Home > Covid-19 > Has the ‘Continuum of Care’ been abandoned during COVID-19?

Misean Cara’s Niamh Caffrey reflects on the pressures on healthcare systems to balance their response to COVID-19 while maintaining treatment of other medical issues.

Although it is too early in this global pandemic to be confident of its wider effects, such secondary impacts of pandemics are, unfortunately, not new, as witnessed by many Misean Cara members who responded to the 2014-2016 West African Ebola Virus Epidemic.

Our members across the globe reported strict lockdowns upon first suspicion of COVID-19 cases, with often draconian enforcement. They reported dwindling numbers of patients accessing regular, routine and essential healthcare services, as the simmering household level fear poured out across national and global societies; fear not only of the restrictions but of the severity and infectious nature of COVID-19.

Temperature checks at the Ruben centre, Nairobi; supported by Edmund Rice Development and Misean Cara

The irregularity of patients combined with overwhelmed health systems, severely undermined health services, likely allowed vaccine-preventable and treatable conditions to soar. And although it is too early in this global pandemic to be confident of its wider effects, such secondary impacts of pandemics are, unfortunately, not new, as witnessed by many Misean Cara members who responded to the 2014-2016 West African Ebola Virus Epidemic.

It is a balancing act.

Health facilities are trying to balance responding to the urgent needs of those both infected and exposed to COVID-19, while trying to raise hygiene levels within their centres, among staff and patients.


Misean Cara supported the Salesians to provide faceshields and PPE for front line healthcare workers in the Philippines.

They are all the while trying to stay up-to-date with emerging information on this novel virus and engage in coordinated action for the continuation of essential health services.

The seesaw which balances COVID-19 rapid responses with the continuum of routine healthcare has, for too long I fear, been tipped heavily towards COVID-19 alone.

The continuum of care, the delivery of healthcare from diagnosis through to end of life care encompassing all in-between, has been neglected as we capture in-country service results from our healthcare facilities. The continuum of care has fallen in the waste bins alongside extensive supplies of Personal Proactive Equipment needed to respond to COVID-19.

My fear has been echoed from the Royal College of Surgeons here in Ireland and the London School of Hygiene and Tropical Medicine who both anticipate dire consequences stemming from the interruption to essential services during the COVID-19 crisis. Professor Ruairi Brugha from the Royal College of Surgeons predicts that an interruption to Antiretroviral Treatment during the high health system demand presented by COVID-19 could lead to a 10% rise in HIV deaths over 5 years, a reversing of tuberculosis progress 5-8 years and a doubling of the current malaria burden, with a potential 36% rise in deaths in the next 1-2 years. The London School of Hygiene and Tropical Medicine has demonstrated a 24% reduction of institutional deliveries during COVID-19 to date, with no evidence of a rebound.


When does the continuum of health care provision take priority in disease outbreaks? Does it, or should it, ever? When do preventative measures for something become worse on a population level then the virus itself?

During the Ebola Outbreak, we didn’t stop and ask these questions early enough. Instead we saw 10,000 additional and preventable deaths due to malaria, HIV and AIDS, and tuberculosis.

Misean Cara members across Africa, many of whom responded tirelessly to the Ebola outbreak, were again called to be local community champions, and bring their knowledge from past epidemics to today’s global pandemic.

A health facility in Mukuru Slum in Kenya “downed tools” for two days, until the Government authorities provided the facility with Personal Protective Equipment allowing the staff to continue to operate all regular health services – including treating COVID-19 –  in a safe manner.

COVID-19 did not stop at any country border, nor does the global missionary movement.

Mill Hill Missionaries have been supporting the community of Kitale, Kenya with outreach about COVID-19 and provision of washable masks, supported by Misean Cara.

Across the globe, Misean Cara members have assisted in the development of toll-free phone lines, outdoor triage points, virtual health platforms and worked to introduce and strengthen home-based care and their supply chains. This has not only ensured that healthcare services beyond COVID-19 measures are delivered, but has prevented many from seeking alternative, and often dangerous, healthcare interventions. Regular, medically sound and accessible services in terms of immunization, safe motherhood and HIV+ treatment cannot afford to falter.

Misean Cara members have worked hard to keep an equilibrium between COVID-19 responses and routine health services. However, with the potential resurgence of COVID-19 across many European countries and the redirection of many global donors to tackle COVID-19 only, I fear our missionaries will be overstretched, and unable to keep the balance.

I fear that those already vulnerable – particularly in the Global South – will be unable to hold strong in this unequal fight to find a balance between responding to the threat of COVID-19 and continuing essential health services.


The first part of this series of reflections on the global pandemic by Misean Cara’s Niamh Caffrey is here.

The third part of Niamh Caffrey’s series is about missionaries supporting innovation in the face of COVID-19.

In the final part of this 4-part series Niamh Caffrey analyses the risk of hunger in this time of COVID-19, the Hunger Pandemic.