Measuring unanticipated opportunity costs of South Africa's COVID-19 response for children, mothers and people living with non-communicable diseases

Before the COVID-19 epidemic, SA's life expectancy was on an upward trajectory, with gains towards 2030 SDG targets. In response to the epidemic, the government instituted a lockdown to flatten the curve. Though there have been benefits, there are questions about the impact on non-COVID-19 health outcomes. Rapid decision making has also left community perspectives behind. SAMRC Centre for Health Economics and Decision Science-PRICELESS SA & the MRC/Wits Agincourt Unit have partnered to investigate this. Our hypotheses are firstly, that during COVID-19 epidemic there has been and will continue to be a decrease in supply and demand of routine health services which may impact on morbidity and mortality for individuals with HT, Diabetes, pregnant mothers and children under 5. Secondly, the perspective of health workers and community members regarding provision and access to routine health services during the COVID-19 epidemic will differ from that of public policy makers. The proposal aims to quantitatively measure the impact of diverting a workforce who are managing COVID-19, on routine preventive and curative health services. This will include supply and demand side perspectives. We will also qualitatively evaluate the views of the public and of healthcare workers in rural and urban areas. This will be a mixed-method study with a multi-disciplinary approach that will quantify health service opportunity costs due to the COVID-19 response. We will use a time series analysis of health services headcount data, addressing geographical and equity impacts, and qualitative interviews to understand the perspective of the public and health workers. The results will enable policymakers to make evidence-based decisions regarding resource allocation, between maintaining health services and mitigating the epidemic, that are also responsive to community needs and priorities. Our robust track record of policy action research over a decade in SA predicts a successful outcome.