The impact of COVID-19 pandemic on health service utilization in Ghana – a retrospective analysis of DHIMS-2 data
This retrospective analysis of DHIMS-2 data from 2018 to 2022 reveals that the COVID-19 pandemic significantly reduced health service utilization across Ghana, with a non-epicentre region (Northern) experiencing more severe declines in most services compared to an epicentre (Ashanti), highlighting the need for pandemic mitigation strategies to account for disruptions even in non-epicentre areas.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
When a global health crisis strikes, the immediate focus naturally falls on the virus itself: how it spreads, how many people it infects, and how to treat the sick. Yet, a pandemic is a massive disruption that ripples through every part of society, including the quiet, daily rhythm of seeking medical care for conditions that have nothing to do with the virus. In countries like Ghana, where health systems already face significant challenges, the fear of infection and the strict rules put in place to stop the spread of disease can cause people to stay home even when they are seriously ill with other problems. This creates a difficult paradox: the measures designed to save lives from one threat can inadvertently cause harm by preventing people from accessing the care they need for everything else. Understanding how these disruptions play out is vital, not just for counting the sick, but for seeing how a health system holds up when the pressure is on. It requires looking at the flow of patients through clinics and hospitals, tracking whether people are coming in for routine checkups, vaccinations, or emergency care, and seeing how those numbers change when fear and restrictions enter the picture.
Researchers set out to understand exactly how the COVID-19 pandemic altered the landscape of health care in Ghana. They turned to a massive digital record-keeping system used by the country's health service, which tracks millions of patient visits across the nation. By looking at data collected from March 2018 through March 2022, they could compare the years before the virus arrived with the years when it was present. Their goal was to see not just the national picture, but to compare two very different regions: the Ashanti region, which was a major hotspot for the virus with high infection rates and strict lockdowns, and the Northern region, which had far fewer cases and was considered a non-epicenter. They wanted to know if the drop in health care visits was driven primarily by the virus itself, or if the fear and restrictions caused people to stop coming to the doctor regardless of how many cases were in their specific neighborhood.
The study revealed that the pandemic caused a sharp and sudden drop in health care use across the board, but the story was more complex than simply "more virus equals fewer visits." In the early months of the pandemic, specifically around April 2020, the number of people visiting outpatient clinics and being admitted to hospitals fell dramatically. At the lowest point, there were fewer than two million outpatient visits in a single month, a significant dip from the usual average of over two and a half million. This decline happened even though the virus was still in its early stages of spreading. The researchers found that people stopped coming for a wide range of services, including care for chronic conditions like high blood pressure and diabetes, as well as childhood vaccinations. The fear of catching the virus in a waiting room, combined with government lockdowns that restricted movement, kept people away. Interestingly, the drop was most severe for general clinic visits and hospital admissions, while care for pregnant women remained relatively stable, suggesting that the urgency of pregnancy kept many women coming to the clinic despite the risks.
A striking finding emerged when the researchers compared the two regions. One might assume that the area with the most virus cases would see the biggest drop in health care use, as the fear would be highest there. However, the data showed the opposite. The Northern region, which had very few confirmed cases of COVID-19, experienced a much larger proportional drop in health care visits than the Ashanti region, which was the epicenter of the outbreak. In the Northern region, hospital admissions fell by nearly a quarter, and outpatient visits dropped by more than a quarter. In the Ashanti region, the drops were smaller, though still significant. This suggests that the disruption was not just about the virus itself, but about the psychological impact of the pandemic and the specific local reactions to it. In the North, where the virus was less visible, the fear of the unknown and perhaps a lack of trust in the health system led people to stay home even more than in the heavily affected Ashanti region.
As the pandemic wore on and restrictions were eased, health care use began to climb back up, but the recovery was uneven. By the third quarter of 2020, many services started to return to normal levels, with outpatient visits and hospital admissions rising again. However, the recovery for pregnant women was slower, and in some areas, visits continued to decline even as other services bounced back. The researchers noted that the initial shock of the pandemic had lasting effects, particularly for people with chronic diseases who had delayed their care. The study concludes that when preparing for future pandemics, health officials cannot focus only on the areas with the highest infection rates. The data shows that even regions with few cases can suffer a severe collapse in health care use due to fear and confusion. To protect public health, strategies must address the barriers to care in all communities, ensuring that people feel safe enough to seek help for all their health needs, not just the ones directly related to the pandemic.
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