To what extent did households in developing countries forgo needed healthcare during the COVID-19 pandemic? Repeated survey estimates from 25 countries in 2020 and 2021.

Introduction: During the first year of the COVID-19 pandemic, health system disruptions, fear of becoming infected with COVID-19, mobility restrictions and lockdowns, and reduced household incomes likely contributed to households forgoing needed healthcare. The objective of this study was to measure the prevalence of forgone healthcare and how its drivers changed between the early period of the pandemic in 2020 and the first half of 2021. Methods: Using repeated measures collected over two time periods in 63 000 households in 25 low-income and middle-income countries, this analysis documents how the prevalence of forgone healthcare and its drivers changed between 2020 and 2021. Results: In 2020, in the sample pooled across all countries, 17.9% of households reported not being able to obtain needed healthcare. The prevalence of forgone care was 15.6% in low-income countries (LICs), 17.0% in lower-middle-income countries (LMICs) and 20.5% in upper-middle-income countries (UMICs). In 2021, the prevalence of forgone care was lower-10.3% in the pooled sample, 7.9% in LICs, 15.1% in LMICs and 5.3% in UMICs. Financial barriers were the most common reason for not obtaining needed healthcare in both time periods: 42% in 2020 and 45% in 2021 and were higher in LICs and LMICs than in UMICs. Conclusion: This study is a comprehensive analysis of the changes in forgone care in low-income and middle-income countries. It documents the predominance of financial barriers among those who could not obtain needed healthcare. It suggests the importance of pandemic preparedness to protect access by vulnerable households to essential healthcare service. The study also demonstrates that phone surveys could, at scale, be a cost-effective way to improve the monitoring of progress towards universal health coverage.