New research results show that healthcare systems are beginning to recover from the pandemic

After three years of the COVID-19 pandemic, the countries’ health systems have begun to show the first major signs of health system recovery, according to WHO Interim Report on the “Fourth Round of the Global Pulse Survey on Continuity of Essential Health Services during the COVID-19 Pandemic: November 2022 – January 2023.”. By early 2023, countries reported reduced disruptions to routine health services, but highlighted the need to invest in recovery and greater resilience for the future.

Among the 139 countries that responded to the fourth round of the WHO’s pulse survey, countries reported continuous disruptions in nearly one-quarter of services on average. In the 84 countries where trend analysis is possible, the percentage of service interruptions decreased on average from 56% in July-September 2020 to 23% in November 2022-January 2023.

Persistent disruptions are caused by demand- and supply-side factors, including low levels of health care seeking in communities, as well as limited availability of health workers and other health care resources such as open clinics or available supplies of drugs and products.

“It is welcome news that health systems in most countries are beginning to restore essential health services for the millions of people who missed them during the pandemic,” said Dr Rudi Eggers, WHO Director of Integrated Health Services. “But we must ensure that all countries continue to close this gap to recover health services and apply the lessons learned to build more prepared and resilient health systems for the future.”

The first visible signs of recovery

In this new survey, fewer countries reported deliberate reductions in access to all service delivery platforms and essential public health functions since 2020–21 reporting, demonstrating an important step to return to pre-pandemic service delivery levels and wider system functioning.

By the end of 2022, most countries reported partial signs of recovery in services, including services for sexual, reproductive, maternal, newborn, child and adolescent health; diet; immunization; infectious diseases (including malaria, HIV, TB and other sexually transmitted infections); neglected tropical diseases; non-communicable diseases; management of mental, neurological and substance abuse disorders; care for the elderly; and traditional and/or complementary care.

The number of countries reporting disruptions to their national supply chain system has decreased from almost half (29 of 59 responding countries) to about a quarter (18 of 66 responding countries) over the past year.

Despite signs of recovery, service outages persist in all countries across all regions and income levels, and in most service delivery settings and monitoring service areas. Countries also face a growing backlog of services – most often in screening, diagnosis and treatment services for non-communicable diseases – which can lead to negative consequences as people delay access to timely care.

The recovery of essential health service delivery is critical because disruptions—including services for health promotion, disease prevention, diagnosis, treatment, rehabilitation, and palliation—can have even greater adverse health effects at the population and individual levels than the pandemic itself, especially among vulnerable populations.

Integration of COVID-19 services into basic health services

In another important step towards system recovery and transition, most countries have made progress in integrating services related to COVID-19 into routine health care delivery. Approximately 80-90% of countries have fully integrated COVID-19 vaccination, diagnostics and case management services, as well as post-COVID-19 services into routine service delivery.

However, the majority of countries (80% of 83 responding countries) reported at least one bottleneck to increasing access to essential tools for COVID-19 (e.g. diagnostics, therapy, vaccines and personal protective equipment for COVID-19), with health problems labor force and lack of financial resources are the most common obstacles.

Further support needed for recovery, resilience and preparedness

Most countries have begun to apply what they have learned during the COVID-19 pandemic, including through the institutionalization of a number of innovative strategies to mitigate service disruptions in routine health care delivery. These include the use of telemedicine approaches, the promotion of home care or self-care interventions, approaches to strengthen the availability of health workers, capacity and support mechanisms, innovations in the procurement and delivery of medicines and supplies, more routine community communication and partnerships with private sector service providers.

Three-quarters of countries reported additional funding for long-term system recovery, resilience and preparedness.

Countries have expressed the need for WHO support to address remaining challenges in the context of COVID-19 and beyond, which are most often related to strengthening the health workforce, building capacity to monitor health services, designing primary health care — models of care, management, policies and planning and financial planning and financing.

Note to editors:

In the fourth round of the World Health Pulse Survey, 222 countries, territories and territories were invited to respond to a standardized online survey between November 2022 and January 2023. The fourth survey followed on from the previous WHO pulse surveys in 2020 and 2021: 1st round (May-September 2020), 2nd round (January – March 2021)and 3rd round (November-December 2021) which showed the extent to which the pandemic has affected the continuity of basic health services and how countries are taking action. While pulse surveys have limitations such as reporting bias and representativeness, the strength of this effort is that it is comprehensive and provides information quickly. The term “country” should be understood to include all countries, territories and areas. The trend analysis was completed based on responses from 84 countries, territories or areas that responded to at least one part of the survey in all four rounds of the pulse survey.