Factors associated with hospital service access during COVID-19: A longitudinal study in Uganda

BACKGROUND: A global review summarized that the failure of healthcare systems and the capability of pandemic responses affected adverse health outcomes more than restricted movement policies. Studies on sub-Saharan Africa reported that lockdowns directly impeded access to necessary health services. We examined the factors associated with the accessibility of hospital services in Uganda. METHODS: We performed a multiple linear regression analysis. The outcome variable is the number of monthly outpatients (NMPs) at eight services (obstetrics, maternal care, family planning, malaria testing, HIV testing, antiretroviral therapy, diabetes, and child immunization) in four regional referral hospitals (Kabale, Lira, Soroti, and Naguru), comprising 32 services. Explanatory variables included the stringency index (SI) and vaccination policy (VP) from the Oxford COVID-19 government response tracker, and COVID-19 confirmed cases (CC). The data covered the period from January 2019 to December 2021. Statistical significance was set at 0.05. RESULTS: The SI showed a significantly negative association with NMPs (16/32 services, 50.0%) in four hospitals. The CC also showed similar trends (8/32 services) in three hospitals. In contrast, VP was positively associated with NMPs (8/32 services). Of the eight services, both malaria and HIV testing were negatively associated with SI in all hospitals. Naguru hospital in the capital city, where health facilities were sufficient, was the least affected by SI (2/8 services) while Kabale and Lira hospitals in local cities were negatively impacted regarding SI (5/8 services). CONCLUSIONS: This study showed that the restrictive measures to control COVID-19 transmission had the greatest impact on the disruption of hospital service access, more than the COVID-19 infection itself. Innovative service delivery systems for all necessary populations should be developed during mobility restrictions in health-resource-limited settings for future health crises. KEY MESSAGES: • Stringency, public health and social measures, showed the strongest association with the disruption of hospital service access in Uganda, particular in areas with insufficient health facilities. • Innovative service delivery systems for all necessary populations should be developed in health-resource-limited settings for future health crises.