Second round of the national pulse survey on continuity of essential health services during the COVID-19 pandemic: January-March 2021


The World Health Organization (WHO) published this second round of survey on the state of essential health services during the Covid-19 pandemic on April 22, 2021. It integrates many key questions from previous WHO pulse surveys, including the first survey published in August 2020.

Sent to over 216 countries and territories, the survey aimed at assessing pandemic-related disruptions to health systems and services in various parts of the world. It looked at 63 different service delivery channels including primary care; emergency, critical and operative care; rehabilitative, palliative and long-term care; as well as auxiliary services. It evaluated impacts on reproductive, maternal, newborn, child and adolescent health (RMNCAH); immunisation; communicable and non-communicable diseases; neglected tropic diseases; and mental, neurological and substance use (MNS) disorders among others.

Of the 216 countries and territories, 135 (63 per cent) submitted their responses to the survey. Among those, 81 completed all the sections of the survey. Most of the survey responses reflect the disruptions experienced during the period of October 2020 to February 2021.

The 102-page survey report is divided into 10 sections: Key points (section 1); Introduction (section 2); Methods (section 3); Results (Section 4); Overall service disruptions (Section 5); Reasons for service disruptions (Section 6); Responsiveness to mitigate service disruptions (Section 7); Information Tracking (Section 8); Tracking the global situation: Comparison of Round 1 and 2 survey findings (Section 9); and Conclusions (Section 10).


  1. As many as 94 per cent of the 135 countries responding to the survey reported some disruption to health services in the three months preceding their responses. Around 34 per cent reported facing disruptions in more than 50 per cent of services included under the survey. However, the extent of disruptions was less compared to 2020 figures.

  2. Some disruption across all service delivery channels was reported in around 35 per cent of 112 countries. Routine appointments and health promotion services – falling under primary care – were disrupted in around half the respondent countries.

  3. The survey notes that emergency surgeries and emergency obstetric surgeries faced disruptions in 17 and 12 countries respectively. Delays in elective surgeries were also reported by 65 countries.

  4. On average, RMNCAH and nutrition services were disrupted in 35 per cent of the respondent countries. Family planning and contraceptive services in addition to malnutrition management were the two services most frequently affected, with more than 40 per cent countries reporting disruptions.

  5. Facility-based births in 25 per cent countries as well as safe abortion and post-abortion care in 28 per cent countries were affected due to the Covid-19 pandemic in early 2021, the survey reports. Moreover, services dealing with sexual violence prevention and response were also impacted in 39 per cent countries.

  6. The WHO regards routine immunisation programmes crucial for infants and young children. It also estimates that immunisation prevents around 2-3 million deaths annually. Approximately one-third of the countries responding to the survey reported disruptions to immunisation services.

  7. Disruptions to the prevention and treatment of communicable diseases were particularly concerning. Around 36 per cent of the countries reported outbreak detection and control activities for diseases like HIV, TB, hepatitis and malaria being affected during the survey period.

  8. Among services for noncommunicable diseases, cancer screening was affected the most with more than 40 countries reporting disruptions and 16 countries recording more than 50 per cent services affected.

  9. About 45 per cent countries had their MNS services disrupted, including suicide prevention programmes (44 per cent), neuroimaging and neurophysiology services (53 per cent), and overdose prevention and management programmes (34 per cent).

  10. Reasons stated for service disruptions included insufficient availability of staff, changes in treatment policies and lack of enough personal protective equipment. On the side of those seeking health services, the disruptions were due to fear, perceived financial difficulties caused by the pandemic and travel restrictions employed to curb the spread of Covid-19.

  11. During the survey period, over half of the countries had some form of government regulations in place to limit access to at least one service delivery platform. Services which were scaled back included mobile clinics (45 per cent of 86 countries), community-based services (45 per cent of 103 countries), outpatient services (38 per cent of 108 countries) and inpatient services (36 per cent of 107 countries).

  12. The survey reports that 95 (85 per cent) countries surveyed said they regularly checked on the continuity of crucial medical services during the pandemic. Additionally, 84 (75 per cent) of those also monitored implementation to lessen possible disruptions.

    Focus and Factoids by Ashish Singh.

    PARI Library's health archive project is part of an initiative supported by the Azim Premji University to develop a free-access repository of health-related reports relevant to rural India.


World Health Organization


World Health Organization


22 Apr, 2021