Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements
Authors: Ahmed Syed A K Shifat , Ajisola Motunrayo , Azeem Kehkashan , Bakibinga Pauline , Chen Yen-Fu , Choudhury Nazratun Nayeem , Fayehun Olufunke , Griffiths Frances , Harris Bronwyn , Kibe Peter , Lilford Richard J , Omigbodun Akinyinka , Rizvi Narjis , Sartori Jo , Smith Simon , Watson Samuel I , Wilson Ria , Yeboah Godwin , Aujla Navneet , Azam Syed Iqbal , Diggle Peter J , Gill Paramjit , Iqbal Romaina , Kabaria Caroline , Kisia Lyagamula , Kyobutungi Catherine , Madan Jason J , Mberu Blessing , Mohamed Shukri F , Nazish Ahsana , Odubanjo Oladoyin , Osuh Mary E , Owoaje Eme , Oyebode Oyinlola , Porto de Albuquerque Joao , Rahman Omar , Tabani Komal , Taiwo Olalekan John , Tregonning Grant , Uthman Olalekan A , Yusuf Rita 
Published: August 2020

IntroductionWith COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.MethodsIn seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.ResultsBetween March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.ConclusionSlum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.