Estimating the Effects of COVID-19 on Health Service Utilization in Uganda

The study used data from the District Health Information Software (DHIS2) system to examine the effects of COVID-19 on health service use in Uganda from March 2020 to May 2021. The analysis focused on selected health services, including outpatient attendances, maternal and infant health services, child illness visits, family planning visits, and vaccinations. The study found that the COVID-19 pandemic did not have an impact on district reporting in the DHIS2 system. However, most of the negative COVID-19 effects on health service utilization occurred in the beginning of the pandemic, from March through May 2020. The most severe negative COVID-19 effects during this time were on outpatient attendance, child illness visits, and some specific family planning services such as those providing injectables and oral contraceptives. Outpatient attendance was significantly affected by COVID-19, with new attendance and reattendance levels being about 20 percent and 37 percent below predicted levels in April and May 2020, respectively. However, the total models for both outpatient attendance types did not show consistent recovery by May 2021. Maternal and infant health services were also affected by COVID-19, with significant negative effects on ANC services at the beginning of the pandemic. Observed values were significantly less than model predictions for average ANC1 and total ANC4 in April and May 2020, respectively. However, ANC4 showed evidence of at least full recovery, never falling below predicted levels after June 2020. Child illness visits were also significantly affected by COVID-19, with levels of diarrhea cases among children falling significantly below predictions in April and May 2020 but then exceeding predictions starting in August 2020. Levels of child cases of malaria were also negatively affected by COVID-19 at the beginning of the pandemic, and the average model showed that such levels remained below predictions for most of the pandemic. Family planning visits were not immediately affected by COVID-19 at the beginning of the pandemic, but there were negative COVID-19 effects on levels of services for implants and oral contraceptives in April 2020. However, injectables and implant-specific family planning services remained consistently high after May 2020 for most of the remaining months in the pandemic. Vaccination-related services also experienced some initial negative COVID-19 effects, but these were relatively small in comparison to the other services. The study found that vaccination levels completely recovered, if not exceeded predictions, by June 2020, but had more oscillation patterns than what occurred before the pandemic. Overall, the study found that the COVID-19 pandemic had a significant impact on health service utilization in Uganda, particularly in the early stages of the pandemic. The most severe negative COVID-19 effects were on outpatient attendance, child illness visits, and some specific family planning services. However, most services showed some level of recovery by the end of the pandemic.