{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T18:07:19Z","timestamp":1787162839284,"version":"build-2736575974"},"reference-count":25,"publisher":"South African Medical Association NPC","issue":"1","license":[{"start":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T00:00:00Z","timestamp":1671494400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["S Afr Med J"],"abstract":"<jats:p>Background. In a previous article on the impact of COVID-19, the authors compared access to routine health services between 2019 and 2020. While differential by province, a number of services provided, as reflected in the District Health Information System (DHIS), were significantly affected by the pandemic. In this article we explore the extent to which the third and fourth waves affected routine services.Objectives. To assess the extent to which waves 3 and 4 of the COVID-19 pandemic affected routine health services in South Africa, and whether there was any recovery in 2021.Methods. Data routinely collected via the DHIS in 2019, 2020 and 2021 were analysed to assess the impact of the COVID-19 pandemicand extent of recovery.Results. While there was recovery in some indicators, such as number of children immunised and HIV tests, in many other areas, including primary healthcare visits, the 2019 numbers have yet to be reached \u2013 suggesting a slow recovery and continuing impact of the pandemic.Conclusions. The COVID-19 pandemic continued to affect routine health services in 2021 in a number of areas. There are signs of recovery to 2019 levels in some of the health indicators. However, the impact indicators of maternal and neonatal mortality continued to worsen in 2021, and if interventions are not urgently implemented, the country is unlikely to meet the Sustainable Development Goals targets.<\/jats:p>","DOI":"10.7196\/samj.2022.v113i1.16619","type":"journal-article","created":{"date-parts":[[2022,12,20]],"date-time":"2022-12-20T04:13:00Z","timestamp":1671509580000},"page":"17-23","source":"Crossref","is-referenced-by-count":13,"title":["Recovering from COVID lockdowns: Routine public sector PHC services in South Africa, 2019 - 2021"],"prefix":"10.7196","volume":"113","author":[{"given":"Y","family":"Pillay","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H","family":"Museriri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"P","family":"Barron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T","family":"Zondi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4425","published-online":{"date-parts":[[2022,12,20]]},"reference":[{"key":"9696","doi-asserted-by":"crossref","unstructured":"Pillay Y, Pienaar S, Barron P, Zondi T. Impact of COVID-19 on routine primary healthcare services in South Africa. S Afr Med J 2021;111(8):714-719. https:\/\/doi.org\/10.7196\/SAMJ.2021.v111i8.1578","DOI":"10.7196\/SAMJ.2021.v111i8.15786"},{"key":"9697","unstructured":"Jacob L, Kalder M, Kostev K. Decrease in the number of patients diagnosed with cancer during"},{"key":"9698","doi-asserted-by":"crossref","unstructured":"the COVID-19 pandemic in Germany. J Cancer Res Clin Oncol 2022;148:3117-3123. https:\/\/doi.","DOI":"10.1007\/s00432-022-03922-5"},{"key":"9699","unstructured":"org\/10.1007\/s00432-022-03922-5"},{"key":"9700","unstructured":"The Global Fund. The impact of COVID-19 on HIV, TB and malaria services and systems for health, April 2021. Geneva: TGF, 2021. https:\/\/www.theglobalfund.org\/media\/10776\/covid-19_2020- disruption-impact_report_en.pdf (accessed 22 April 2022)."},{"key":"9701","unstructured":"World Health Organization. Essential health services face continued disruption during COVID-19 pandemic. Geneva: WHO, 7 February 2022. https:\/\/www.who.int\/news\/item\/07-02-2022-essential- health-services-face-continued-disruption-during-covid-19-pandemic (accessed 23 April 2022)."},{"key":"9702","unstructured":"United Nations Children\u2019s Fund. COVID-19 continues to disrupt essential health services in 90 per cent of countries. New York: UNICEF, 2021. https:\/\/www.unicef.org\/press-releases\/covid-19- continues-disrupt-essential-health-services-90-cent-countries (accessed 23 April 2022)."},{"key":"9703","unstructured":"Nuffield Trust. Health system recovery from COVID-19: International lessons for the NHS. Epsom: Nuffield Trust, 2022. https:\/\/www.nuffieldtrust.org.uk\/research\/health-system-recovery-from-covid- 19-international-lessons-for-the-nhs (accessed 24 April 2022)."},{"key":"9704","doi-asserted-by":"crossref","unstructured":"Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: Historical roots of current public health challenges. Lancet 2009:374(9692):817-834. https:\/\/doi. org\/10.1016\/S0140-6736(09)60951-X","DOI":"10.1016\/S0140-6736(09)60951-X"},{"key":"9705","doi-asserted-by":"crossref","unstructured":"McLaughlin C, Wyszewianski L. Access to care: Remembering old lessons. Health Services Res 2002;37(6):1441-1443. https:\/\/doi.org\/10.1111%2F1475-6773.12171","DOI":"10.1111\/1475-6773.12171"},{"key":"9706","doi-asserted-by":"crossref","unstructured":"Barron P, Subedar H, Letsoko M, Makua M, Pillay Y. Teenage births and pregnancies in South Africa, 2017 - 2021 \u2013 a reflection of a troubled country: Analysis of public sector data. S Afr Med J 2022;112(4):252-258. https:\/\/doi.org\/10.7196\/SAMJ.2022.v112i4.16327","DOI":"10.7196\/SAMJ.2022.v112i4.16327"},{"key":"9707","unstructured":"Ritshidze. Eastern Cape: State of health. Ritshidze, September 2021. https:\/\/ritshidze.org.za\/eastern- cape-state-of-health\/ (accessed 22 April 2022)."},{"key":"9708","unstructured":"Ritshidze. Free State: State of health. Ritshidze, September 2021. https:\/\/ritshidze.org.za\/wp-content\/ uploads\/2021\/09\/Ritshidze-State-of-Health-Free-State-2021.pdf (accessed 23 April 2022)."},{"key":"9709","doi-asserted-by":"crossref","unstructured":"Tun\u00e7alp \u00d6, Pena-Rosas JP, Lawrie T, et al. WHO recommendations on antenatal care for a positive pregnancy experience-going beyond survival. BJOG 201;124(6):860-862. https:\/\/doi. org\/10.1111\/1471-0528.14599","DOI":"10.1111\/1471-0528.14599"},{"key":"9710","doi-asserted-by":"crossref","unstructured":"Vogel JP, Souza IP, Mori R, et al. Maternal complications and perinatal mortality: Findings of the World Health Organization Multicountry Survey on Maternal and Newborn Health. BJOG 2014;121(1):76- 88. https:\/\/doi.org\/10.1111\/1471-0528.12633","DOI":"10.1111\/1471-0528.12633"},{"key":"9711","unstructured":"Pattinson R, Fawcus S, Bebhardt S, Soma-Pillay P, Niit R, Moodley J. The impact of COVID-19 on use of maternal and reproductive health services and maternal and perinatal mortality. In: Govender K, George G, Padarath A, Moeti T (editors). South African Health Review, 2021: Health Sector Responses to COVID-19. Durban: Health Systems Trust, 2021."},{"key":"9712","doi-asserted-by":"crossref","unstructured":"Rhoda N, Velaphi S, Gebhardt G, Kauchali S, Barron P. Reducing neonatal deaths in South Africa: Progress and challenges. S Afr Med J 2018;108(Suppl 1):S9-S16. https:\/\/doi.org\/10.7196\/SAMJ.2018. v108i3.12804","DOI":"10.7196\/SAMJ.2017.v108i3b.12804"},{"key":"9713","doi-asserted-by":"crossref","unstructured":"Nzioki JM, Ouma J, Ombaka JH, Onyango RO. Community health worker interventions are key to optimal infant immunisation coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya. Pan Afr Med J 2017;28:21. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5680999\/ (accessed 23 April 2022).","DOI":"10.11604\/pamj.2017.28.21.11255"},{"key":"9714","doi-asserted-by":"crossref","unstructured":"Nnaji CA, Wiysonge CS, Lesosky M, Mahomed H, Ndwandwe D. COVID-19 and the gaping wounds of South Africa\u2019s suboptimal immunisation coverage: An implementation research imperative for assessing and addressing missed opportunities for vaccination. Vaccines 2021;9(7):691. https:\/\/doi. org\/10.3390\/vaccines9070691","DOI":"10.3390\/vaccines9070691"},{"key":"9715","unstructured":"Shung-King M, Lake L, Hendricks M, et al. The impact of COVID-19 on children: Insights from the Western Cape experience. In: Govender K, George G, Padarath A, Moeti T (editors). South African Health Review, 2021: Health sector responses to COVID-19. 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