Impact of COVID-19 on the essential healthcare services at primary healthcare level

Abstract Background The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low- and middle-income countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia. Methods We applied a conventional qualitative study design using semi-structured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases. Results Overall, visits to the PHC facilities were decreased due to fear to contract COVID-19 coupled with lack of information, misinformation and panic. There was a lack of digital platforms for ensuring continuous patient-provider communication and phone calls were the main way of communication. PHC providers intentionally limited the number of maternal and child visits to only essential antenatal visits, newborn screenings and routine child immunizations. Still, the latter has suffered resulting in delayed and decreased vaccinations. The pandemic remarkably decreased the number of follow-up visits and monitoring of patients with chronic conditions resulting in more critical and severe conditions. Conclusions The COVID-19 pandemic affected the provision and utilization of essential health services at PHC facilities by changing people’s health-seeking behavior. Unified national-level guidance for PHC facilities is needed to direct the provision of essential services, effective health communication and usage of digital platforms. Key messages • Though provider encounters should be limited during outbreaks, continuous provision of essential services is critical in the prevention of morbidity, complications and worsened disease severity. • Efforts are needed to develop effective health and risk communication strategies and enhance appropriate usage of digital platforms to promote adequate health-seeking behavior among the public.


Background:
The demographic picture in Bulgaria became worse and worse since the democratic changes at the end of the 20th century. Our country was at one of the first positions according to the level of death rate and the rate of population decline. The study aims to analyse the effect of the COVID-19 pandemic on the main demographic indicators in Bulgaria. Methods: Data from Bulgarian National Statistical Institute were used to analyse population growth and life expectancy and to calculate the death rate, birth rate, infant mortality rate, and the share of people over 65 years of age for 2019 in comparison with 2021.

Results:
In 2019 before the onset of COVID-19, the Bulgarian population consists of 6 951 481 people. In 2021 it declines to 6 838 937 people. The decrease in birth rate is not very significant -from 8.9ø /2019/ to 8.5ø /2021/. The analysis provides estimates of excess deaths observed during the peak of the COVID-19 outbreak in Bulgaria. The death rate is very much increased -from 15.5ø to 21.7ø. The increase affects the female and male populations equally -from 19.6ø for men in 2019 to 23.2ø in 2021 and from 16.4ø for women to 20.2ø. The life expectancy shows a certain decrease -from 74.8 years /2019/ to 74.64 /2021/. Correspondingly, life expectancy was reduced for females-by 78.34 -78.22 and for males by 71.37 -71.11 years. The level of infant mortality is not changed -5.6ø. People over 65 years are 21.6% of the total population during the compared period.

Conclusions:
The Bulgarian population is very strongly affected by COVID -19 pandemic. The COVID-19 pandemic has caused a significant number of deaths worldwide but Bulgaria ranks first in the world in terms of mortality rates. Life expectancy decline reflects the impact of temporary epidemic mortality. The impact on children from the pandemic is not very significant for the country. Society should be making major and cost-effective efforts to reduce mortality. Key messages: The sharp change in demographic realities has significant effects on the country's economy. The deterioration of natural growth exacerbates the need to increase labour productivity in areas with the fastest declining populations.
Abstract citation ID: ckac131.064 Impact of COVID-19 on the essential healthcare services at primary healthcare level

Background:
The COVID-19 pandemic triggered numerous challenges for the healthcare systems worldwide, particularly affecting the continuity of essential health services in low-and middleincome countries. We explored the effects of the COVID-19 pandemic on the utilization and delivery of essential health services in Armenia.

Methods:
We applied a conventional qualitative study design using semistructured in-depth interviews (n = 17) in public and private primary healthcare (PHC) facilities in Armenia (2021). Participants included physicians providing primary health services (e.g. endocrinologists, gynecologists/obstetricians, and pediatricians), regular PHC facility patients (e.g. adults with chronic diseases, parents of children), and policymakers. Iterative thematic analysis was done based on inductively emerged 3 main themes: patient-provider communications, maternal and child health services, and management of chronic diseases.

Results:
Overall, visits to the PHC facilities were decreased due to fear to contract COVID-19 coupled with lack of information, misinformation and panic. There was a lack of digital platforms for ensuring continuous patient-provider communication and phone calls were the main way of communication. PHC providers intentionally limited the number of maternal and child visits to only essential antenatal visits, newborn screenings and routine child immunizations. Still, the latter has suffered resulting in delayed and decreased vaccinations. The pandemic remarkably decreased the number of follow-up visits and monitoring of patients with chronic conditions resulting in more critical and severe conditions.

Conclusions:
The COVID-19 pandemic affected the provision and utilization of essential health services at PHC facilities by changing people's health-seeking behavior. Unified national-level guidance for PHC facilities is needed to direct the provision of essential services, effective health communication and usage of digital platforms.

Issue:
Tobacco use intersects with the COVID-19 pandemic not only in terms of health consequences, but also on public health systems, economies, and the environment.

Description of the problem:
The global tobacco supply contributes significantly to environmental pollution of the natural ecosystems. The damage is compounded by tobacco consumption and its resultant waste, which leaves a significant carbon footprint on the environment, undermining the planet's ecological stability and intensifying climate change. Furthermore, tobacco use exacerbates inequalities and adds burdens to COVID-19-related mortality, which are major challenges to recovery from the COVID-19 pandemic. ; Warn about the dangers of tobacco (article 11); Enforcing bans on tobacco advertising, promotion, and sponsorship (TAPS) (article13); and Raise tobacco taxes (article 6).

Lessons:
To accelerate recovery, it is critical to call for actions for governments and policy-makers to strengthen synergies and policy actions to emphasise tobacco control across equity, public health, climate actions, and counteract against the tobacco industry during and beyond COVID-19 as global authorities pledge to achieve the SDGs. (2) All interviewed children find COVID-19 and home-schooling a challenge.
(3) LBC express more intense fear about infecting their grandparents than non-LBC. (4) Closer family ties to parents and siblings and access to better equipment help LBC to cope better than non-LBC. LBC view a positive side of Covid-19 in being able to enjoy more time with a parent, who would have otherwise worked abroad.

Conclusions:
Overall, all children perceive the COVID-19 pandemic as a challenge, yet closeness with a returned parent and with siblings and more affluence helps LBC to cope better than non-LBC with COVID-19 precautionary measures like home-schooling. Key messages: All children are affected by the COVID-19 pandemic. Emotional stability in the family is important in fostering resilience and coping mechanisms among children. LBC experience the added benefit of better equipped homes and enjoy the presence of the migrant parent at home.