PLoS ONE (Jan 2022)

Disruptions, restorations and adaptations to health and nutrition service delivery in multiple states across India over the course of the COVID-19 pandemic in 2020: An observational study

  • Rasmi Avula,
  • Phuong Hong Nguyen,
  • Sattvika Ashok,
  • Sumati Bajaj,
  • Shivani Kachwaha,
  • Anjali Pant,
  • Monika Walia,
  • Anshu Singh,
  • Anshuman Paul,
  • Ayushi Singh,
  • Bharati Kulkarni,
  • Deepak Singhania,
  • Jessica Escobar-Alegria,
  • Little Flower Augustine,
  • Madhulika Khanna,
  • Maitreiyee Krishna,
  • Nandhini Sundaravathanam,
  • Prakash Kumar Nayak,
  • Praveen Kumar Sharma,
  • Prerna Makkar,
  • Puspen Ghosh,
  • Sadhana Subramaniam,
  • Sai Mala,
  • Rakesh Giri,
  • Sameeksha Jain,
  • Santosh Kumar Banjara,
  • Sapna Nair,
  • Sebanti Ghosh,
  • Suman Das,
  • Sumeet Patil,
  • Tanmay Mahapatra,
  • Thomas Forissier,
  • Priya Nanda,
  • Suneeta Krishnan,
  • Purnima Menon

Journal volume & issue
Vol. 17, no. 7

Abstract

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Background Modeling studies estimated severe impacts of potential service delivery disruptions due to COVID-19 pandemic on maternal and child nutrition outcomes. Although anecdotal evidence exists on disruptions, little is known about the actual state of service delivery at scale. We studied disruptions and restorations, challenges and adaptations in health and nutrition service delivery by frontline workers (FLWs) in India during COVID-19 in 2020. Methods We conducted phone surveys with 5500 FLWs (among them 3118 Anganwadi Workers) in seven states between August–October 2020, asking about service delivery during April 2020 (T1) and in August-October (T2), and analyzed changes between T1 and T2. We also analyzed health systems administrative data from 704 districts on disruptions and restoration of services between pre-pandemic (December 2019, T0), T1 and T2. Results In April 2020 (T1), village centers, fixed day events, child growth monitoring, and immunization were provided by Conclusions Services to mothers and children were disrupted during stringent lockdown but restored thereafter, albeit not to pre-pandemic levels. Rapid policy guidance and adaptations by FLWs enabled restoration but little remains known about uptake by client populations. As COVID-19 continues to surge in India, focused attention to ensuring essential services is critical to mitigate these major indirect impacts of the pandemic.