Continuity of Essential Health Services Amidst COVID-19 pandemic in Tanzania: a pre and post implementation support assessment.
Authors: Katembo Anna-Grace , Hokororo Joseph , Mutayoba Rita , Kiremeji Michael , Ndjovu Anthony , Kinyenje Eric , Eliakimu Eliudi 
Published: December 2022

Abstract

Background
Countries worldwide are facing many challenges as they strive to ensure that health systems maintain essential health services (EHS) as they respond to the coronavirus disease of 2019 (COVID-19) pandemic. EHS have experienced widespread disruption due to pandemic-related social restrictions, high patient caseloads, underresourced health facility infrastructures, and shortages of medical equipment, medicines, diagnostics and staff, with health care workers (HCWs) placed under enormous strain. In Tanzania, unlike many other countries, which did not follow strict lockdown measures, disruption ofaccess to and utilization of health care services primarily due to anxiety and fear of contact with the infection while seeking medical care was observed. Redistribution of HCWs for a dedicated team allocated in the treatment sites and isolation sites further strained the available shortage of human resources for health.
Method
The continuity of essential health services (CES) project was implemented for one year from October 2020 to September 2021, whereby capacity strengthening to HCWs and strengthening of triage areas through minor renovation and equipment support was implemented. A cascade blended model of training was used to train HCWs.
A pre-post study design was used to assess CES delivery in 17 regions of mainland Tanzania and Zanzibar from July 2019 to June 2020 (pre-project implementation) and July 2020 to September 2021 (post-project implementation). The study focused on four key indicators: (i) Number of institutional deliveries, (ii) Number of women who completed at least 4 ANC visits, (iii) Number of women who completed 4 PNC visits, and (iv) Number of children immunized with DPT3/Measles 2 Vaccination.
The assessment used secondary data analysis whereby data on key indicators were extracted from the Tanzania District Health Information System 2 (DHIS2) platform as a national Health Management Information System to Microsoft Office Excel (version 2019) for all 297 facilities (264 facilities for Mainland and 33 for Zanzibar).
Results
It was found that all key indicators that were assessed were maintained following the implementation of the project interventions that aimed at maintaining EHS during the COVID-19 pandemic. This was contributed by the project interventions that were implemented, including HCWs training on infection prevention and control (IPC), distribution of the IPC reference documents including IPC guidelines and standard operating procedures (SOPs), provision of WASH and emergence medical equipment together with ring fencing to health facilities.
Conclusion.
The study found that the project interventions have remained relevant to the needs of communities, i.e., mothers and children under 5 years, as demonstrated by the maintenance of the essential MNCH services, as seen in the analysis performed from baseline to end-line in a number of the key EHS indicators: institutional deliveries, ANC, PNC and immunization, which were tracked. This calls for joint efforts between the government and partners on resource mobilization for scale-up so that the EHS is maintained and the country is prepared for these pandemics.