Provision and utilization of basic maternal healthcare during the pandemic in Ecuador: The health workers' perspective.

Context: Ecuador was one of the most affected counties in Latin America during coronavirus disease 2019 (COVID-19). Its health system already faced financing and organizational problems before the pandemic. Aims: To analyze the effects of the pandemic on the provision and utilization of maternal health services in units of the Public Health of Ecuador as perceived by the health personnel. Material and Methods: This is a mixed methods study with two rapid evaluation cycles. The first cycle collected information during January-March and the second one during April-June, 2021. An online questionnaire and semistructured interviews were applied to professionals involved in the management and provision of maternal health programs. Both instruments explored provision and utilization of maternal health services. Questionnaires were processed using SPSS and descriptive statistics. Interviews were exported to Results: A total of 207 health workers participated in the first cycle, and 200 in the second one. They recognized that during the pandemic, healthcare personnel were reduced by more than 30% due to the presence of risk factors among them as well as the lack of budget for new contracts. The availability of materials and supplies was also reduced by nearly 50%, mainly due to the lack of budget. The demand for maternal healthcare in public health units was reduced because people feared being infected by COVID-19 and nearly 25% goes to the private sector. Conclusions: The pandemic has had a negative effect on the provision as well as utilization of maternal healthcare services. Nevertheless, health professionals implemented diverse strategies to reduce this negative effect on maternal care.