Covid-19 in developing countries: secondary impacts Contents

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3Non-covid related healthcare

“Health services and health actors around the world are currently run absolutely ragged. Everybody is exhausted.” (Aaron Oxley, Executive Director, RESULTS UK)62

The impact of covid-19 upon routine vaccinations and treatments

27.The rapid spread of covid-19 is overwhelming many health systems and causing significant loss of life.63 Over 2 million people have died from covid-19 since its outbreak according to data from the World Health Organisation (WHO).64 Until late 2019, developing countries had made advances in many areas of healthcare including by reducing the rate of maternal and child deaths and by increasing the rate of childhood immunisation with funding for basic health services increasing by 41% between 2010 and 2018 to reach $10 billion.65 Recently, however, funding has stalled again, according to the UN.66

28.There was a clear consensus in our evidence that the covid-19 pandemic has had severe knock-on impacts across all forms of health service provision. Covid cases were exhausting staff, diverting and absorbing resources, flooding facilities, complicating procedures and processes and stopping patients with other conditions from attending due to availability of personnel, transport issues, and fear of infection. The FCDO, citing a WHO survey of members states, said,

“70% of surveyed countries reported (partial or severe) disruption to routine immunisations, 56% reported disruption to antenatal care, 52% disruption to sick child services, and 19% disruption to emergency surgery.”67

29.Aaron Oxley, Executive Director at RESULTS UK, told us that a three-month lockdown with a ten-month recovery period would result in 6.3 million additional cases of tuberculosis by 2025 with 1.4 million additional deaths, setting back the global fight against the disease by five to eight years.68 Studies for other health areas showed comparable setbacks:

• at least 80 million children under the age of one risk missing out on routine vaccines for diseases such as measles, polio and diphtheria69
• an estimated 50 million children in Pakistan and Afghanistan—where pockets of polio persist—likely to miss routine polio vaccines70
• an estimated 11.5 million people affected by disruptions to anti-retroviral services for HIV/AIDS in 36 countries between April and June 2020 and 75% of the Global Fund’s HIV/AIDS programmes reporting moderate to high levels of disruption to service delivery.71

30.Witnesses told us of measures that they and their partner organisations had taken in response to the obstacles created by the pandemic. These included setting up tele-medicine systems to diagnose and treat patients remotely, and delivering essential drugs directly to patients rather than expecting patients to visit facilities.72 Witnesses commended the inclusion of communities and local civil society organisations by the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund)–the largest multilateral financing mechanism for health systems strengthening–in the forming of strategies.73

UK ODA funding of global health

31.As the second-largest donor to global health,74 the UK Government plays an important role in the facilitation of such measures. The Foreign Secretary listed the strengthening of health systems and Universal Health Coverage as top priorities for the international community in building back better at the UN High-Level Event on Financing for Development on 29 September 2020.75

32.The UK Government has committed over £764 million to date in the response to covid-19 and its impact.76 In their submission, the FCDO stated that they were “supporting a range of priorities” relating to global health through:77

• a pledge of up to £1.4 billion to the Global Fund to provide anti-retroviral therapy for people living with HIV, support healthcare in relation to tuberculosis and malaria, and strengthen health systems and global health security78
• up to £1.65 billion pledge to Gavi, the Global Vaccine Alliance, for 2021–2025 to support routine immunisation79
• £30 million, with an additional £50 million commitment, to the Global Financing Facility to support access to reproductive, maternal, new-born, child and adolescent services80
• £400 million to the Global Polio Eradication Initiative over the next four years, and
• £75 million support to the World Health Organisation (WHO) for their covid-19 response, in addition to a £120m per annum (on average) financial contribution to assist the WHO

33.Our witnesses called for the protection of funding for essential non-covid health services. Katie Husselby, Co-ordinator at Action for Global Health, told us that money might be diverted from these services, which she said were already underfunded.81 RESULTS UK called for timely and more rapid disbursement of UK funds for other diseases including polio, tuberculosis and HIV/AIDS to avert a rise in the rates of death from such diseases as well as an increase in the long-term costs in eradicating them.82

34.We also heard calls for more transparency and accountability in the planning and funding of the covid-19 response at multilateral and national levels.83 Both Ms Husselby and Mike Podmore, Director of STOPAIDS, considered the UK’s global health strategy to be insufficiently transparent and therefore difficult to assess.84 At a multilateral level, Mr Podmore considered other organisations such as the WHO not inclusive enough towards civil society organisations when devising strategies against the impact of covid-19.85 At national level, Ms Husselby told us that the Government’s interventions in relation to covid-19, to the universal principle of the SDGs to “Leave No One Behind”86 and to SDG 3 (good health and well-being) could not be assessed properly without a cross-departmental UK global health strategy.87

35.Wendy Morton MP, Minister for European Neighbourhood and the Americas at the FCDO whose remit includes global health security and the global work on covid-19 vaccines, told us that transparency and accountability were important to the FCDO:

“For me, it is always about making sure, whatever we are doing, it reaches those people who need it. Crucially, the transparency and accountability is so important.”88

In its submission to part one of our inquiry in April 2020, DFID told us that they were “already working well” across Departments to ensure a strategic approach to global health policy-making, and mentioned the Global Health Oversight Group as one way of ensuring oversight.89 DFID also stated that they would revisit the impact of the pandemic on cross-government global health security “once the situation is more settled”.90

36.Covid-19 has affected healthcare systems in developing countries negatively. The urgency with which countries have had to respond has diverted already scarce resources towards covid-related care at the expense of other essential healthcare. This has caused disruption to routine vaccinations and treatments and is storing up years of future problems as well as a potential reversal of hard-won gains in global health. The FCDO should show global leadership in its commitment to global health, as outlined in the Strategic Framework for ODA, through maintaining its existing commitments to routine immunisation programmes and other essential healthcare across developing countries. It should further tell us how it assesses the impact of covid-19 on healthcare and decides to mitigate it. Our interim findings report recommended that the Government should publish a multi-year, cross-departmental global health strategy, to map out how UK policy can deliver a strategic and integrated approach to strengthening global health. In the midst of a pandemic, this is needed more than ever, and we reiterate our previous recommendation. Furthermore, this global health strategy should set out how the UK intends to use levers at multilateral and bilateral levels to achieve its aims, how this ensures progress towards the UN Sustainable Development Goals, and how the strategy will reach the most marginalised and vulnerable communities. Whilst we commend the Government’s response to covid-19, we are concerned that several of the measures listed in the FCDO’s submission in October 2020—the £80 million commitment to the Global Financing Facility and the £400 million commitment to the Global Polio Eradication Initiative—pre-date the outbreak of covid-19 and ask the FCDO to provide us with an updated list, which sets out the Government’s funding for healthcare since the outbreak of covid-19.

Building more resilient and inclusive healthcare systems

37.Community engagement with healthcare services and facilities has suffered considerably as a result of the pandemic.91 According to the UN Department of Economic and Social Affairs (UN DESA), people are “unable or afraid to go to health-care facilities”—even in the case of urgent medical care—in part due to fear of contracting covid-19.92 Additionally, covid-19 has made access to healthcare more difficult due to movement restrictions, lack of personal protective equipment (PPE) for providing healthcare and lack of trust in service provision.93

38.Bond and the International Committee of the Red Cross told us of cases where vulnerable people were denied essential and emergency healthcare and had unequal access to information, especially people with disabilities, women and girls, sexual and gender minorities and refugees and internally displaced people.94

39.We did, however, also receive examples of positive work to build trust in healthcare systems at local level to counter these trends. For example, Marie Stopes International told us that they had worked successfully with key community stakeholders including chiefs, chairs and peripheral health unit staff in Sierra Leone to strengthen messaging and reduce fear about accessing healthcare services during the pandemic.95

40.Covid-19’s impact on income is reducing the capacity of vulnerable people to afford essential healthcare.96 According to the UN, rising health expenses are pushing millions of people into extreme poverty with an estimated one billion people projected to spend at least 10% of their household budgets on healthcare in 2020, and the majority of them living in low- and middle-income countries.97 Action for Global Health warned that the cost of health interventions was likely to increase following lockdown as many of those services would need to be delivered door to door instead of in mass settings, rendering them more expensive.98

41.We heard that user fees present a significant barrier to accessing healthcare.99 In their survey of over 1,400 people in late August 2020, the Norwegian Refugee Council found that 77% of respondents had reduced their spending on medical services due to covid-19’s impact on their income.100 Ms Husselby told us that the financial hardship caused by covid-19’s economic impact and payment of user fees created a financial barrier for vulnerable groups.101

42.Accordingly, contributors to the inquiry called for the removal of barriers to accessing essential healthcare, greater inclusion of communities in the planning and execution of the covid-19 response,102 protection of funding for essential non-covid health services,103 the end of user fees,104 and the introduction of Universal Health Coverage globally.105

43.Our witnesses considered the covid-19 response an opportunity to integrate more effectively healthcare services and equipment for various diseases by sharing resources rather than transferring them to the covid-19 response. Action for Global Health told us that “the issues that negatively impact the covid-19 response also impact the ability to maintain other essential health services, at even greater cost”.106 Aaron Oxley said that,

“at the moment those adaptations are not going nearly far enough to ameliorate the damage being done”, leaving “some very big mountains to climb”.107

44.In their submission in October 2020, the FCDO told us that the UK Government’s response aimed to maintain affordable access to and delivery of essential health services for health, nutrition, water, sanitation and hygiene, and sexual and reproductive health and rights.108 Furthermore, one example of an integrated approach is the FCDO’s funding for the Global Polio Eradication Initiative, which will enable countries to respond to covid-19 through networks created to counter polio. Ms Morton told us that:

“Polio workers on the ground have resumed vaccinations. They have combined their efforts to support the growing need to protect communities against the pandemic. As part of their role, polio workers help with covid-19 testing and the training of health workers on infection prevention and control. They are a group of people who are already working in communities and across communities.”109

45.At a time of heightened need, it is more important than ever that healthcare is provided in a way that uses stretched resources as efficiently as possible through integrating responses to multiple health challenges. As part of a global health strategy, the FCDO should work with developing countries to reduce financial barriers to accessing healthcare for communities, prioritising low-cost approaches to lifesaving treatments and incorporating the feedback of communities more effectively into their response. Furthermore, the FCDO should advocate for the integration of the various streams of healthcare provision even more in its work with partner organisations to help accomplish an effective response to other diseases alongside covid-19 during the pandemic.