The uptake of and access to Expanded Programme for Immunization services among children aged 0 to 12 months during the COVID-19 pandemic in Free State Province, South Africa

Abstract

Introduction South Africa had the first case of COVID-19 on 5 March 2020 and has since then seen a rapid transition from imported cases to community transmission, increase in rates of infection, which led to restrictions in a number of activities, to reduce the risk of transmission. The provision of EPI services was one of the health programmes that slowed down during the time of the pandemic. The aim of the study was to describe the uptake and access to, and explore the effects of the pandemic disruption on the Expanded Programme for Immunization services among children aged 0 to 12 months during the COVID-19 pandemic, explore the effects in Free State Province, South Africa Methodology This is a descriptive exploratory research study, conducted utilising both quantitative and qualitative data was collected and analysed sequentially. The quantitative component was the analysis of data from the DHIS electronic database, disaggregated by district, assessing the differences in EPI services uptake between the periods 12 months before and 12 months after the emergence of COVID-19. The data was analysed using non-parametric tests: Wilcoxon rank sum test and Kruskal Wallis tests. Sequentially, qualitative data was collected through unstructured key informant interviews conducted, with the provincial and district managers of the EPI and Maternal and Child Health programmes to understand their experiences implementing the EPI programme during the COVID- 19 pandemic. The latent thematic analysis was applied to the data collected, following a framework based on the WHO building block of a health system. Results The study established that although there were declines in immunization uptake among one-year old children, after the emergence of the COVID-19 were not significant (P-Value >0.005). The qualitative results showed that, although the decline in EPI uptake, COVID-19 increased the demand for health services on the health system, negatively affecting the delivery of PHC services, 4 generally. The EPI services and access were also significantly challenged. However, the study suggests that the EPI service delivery challenges experienced during the COVID-19 emergency period were not new, but they aggravated the pre-pandemic health system issues that were always slowing down the programme performance. These are issues such as shortage of staff, limited funding, lack of pandemic and emergency preparedness, strategic information and data management capacity gaps and weaknesses in leadership and governance decision making processes and interventions. Conclusion and recommendations The emergence of COVID-19 aggravated pre-existing health systems gaps and challenges. To ensure maintenance of services like EPI during pandemics like COVID-19, there is need to address these gaps. We recommend health system investment in emergency and pandemic preparedness and readiness, more robust EPI marketing, advanced strategic information technologies, and exposure of programme managers to strategic conversations.