Backlogs and delays in non-emergency health care caused by the COVID-19 pandemic have stretched health systems and left millions of people without care in virtually all countries in the WHO European Region.
Published jointly by WHO/Europe, the European Observatory on Health Systems and Policies and the Nuffield Trust, the new study reveals that, especially during the pandemic’s crisis peaks, millions of people saw their elective procedures cancelled or postponed, primarily to keep capacity available for COVID-19 patients and to avoid infections. New evidence shows that each delay has possibly led to worse health, prolonged recovery and decreased chances of survival.
The policy brief also identifies policies that can help countries address the impact of such disruptions moving forward.
“We all know that while countries in our Region have some of the strongest health systems in the world, not a single one was fully prepared nor resilient enough to tackle the wide-ranging impacts of this emergency,” said WHO Regional Director for Europe Dr Hans Henri P. Kluge.
“To restore services to pre-pandemic levels and catch up on care, we need to understand and act on what we have learned, including by investing in the health workforce, increasing funding for future health infrastructure, and maintaining the innovative forms of service delivery that proved useful in reaching out to key groups affected by the pandemic,” Dr Kluge added.
Health services disrupted across the European Region
WHO conducted 3 pulse surveys covering February 2020 through November 2021. Between February and August 2020, 92% of countries in the Region reported some form of disruption. As the pandemic progressed, countries reported lower rates of disruptions, but an average of 26% of services were still disrupted.
The new study shows that disruptions and backlogs have affected a wide range of services. Although the early stages of the pandemic saw primarily the disruption of hospital services, dental care and mental health services, this changed as months went by. In 2021, backlogs affected mainly primary care and emergency care.
“These findings are important and should be seen as a call to action for health systems across the Region,” said Dr Natasha Azzopardi Muscat, Director of the Division of Country Health Systems and Policies at WHO/Europe. “The disruptions have led to high unmet need during the pandemic, and each delay, especially in areas such as cancer care or routine vaccinations, can have serious consequences.”
What countries can do now to reduce backlogs
Decision-makers should work to clear backlogs as quickly as possible to maintain any health gains made before the pandemic and avoid excess mortality. They should also realize that simply returning to pre-pandemic levels of health care will not be enough to lower waiting times.
So far, countries have taken different measures to reduce backlogs. It is critical that these measures help catch up on care in the short term while also building capacity over the longer term.
“It is important that policies to recover from backlogs do not inadvertently increase inequalities,” warned Dr Ewout van Ginneken, Programme Manager at the European Observatory and editor of the policy brief. “And it is essential that we are able to systematically collect reliable data on waiting times, which is not the case in some countries.”
The key policies to address and reduce backlogs include:
- hiring more health workers and health staff, including through flexible recruitment and training, and improving working conditions, especially with mental health support and better pay;
- managing capacity and productivity by extending hours of care, introducing financial incentives to clear backlogs, and expanding access to telehealth services; and
- upgrading health facilities and investing in primary and community care, while expanding home care and rehabilitation services.
WHO/Europe is currently working with countries across the Region to implement policies to address the backlogs generated during the COVID-19 pandemic. Many of the policies needed to reduce backlogs will add pressure to an already overstretched health workforce. This means that any efforts to tackle backlogs will need to go hand in hand with the protection of health workers’ physical and mental health.