A longitudinal study examining determinants of essential health services during the COVID-19 pandemic in regional referral hospitals across Uganda

The COVID-19 pandemic disrupted essential health services worldwide. In sub-Saharan Africa, lockdowns initially controlled virus transmission but later negatively affected non-COVID-19 healthcare. In Uganda, government policies evolved from strict movement restrictions to moderate restrictions with consideration for socioeconomic activities. This study assessed the impact of COVID-19 measures on hospital access in Uganda. We performed a longitudinal observational study using monthly outpatient data from four regional referral hospitals (RRHs) in 2019-2021. Outpatients of seven services-delivery, antenatal care (ANC), malaria testing, HIV testing, antiretroviral therapy (ART), diabetes care, and childhood immunization-were examined. Determinants included new COVID-19 cases, a stringency index, and a vaccine policy index from the Oxford database. Multilevel mixed-effects models assessed the associations between the number of outpatients and three indices. The stringency index significantly reduced access to services of delivery, ANC, malaria and HIV testing, and diabetes care. Increased COVID-19 cases negatively impacted delivery services, while vaccination policies positively influenced delivery and diabetes care. Uptake of ART services remained stable. Hospitals in low-population areas were more affected than those in higher-population areas. Strict movement restrictions impeded access to essential hospital services. This study highlights the need for adaptable measures to sustain routine healthcare during novel pandemics.