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Background: Vaccine hesitancy remains a critical barrier in mitigating the effects of the ongoing COVID-19 pandemic. The willingness of health care workers (HCWs) to be vaccinated, and, in turn, recommend the COVID-19 vaccine for their patient population is an important strategy. This study aims to understand the uptake of COVID-19 vaccines and the reasoning for vaccine hesitancy among facility-based health care workers (HCWs) in LMICs. Methods: We conducted nationally representative phone-based rapid-cycle surveys across facilities in six LMICs to better understand COVID-19 vaccine hesitancy. We gathered data on vaccine uptake among facility managers, their perceptions of vaccine uptake and hesitancy among the HCWs operating in their facilities, and their perception of vaccine hesitancy among the patient population served by the facility. Results: 1,148 unique public health facilities participated in the study, with vaccines being almost universally offered to facility-based respondents across five out of six countries. Among facility respondents who have been offered the vaccine, more than 9 in 10 survey respondents had already been vaccinated at the time of data collection. Vaccine uptake among other HCWs at the facility was similarly high. Over 90% of facilities in Bangladesh, Liberia, Malawi, and Nigeria reported that all or most staff had already received the COVID-19 vaccine when the survey was conducted. Concerns about side effects predominantly drive vaccine hesitancy in both HCWs and the patient population. Conclusion: Our findings indicate that the opportunity to get vaccinated in participating public facilities is almost universal. We find vaccine hesitancy among facility-based HCWs, as reported by respondents, to be very low. This suggests that a potentially effective effort to increase vaccine uptake equitably would be to channel promotional activities through health facilities and HCWs.However, reasons for hesitancy, even if limited, are far from uniform across countries, highlighting the need for audience-specific messaging. [ABSTRACT FROM AUTHOR]

Background: The Coronavirus Disease 2019 (COVID-19) pandemic has had wide-reaching direct and indirect impacts on population health. In low- and middle-income countries, these impacts can halt progress toward reducing maternal and child mortality. This study estimates changes in health services utilization during the pandemic and the associated consequences for maternal, neonatal, and child mortality. Methods and findings: Data on service utilization from January 2018 to June 2021 were extracted from health management information systems of 18 low- and lower-middle-income countries (Afghanistan, Bangladesh, Cameroon, Democratic Republic of the Congo (DRC), Ethiopia, Ghana, Guinea, Haiti, Kenya, Liberia, Madagascar, Malawi, Mali, Nigeria, Senegal, Sierra Leone, Somalia, and Uganda). An interrupted time-series design was used to estimate the percent change in the volumes of outpatient consultations and maternal and child health services delivered during the pandemic compared to projected volumes based on prepandemic trends. The Lives Saved Tool mathematical model was used to project the impact of the service utilization disruptions on child and maternal mortality. In addition, the estimated monthly disruptions were also correlated to the monthly number of COVID-19 deaths officially reported, time since the start of the pandemic, and relative severity of mobility restrictions. Across the 18 countries, we estimate an average decline in OPD volume of 13.1% and average declines of 2.6% to 4.6% for maternal and child services. We projected that decreases in essential health service utilization between March 2020 and June 2021 were associated with 113,962 excess deaths (110,686 children under 5, and 3,276 mothers), representing 3.6% and 1.5% increases in child and maternal mortality, respectively. This excess mortality is associated with the decline in utilization of the essential health services included in the analysis, but the utilization shortfalls vary substantially between countries, health services, and over time. The largest disruptions, associated with 27.5% of the excess deaths, occurred during the second quarter of 2020, regardless of whether countries reported the highest rate of COVID-19-related mortality during the same months. There is a significant relationship between the magnitude of service disruptions and the stringency of mobility restrictions. The study is limited by the extent to which administrative data, which varies in quality across countries, can accurately capture the changes in service coverage in the population. Conclusions: Declines in healthcare utilization during the COVID-19 pandemic amplified the pandemic's harmful impacts on health outcomes and threaten to reverse gains in reducing maternal and child mortality. As efforts and resource allocation toward prevention and treatment of COVID-19 continue, essential health services must be maintained, particularly in low- and middle-income countries. Tashrik Ahmed and co-workers study health-care use and maternal and child health outcomes across low- and lower-middle-income countries during the COVID-19 pandemic. Author summary: Why was this study done?: Disruptions to essential health services during the SARS-CoV-2 (COVID-19) pandemic amplify the pandemic's impact on morbidity and mortality and pose a profound threat to the ability of low- and middle-income countries to achieve Universal Health Coverage (UHC) and the Sustainable Development Goals (SDGs). While early studies projected mortality based on hypothesized scenarios, this study presents indirect child, neonatal, and maternal mortality projections during the COVID-19 pandemic based on actual service utilization data. This study adds to multicountry evidence on changes in the utilization of essential health services from low- and middle-income countries. What did the authors do and find?: We used data on service utilization in 18 countries to estimate the percent change in health services delivered between March 2020 and June 2021, compared to expected levels given prepandemic trends. The analysis indicates that all countries experienced service disruptions, the largest of which occurred at the pandemic's start and during months with strict mobility restrictions, regardless of the reported monthly COVID-19 mortality rates, demonstrating variation in the magnitude of disruptions across countries, services, and time. Using a mathematical model, we project these disruptions are associated with an additional 113,962 deaths among women in children in the 18 countries, representing increases of 3.6% in child mortality and 1.5% in maternal mortality. What do these findings mean?: The projected excess mortality caused by disruptions to essential health services is smaller than many initial projections, though still comprises a substantial increase in mortality. There is strong evidence to recommend that context-specific measures to safeguard essential services be integrated into pandemic preparedness and response activities. [ABSTRACT FROM AUTHOR]

The article examines the factors that need to consider to modify the organizational evaluation process to enhance health equity initiatives world wide. Topics mentioned include the importance of investing in several forms of evidence generation and use and independent evaluation, the issues pertaining to health equity, and the role of evaluation in decision making and capacity building.