After three years of the COVID-19 pandemic, health systems in countries globally have started showing the first major signs of health system recovery, according to a report conducted by the World Health Organization (WHO).

The fourth round of the global pulse survey on continuity of essential health services during the COVID-19 pandemic: November 2022–January 2023 revealed that by early 2023, countries reported experiencing reduced disruptions in the delivery of routine health services, but highlighted the need to invest in recovery and stronger resilience for the future.

“It is welcome news that health systems in the majority of countries are starting to restore essential health services for millions of people who missed them during the pandemic,” said Dr Rudi Eggers, WHO Director for Integrated Health Services.

“But we need to ensure that all countries continue to close this gap to recover health services, and apply lessons learnt to build more prepared and resilient health systems for the future.”

Among the 139 countries that responded to the fourth round of WHO’s pulse survey, countries reported continued disruptions in almost one-quarter of services on average.

In 84 countries where trend analysis is possible, the percentage of disrupted services declined on average from 56 per cent in July-September 2020 to 23 per cent in November 2022- January 2023.  

These disruptions are due to both demand- and supply-side factors, including low levels of healthcare-seeking in communities as well as limited availability of health workers and other healthcare resources such as open clinics or available stocks of medicines and products. 

First notable signs of recovery

Fewer countries reported intentionally scaling back access across all service delivery platforms and essential public health functions since 2020/2021 period.

According to WHO, this shows an important step to return to pre-pandemic levels of service delivery and broader system functioning. 

The data showed that by the end of 2022, most countries reported signs of recovery in areas such as immunisation, sexual, reproductive, maternal, newborn, child and adolescent health, nutrition communicable diseases and among others.

Despite signs of recovery, service disruptions persist across countries in all regions and income levels, and across most service delivery settings and tracer service areas.

Countries are also dealing with increasing service backlogs – most frequently in services for screening, diagnosis and treatment of noncommunicable diseases – which can lead to negative consequences as people are delayed access to timely care.

Integrating COVID-19 services into essential health services 

WHO said that countries have made progress in integrating COVID-19 services into routine health service delivery.

About 80 to 90 per cent of countries have fully integrated COVID-19 vaccination, diagnostic and case management services as well as services for post-COVID-19 conditions into routine service delivery. 

Still, most countries reported at least one bottleneck to scaling up access to essential COVID-19 tools, with health workforce issues and lack of funding representing the most common barriers. 

Further support is needed for recovery, resilience and preparedness 

Most countries have started to apply what they have learnt during the COVID-19 pandemic, including through the institutionalization of a number of innovative service disruption mitigation strategies into routine health service delivery.

These include the deployment of telemedicine approaches, promotion of home-based care or self-care interventions, approaches for strengthening health workers’ availability, capacities and support mechanisms, innovations in procuring and delivering medicines and supplies, more routine community communications, and partnerships with private sector providers. 

Three-quarters of countries reported additional funding allocation towards longer-term system recovery, resilience and preparedness. 

Countries expressed the need for WHO support to address remaining challenges in the COVID-19 context and beyond, most frequently related to health workforce strengthening, building the monitoring capacities of health services, designing primary health care — oriented models of care, governance, policy and planning and financial planning and funding.