Health service utilisation during the COVID-19 pandemic in sub-Saharan Africa in 2020: a multicountry empirical assessment with a focus on maternal, newborn and child health services.

INTRODUCTION: There are concerns about the impact of the COVID-19 pandemic on the continuation of essential health services in sub-Saharan Africa. Through the Countdown to 2030 for Women's, Children's and Adolescents' Health country collaborations, analysts from country and global public health institutions and ministries of health assessed the trends in selected services for maternal, newborn and child health, general service utilisation. METHODS: Monthly routine health facility data by district for the period 2017-2020 were compiled by 12 country teams and adjusted after extensive quality assessments. Mixed effects linear regressions were used to estimate the size of any change in service utilisation for each month from March to December 2020 and for the whole COVID-19 period in 2020. RESULTS: The completeness of reporting of health facilities was high in 2020 (median of 12 countries, 96% national and 91% of districts ≥90%), higher than in the preceding years and extreme outliers were few. The country median reduction in utilisation of nine health services for the whole period March-December 2020 was 3.9% (range: -8.2 to 2.4). The greatest reductions were observed for inpatient admissions (median=-17.0%) and outpatient admissions (median=-7.1%), while antenatal, delivery care and immunisation services generally had smaller reductions (median from -2% to -6%). Eastern African countries had greater reductions than those in West Africa, and rural districts were slightly more affected than urban districts. The greatest drop in services was observed for March-June 2020 for general services, when the response was strongest as measured by a stringency index. CONCLUSION: The district health facility reports provide a solid basis for trend assessment after extensive data quality assessment and adjustment. Even the modest negative impact on service utilisation observed in most countries will require major efforts, supported by the international partners, to maintain progress towards the SDG health targets by 2030.

Analyzing the contributions of transdisciplinary research to the global sustainability agenda in African cities.

It is almost 6 years since the UN's Sustainable Development Goals (SDGs) were adopted, and countries have less than 10 years to achieve the set targets. Unlike most of the world, sub-Saharan African countries have reported only minimal progress, one that the COVID-19 pandemic has unfortunately disrupted. Transdisciplinary research (TDR) has been conceptualized as important for achieving sustainability goals such as the SDGs. In this paper we (i) analyze the contributions of the five TDR projects toward the achievements of the SDGs at the city level in Africa, and (ii) explore the interactions between the assessed SDGs across the five projects. The projects' contributions towards the achievements of the SDGs were examined in three thematic areas: (i) contexts, (ii) processes and (iii) products. The five projects were funded under the Leading Integrated Research for Agenda 2030 in Africa (LIRA) programme. The projects were being implemented in nine cities across five African countries Accra (Ghana), Kumasi (Ghana), Korhogo (Ivory Coast), Abuja Metro (Nigeria), Mbour (Senegal), Cape Town (South Africa), Nelson Mandela Bay Metro (South Africa), Grahamstown (South Africa) and Kampala (Uganda) and data were collected on each of the five projects in these cities. The contextual contributions include co-analysis and reflection on policy and institutional silos and social innovations amenable to contextual complexity. A shift in how actors perceived and conceptualized sustainability challenges and the role of the projects as transformative social agents constituted the two main process contributions. Tool development, virtual models and maps, and handbook are the product contributions by the projects. Our analysis of the SDG interactions indicated the need for cross-sectoral collaborations to ensures resource use efficiency, knowledge and experience sharing, and seamless flow of information and data to accelerate the SDG implementation.