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Impact of the societal response to COVID-19 on access to healthcare for non-COVID-19 health issues in slum communities of Bangladesh, Kenya, Nigeria and Pakistan: results of pre-COVID and COVID-19 lockdown stakeholder engagements
  1. Syed A K Shifat Ahmed1,
  2. Motunrayo Ajisola2,
  3. Kehkashan Azeem3,
  4. Pauline Bakibinga4,
  5. Yen-Fu Chen5,
  6. Nazratun Nayeem Choudhury1,
  7. Olufunke Fayehun6,
  8. Frances Griffiths5,7,
  9. Bronwyn Harris5,
  10. Peter Kibe4,
  11. Richard J Lilford8,
  12. Akinyinka Omigbodun9,
  13. Narjis Rizvi3,
  14. Jo Sartori8,
  15. Simon Smith5,
  16. Samuel I Watson5,8,
  17. Ria Wilson5,
  18. Godwin Yeboah10,
  19. Navneet Aujla5,
  20. Syed Iqbal Azam3,
  21. Peter J Diggle11,
  22. Paramjit Gill5,
  23. Romaina Iqbal3,
  24. Caroline Kabaria4,
  25. Lyagamula Kisia4,
  26. Catherine Kyobutungi4,
  27. Jason J Madan12,
  28. Blessing Mberu4,
  29. Shukri F Mohamed4,5,
  30. Ahsana Nazish3,
  31. Oladoyin Odubanjo13,
  32. Mary E Osuh14,
  33. Eme Owoaje15,
  34. Oyinlola Oyebode5,
  35. Joao Porto de Albuquerque10,
  36. Omar Rahman16,
  37. Komal Tabani3,
  38. Olalekan John Taiwo17,
  39. Grant Tregonning10,
  40. Olalekan A Uthman5,
  41. Rita Yusuf1
  42. On behalf of the Improving Health in Slums Collaborative
  1. 1Centre for Health, Population and Development, Independent University Bangladesh, Dhaka, Bangladesh
  2. 2National Institute for Health Research Project, University of Ibadan, Ibadan, Oyo State, Nigeria
  3. 3Community Health Sciences Department, Aga Khan University, Karachi, Pakistan
  4. 4African Population and Health Research Center, Nairobi, Kenya
  5. 5Division of Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
  6. 6Department of Sociology, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
  7. 7Centre for Health Policy, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
  8. 8Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
  9. 9Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
  10. 10Institute for Global Sustainable Development, University of Warwick, Coventry, UK
  11. 11Lancaster Medical School, Lancaster University, Lancaster, UK
  12. 12Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
  13. 13Nigerian Academy of Science, Lagos, Nigeria
  14. 14Department of Periodontology and Community Dentistry, Faculty of Dentistry, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
  15. 15Department of Community Medicine, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria
  16. 16University of Liberal Arts Bangladesh, Dhaka, Bangladesh
  17. 17Department of Geography, Faculty of Social Sciences, University of Ibadan, Ibadan, Oyo State, Nigeria
  1. Correspondence to Professor Frances Griffiths; f.e.griffiths{at}


Introduction With COVID-19, there is urgency for policymakers to understand and respond to the health needs of slum communities. Lockdowns for pandemic control have health, social and economic consequences. We consider access to healthcare before and during COVID-19 with those working and living in slum communities.

Methods In seven slums in Bangladesh, Kenya, Nigeria and Pakistan, we explored stakeholder perspectives and experiences of healthcare access for non-COVID-19 conditions in two periods: pre-COVID-19 and during COVID-19 lockdowns.

Results Between March 2018 and May 2020, we engaged with 860 community leaders, residents, health workers and local authority representatives. Perceived common illnesses in all sites included respiratory, gastric, waterborne and mosquitoborne illnesses and hypertension. Pre-COVID, stakeholders described various preventive, diagnostic and treatment services, including well-used antenatal and immunisation programmes and some screening for hypertension, tuberculosis, HIV and vectorborne disease. In all sites, pharmacists and patent medicine vendors were key providers of treatment and advice for minor illnesses. Mental health services and those addressing gender-based violence were perceived to be limited or unavailable. With COVID-19, a reduction in access to healthcare services was reported in all sites, including preventive services. Cost of healthcare increased while household income reduced. Residents had difficulty reaching healthcare facilities. Fear of being diagnosed with COVID-19 discouraged healthcare seeking. Alleviators included provision of healthcare by phone, pharmacists/drug vendors extending credit and residents receiving philanthropic or government support; these were inconsistent and inadequate.

Conclusion Slum residents’ ability to seek healthcare for non-COVID-19 conditions has been reduced during lockdowns. To encourage healthcare seeking, clear communication is needed about what is available and whether infection control is in place. Policymakers need to ensure that costs do not escalate and unfairly disadvantage slum communities. Remote consulting to reduce face-to-face contact and provision of mental health and gender-based violence services should be considered.

  • health policy
  • health systems
  • public health
  • other infection
  • disease
  • disorder
  • or injury
  • qualitative study

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  • Handling editor Seye Abimbola

  • Twitter @GodwinYeboah, @shukrifmohamed, @j_p_albuquerque, @GrantTregonning

  • Contributors SAKSA, MA, KA, PB, Y-FC, NC, FF, FG, BH, PK, RL, AO, NR, JS, SS, SIW, RW and GY conceived and wrote the first draft of the paper. All authors contributed to the interpretation and subsequent revision of the paper. All authors approved the final version of the manuscript.

  • Funding This research was funded by the National Institute for Health Research (NIHR) Global Health Research Unit on Improving Health in Slums using UK aid from the UK Government to support global health research. The views expressed in this publication are those of the author(s) and not necessarily those of the NIHR or the UK Department of Health and Social Care.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval All participants provided informed consent to participate before taking part in the study. The NIHR Global Health Research Unit on Improving Health in Slums was granted full ethical approval by the University of Warwick Biomedical and Scientific Research Ethics Sub-Committee (REGO-2017-2043 AM01), the Ministry of Health, Lagos State Government (LSMH/2695/11/259), Research Ethics Committee of the Oyo State Ministry of Health (AD13/479/657), Amref Health Africa (AMREFESRC P440/2018), the National Bioethics Committee Pakistan (4-87/NBC-298/18/RDC3530) and the Bangladesh Medical Research Council BMRC/NREC/2016-2019/759).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.