The impact of COVID-19 on primary health care service provision and utilisation in Tanzania, Sierra Leone and the Democratic Republic of Congo

The impact and implications of the COVID-19 pandemic on routine primary health care provision and utilisation in resource-poor settings is unknown. Initial reports suggest that as health care workers with comorbidities or pre-existing conditions are taken off the 'frontline', others are transferred to COVID-19 response activities, fear of COVID exposure increases absenteeism, and social distancing measures are put in place in health facilities, the capacity to provide services has been reduced. Utilisation has also been affected, potentially by users' fear of catching SARS-CoV-2 infection at health care facilities, misconceptions that services are shut, barriers to accessing health care due to fewer transport options and less disposable income during lockdowns. A reduction in primary healthcare provision could be particularly devastating in low income settings. This multidisciplinary project aims to investigate the impact that the COVID-19 pandemic is having on primary healthcare providers and users in three distinct settings in Central (Democratic Republic of the Congo), East (Tanzania) and West (Sierra Leone) Africa, by building on existing collaborative partnerships. We will conduct the following activities: 1 Data will be collected from healthcare facilities to estimate the change in the number of people seen for essential services e.g. antenatal care, outpatients, routine immunisations, family planning and HIV comprehensive care visits. 2 Qualitative interviews will be conducted with primary healthcare workers to understand barriers and facilitators for effective care provision during the COVID-19 outbreak. 3 Healthcare workers' exposure to SARS-CoV-2 will be estimated in a repeated sero-survey, using a validated serological assay. 4 Qualitative interviews will be conducted with a selection of healthcare users to understand barriers and facilitators of utilisation. 5 A set of recommendations/ key findings will be formulated together with stakeholder