In WHO global pulse survey, 90% of countries report disruptions to essential health services since COVID-19 pandemic
The World Health Organization (WHO) today published a first indicative survey on the impact of COVID-19 on health systems based on 105 countries’ reports. Data collected from five regions over the period from March to June 2020 illustrate that almost every country (90%) experienced disruption to its health services, with low- and middle-income countries reporting the greatest difficulties. Most countries reported that many routine and elective services have been suspended, while critical care - such as cancer screening and treatment and HIV therapy – has seen high-risk interruptions in low-income countries.
"The survey shines a light on the cracks in our health systems, but it also serves to inform new strategies to improve healthcare provision during the pandemic and beyond,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. "COVID-19 should be a lesson to all countries that health is not an ‘either-or’ equation. We must better prepare for emergencies but also keep investing in health systems that fully respond to people’s needs throughout the life course."
Services hit across the board: Based on reports from key informants, countries on average experienced disruptions in 50% of a set of 25 tracer services. The most frequently disrupted areas reported included routine immunization – outreach services (70%) and facility-based services (61%), non-communicable diseases diagnosis and treatment (69%), family planning and contraception (68%), treatment for mental health disorders (61%), cancer diagnosis and treatment (55%).
Countries also reported disruptions in malaria diagnosis and treatment (46%), tuberculosis case detection and treatment (42%) and antiretroviral treatment (32%). While some areas of health care, such as dental care and rehabilitation, may have been deliberately suspended in line with government protocols, the disruption of many of the other services is expected to have harmful effects on population health in the short- medium- and long-term.
Potentially life-saving emergency services were disrupted in almost a quarter of responding countries. Disruptions to 24-hour emergency room services for example were affected in 22% of countries, urgent blood transfusions were disrupted in 23% of countries, emergency surgery was affected in 19% of the countries.
Disruption due to a mix of supply and demand side factors. 76% of countries reported reductions in outpatient care attendance due to lower demand and other factors such as lockdowns and financial difficulties. The most commonly reported factor on the supply side was cancellation of elective services (66%). Other factors reported by countries included staff redeployment to provide COVID-19 relief, unavailability of services due to closings, and interruptions in the supply of medical equipment and health products.
Adapting service delivery strategies. Many countries have started to implement some of the WHO recommended strategies to mitigate service disruptions, such as triaging to identify priorities, shifting to on-line patient consultations, changes to prescribing practices and supply chain and public health information strategies. However, only 14% of countries reported removal of user fees, which WHO recommends to offset potential financial difficulties for patients.
The pulse survey also provides an indication of countries’ experiences in adapting strategies to mitigate the impact on service provision. Despite the limitations of such a survey, it highlights the need to improve real-time monitoring of changes in service delivery and utilization as the outbreak is likely to wax and wane over the next months, and to adapt solutions accordingly.
To that end, WHO will continue to work with countries and to provide supportive tools to address the fallout from COVID-19. Given countries’ urgent demand for assistance during the pandemic response, WHO is developing the COVID19: Health Services Learning Hub, a web-based platform that will allow sharing of experiences and learning from innovative country practices that can inform the collective global response. WHO is also devising additional surveys at the sub-national level and in health facilities to gauge the longer-term impact of disruptions and help countries weigh the benefits and risks of pursuing different mitigation strategies.
Note to editors
The survey ‘Rapid assessment of continuity of essential health services during the COVID-19 pandemic’ (HYPERLINK), was conducted in 159 countries (all WHO regions except the Americas). 105 responses were received (66% response rate) from senior ministry of health officials covering the period from March to June 2020. The purpose of the survey was to gain insights and perspectives on both the impact of the COVID-19 pandemic on up to 25 essential health services in countries and how countries are adapting strategies to maintain essential services.
While pulse surveys have some limitations, the strength of this effort is that it is comprehensive, looking at 25 core health services (as opposed to single topic surveys) and representing disruptions to these services in a comparable way across over 100 countries. It reveals that even robust health systems can be rapidly overwhelmed and compromised by a COVID-19 outbreak, reinforcing the need for sustained data collection and strategic adaptations to ensure maintenance of essential care provision.
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World Mental Health Day: an opportunity to kick-start a massive scale-up in investment in mental health
Joint release by the World Health Organization, United for Global Mental Health and the World Federation for Mental Health
Mental health is one of the most neglected areas of public health. Close to 1 billion people are living with a mental disorder, 3 million people die every year from the harmful use of alcohol and one person dies every 40 seconds by suicide. And now, billions of people around the world have been affected by the COVID-19 pandemic, which is having a further impact on people’s mental health.
Yet, relatively few people around the world have access to quality mental health services. In low- and middle-income countries, more than 75% of people with mental, neurological and substance use disorders receive no treatment for their condition at all. Furthermore, stigma, discrimination, punitive legislation and human rights abuses are still widespread.
The limited access to quality, affordable mental health care in the world before the pandemic, and particularly in humanitarian emergencies and conflict settings, has been further diminished due to COVID-19 as the pandemic has disrupted health services around the world. Primary causes have been infection and the risk of infection in long-stay facilities such as care homes and psychiatric institutions; barriers to meeting people face-to-face; mental health staff being infected with the virus; and the closing of mental health facilities to convert them into care facilities for people with COVID-19.
Move for mental health: let’s invest
That’s why, for this year’s World Mental Health Day, WHO, together with partner organizations, United for Global Mental Health and the World Federation for Mental Health, is calling for a massive scale-up in investment in mental health. To encourage public action around the world, a World Mental Health Day campaign, Move for mental health: let’s invest will kick off in September.
“World Mental Health Day is an opportunity for the world to come together and begin redressing the historic neglect of mental health,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization. “We are already seeing the consequences of the COVID-19 pandemic on people’s mental well-being, and this is just the beginning. Unless we make serious commitments to scale up investment in mental health right now, the health, social and economic consequences will be far-reaching.”
During the past few months, the World Health Organization has issued, in collaboration with partners, guidance and advice on mental health for health workers and other frontline workers, managers of health facilities, and people of all ages whose lives have changed considerably as a result of the pandemic. With the disruption in health services, countries are finding innovative ways to provide mental health care, and initiatives to strengthen psychosocial support have sprung up. Yet, because of the scale of the problem, the vast majority of mental health needs remain unaddressed. The response is hampered by chronic under-investment in mental health promotion, prevention and care for many years before the pandemic.
Countries spend just 2% of their health budgets on mental health
Countries spend on average only 2% of their health budgets on mental health. Despite some increases in recent years, international development assistance for mental health has never exceeded 1% of all development assistance for health. This is despite the fact that for every US$ 1 invested in scaled-up treatment for common mental disorders such as depression and anxiety, there is a return of US$ 5 in improved health and productivity.
World Mental Health Day: an opportunity to commit
The World Mental Health Day campaign will offer opportunities, primarily online given the continuing pandemic, for all of us to do something life-affirming: as individuals, to take concrete actions in support of our own mental health, and to support friends and family who are struggling; as employers, to take steps towards putting in place employee wellness programmes; as governments, to commit to establishing or scaling-up mental health services; and as journalists, to explain what more can and must be done to make mental health care a reality for everyone.
“It is nearly 30 years since the first World Mental Health Day was launched by the World Federation for Mental Health,” said Dr Ingrid Daniels, President of the World Federation for Mental Health. “During that time, we have seen an increasing openness to talk about mental health in many countries of the world. But now we must turn words into actions. We need to see concerted efforts being made to build mental health systems that are appropriate and relevant for today’s – and tomorrow’s - world.
“With so many people lacking access to good quality, appropriate mental health services, investment is needed now more than ever,” said Elisha London, Founder and CEO of United for Global Mental Health. “Everyone, everywhere can participate in this year’s campaign. Whether you have struggled with your own mental health, know someone who has been affected, are a mental health expert, or if you simply believe that investing in mental health is the right thing to do, move for mental health, and help make mental health care and support accessible for everyone.”Key events
United for Global Mental Health: The 24-hour March for Mental Health
On 9 October, people from around the world will be encouraged to participate in a virtual march. A 24-hour livestream will feature people with lived experience, mental health leaders and influencers from the civil society groups already active in 19 countries through the Speak Your Mind campaign. In addition, global partner organizations that are leading and coordinating work on mental health are organizing hour-long sessions on specific themes, including mental health and young people, mental health and older people, and mental health and the LGBTQ+ community. Confirmed partners include Human Rights Watch and Alzheimer’s Disease International. The March will help increase awareness of mental health issues, break down stigma and bring about policy change. Members of the public will be urged to “add their voice” and join the March using online filters to be released in the lead-up to the event.
WHO: The Big Event for Mental Health
On World Mental Health Day, 10 October, the World Health Organization will, for the first time ever, host a global online advocacy Event on mental health. At this event - the Big Event for Mental Health - WHO will showcase the work that its staff are doing around the world to reduce mental illness and the harmful use of alcohol and drugs. World leaders and mental health experts will join the WHO Director-General to talk about their commitment to mental health and what more must be done. World-renowned musicians who have spoken out about the importance of mental health will talk about their motivation and perform. Sportsmen and women whose lives have been affected by mental ill health will share their experiences and how they have dealt with conditions such as depression and anxiety.
During the Event, a Special Prize for a mental health film, a newly-created category of WHO’s inaugural Health for All Film Festival, will be awarded.
World Federation for Mental Health: education and awareness raising
The Federation’s campaign kicks off on 1 September, with the Federation’s President launching the 2020 World Mental Health Day Campaign Educational Material “Mental Health for All: Greater Investment - Greater Access” under the Royal Patronage of HRH Princess Iman Afzan Al-Sultan Abdullah of Malaysia. This includes a Call to Action 2020 from Pamela Y. Collins and Deepa Rao, and will be followed by 45 days of awareness-raising activities led by the Federation’s youth section, including a global online discussion forum and art exhibition.
The World Health Organization
The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goals for 2019-2023 are to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and to provide a further billion people with better health and well-being.
United for Global Mental Health
United for Global Mental Health brings together the global mental health community with governments, funders and campaigners to help make sure everyone, everywhere has someone to turn to in support of their mental health. The not-for-profit organization was launched at the UN in September 2018.
Speak your Mind is a nationally driven and globally united campaign powered by United for Global Mental Health. It works in support of mental health for all. It brings together people with first-hand experience of mental health conditions, experts and civil society organizations to call on leaders to end the neglect of mental health by increasing investment, empowerment and education. The campaign involves campaigners from 19 countries: Argentina, Australia, Ghana, India, Indonesia, Kenya, Liberia, Nepal, New Zealand, Nigeria, Pakistan, Peru, Philippines, Sierra Leone, South Africa, Sri Lanka, Tonga, the United Kingdom and the United States of America.
The World Federation for Mental Health
The World Federation for Mental Health is an international membership organization founded in 1948 to advance, among all peoples and nations, the prevention of mental and emotional disorders, the proper treatment and care of those with such disorders, and the promotion of mental health. The Federation was the initiator of World Mental Health Day.
Today, as part of its commitment to strengthening health information systems and improving health, especially in the context of the COVID-19 pandemic, WHO announced a new approach to improving access to life-saving data: the SCORE for Health Data Technical Package. The COVID-19 pandemic has highlighted the urgent need for timely and reliable data to drive strategic health action. Too many countries still lack both the infrastructure to routinely gather health data and the analytical capacity to use these data for effective health actions and emergency response.
“Countries must be able to measure progress to make progress,” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “Particularly during COVID-19, reliable data is the best way to coordinate response efforts and improve health in all areas.”
Accurate health data are necessary to understand specific country needs in order to improve health and save lives. Data also helps direct scarce resources to where they are needed most.
The SCORE (Survey, Count, Optimize, Review, Enable) Technical Package aims to improve the availability of timely, reliable, validated, and comparable health data. For the first time in a single, harmonized package, it represents all the key elements for optimized health information system performance. Simply put, SCORE will help governments around the globe set benchmarks and improve standards in healthcare.
In response to the challenges of data availability highlighted in the WHO World Health Statistics 2020 report, SCORE includes more than 90 universally-accepted tools and standards for health information systems strengthening. “Using data to inform public health priorities and strategies has never been more important,” said Dr Kelly Henning, Director of Public Health Programs at Bloomberg Philanthropies. “The SCORE Technical Package provides country governments around the world with high-quality, essential technical guidance so that countries can strengthen their own data systems.” WHO is proud to partner with the Bloomberg Philanthropies Data for Health Initiative to deliver this timely resource to countries.
Below are some examples of how SCORE can improve individual lives and communities:
- The birth of a child is registered so they can access essential health services, attend school, and apply for a passport;
- A death is registered with cause-of-death accurately captured so that policy-makers have a better understanding of all-cause and COVID-specific mortality and associated risk factors and implement programs and policies to save lives;
- Health data are disaggregated by age, sex and cause of death to illustrate the root causes of health disparities and help direct resources to the most vulnerable groups such as those who do not speak the local language or face stigma and discrimination in their community;
- Health facilities have the capacity to regularly measure the quality of their services, workforce and patient data and can make a compelling case for increased funding to national and international stakeholders;
- Health data are integrated with other sectors so that social determinants of health such as pollution, sanitation and nutrition are addressed to reduce the overall burden of disease.
The package's initial release includes two documents:
- SCORE Essential Interventions – including an overview of health information systems, underlying elements, and indicators to assess progress with sample actions; and
- SCORE Tools and Standards -- including resources to address critical health data gaps and strengthen country health data.
“We must keep score to save lives. WHO is committed to working with countries and partners to rapidly scale up capacity for data collection and use in order to improve policy and performance,” added Dr Samira Asma, Assistant Director-General for Data, Analytics and Delivery for Impact at WHO. “We must act now to invest in statistical systems in countries, respond to this pandemic and meet the SDGs and the Triple Billion targets. Our window of opportunity is closing, and we cannot wait to address data gaps. Data use to address country needs has to be a priority today.”
Country-owned, disaggregated data will be essential for more resilient and sustainable health systems going forward. COVID-19 is both a wake-up call and a stark reminder of the challenges we still have to address. But it is also an opportunity to build back better through solidarity, information-sharing and collaboration.
SCORE is one example of how a collaborative approach can benefit countries by providing a common set of tools based on shared standards. This package is designed to be practical, actionable and flexible. We will only be successful in combatting COVID-19 if we work together.
Future components of the SCORE Technical Package are due to be released later this year, including the SCORE Assessment Instrument and global, regional and country status reports. Together, these will provide a complete package of information to plan and monitor progress against national and subnational priorities as well as global targets.-----
 Bloomberg Philanthropies Data for Health Initiative provided funding to support the SCORE for Health Data Technical Package