 countries joined – Burkina Faso, Cote d’Ivoire, Ghana, Liberia, Mali, Niger and Nigeria in West Africa and Ethiopia, Kenya, Tanzania, Uganda and Zambia in Eastern Africa.

Data analysis was completed in 8 workshops that were conducted remotely in February-July 2021. The common Stata code used for the analysis is available for download.  After a data quality assessment process produced final datasets, the country teams compared expected utilization levels from previous years beginning with 2017 with service utilization patterns in March to December 2020.

Figure showing the process used to extract and analyze the data.


The period March-December 2020 showed no decline in reporting of the health facility to the centralized data aggregation system (such as DHIS2).

Previous studies based on modeling and key informant interviews had raised concerns that the COVID-19 could adversely affect utilization of maternal and child health services, and thus increase risk of morbidity and mortality. Understanding this issue is critical to developing appropriate responses to the pandemic’s ongoing impact.

Focused policies and programs, supported by the global health community, are needed to reverse the pandemic’s impact on the progress towards the Sustainable Development Goals for health, the articles’ authors conclude.

Resources related to this article:

Other resources related to Countdown’s work to improve use of health facility data are available here.