A new report by the Global Fund to Fight AIDS, Tuberculosis and Malaria shows COVID-19 has massively disrupted health systems and health service delivery for HIV, TB and malaria in low- and middle-income countries in Africa and Asia in 2020. The report highlights the urgent need to scale up the adaptive measures that health facilities adopted to continue the fight against HIV, TB, malaria, to ramp up delivery of critical supplies for the COVID-19 response, and prevent health care systems and community responses from collapse.
Through programmatic spot-checks recording information from 502 health facilities in 32 countries in Africa and Asia between April and September 2020, the Global Fund has assembled a snapshot of the extent of the disruption to health services for HIV, TB and malaria, and of how health facilities have responded.
“This snapshot underscores the scale of the challenge,” said Peter Sands, Executive Director of the Global Fund. “HIV prevention has been knocked backwards. With the dramatic drop in case management for malaria, we face a real risk for a spike in mortality. Much of the progress we’ve made to close the gap on finding “missing” people with TB has been reversed. The stark truth is that we will see more incremental deaths from HIV, TB and malaria in 2021 as a consequence of the disruption caused by COVID-19 in 2020.”
The data collected shows that for April to September 2020, compared to the same six-month period in 2019:
- HIV testing fell 41%.
- TB referrals – where patients suspected of having TB are referred to the next step of diagnosis and treatment – declined by 59%.
- Malaria diagnoses fell by 31%.
- Antenatal care visits fell by 43%.
The spot-checks also highlighted a critical lack of tests, treatments and PPE needed to fight COVID-19, particularly in Africa:
- Only 45% of health facilities had enough essential PPE items for its health workers, including masks, disinfectant, gloves and hand sanitizer.
- Across the 24 countries in Africa that were surveyed, only 11% of health facilities could conduct COVID-19 antigen rapid diagnostic tests, and only 8% could conduct polymerase chain reaction (PCR) tests.
However, the snapshot also shows that countries that implemented adaptive measures to counter the impact of COVID-19 on health service continuity fared better than those that did not adapt. More than two-thirds (68%) of facilities surveyed adopted at least one adaptive measure, such as dispensing long-term supplies of medicines for HIV and TB to patients, or switching to a door-to-door delivery system for mosquito nets and preventative malaria medicines. These successful adaptations to service disruption by COVID-19 need to be further investigated, scaled up and tailored to local contexts.
The Global Fund has already deployed nearly US$1 billion to fight COVID-19 and mitigate the impact on HIV, TB and malaria in more than 100 countries. Through the ACT-Accelerator, the global collaboration to ensure the accelerated launch and equitable deployment of tools to fight COVID-19, the Global Fund is now the primary channel for providing grant support to low- and middle-income countries on tests, treatments (including medical oxygen), PPE and health system strengthening. For the Global Fund to fulfil its responsibility to the ACT-Accelerator and regain lost progress against HIV, TB and malaria, an additional US$10 billion is needed. To date in 2021, the Global Fund has raised US$3.7 billion.
“In most low- and middle-income countries, the crisis is far from over, with infections and deaths from COVID-19 continuing to increase, and the knock-on impact on HIV, TB and malaria continuing to escalate,” said Peter Sands, Executive Director of the Global Fund. “To regain the ground lost on the three epidemics in 2020 and to step up the fight against COVID-19, we have to massively scale up adaptation programs, increase access to COVID-19 tools, and shore up systems for health so they don’t collapse.”
- The impact of COVID-19 on HIV, TB and malaria services and systems for health: a snapshot from 502 health facilities across Africa and Asia
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