External publications

Establishing the effect of COVID-19 lockdown policy on the resilience of facility-based delivery in Kenya: a multi-method study

Kuloba, MaryBennah N. / Christoph Strupat / Thit Thit Aye / Phidelis N. Wamalwa / Judy Gichuki / Benjamin Tsofa / Manuela De Allegri
External Publications (2025)

in: BMC Health Services Research 25, article 1014

DOI: https://doi.org/10.1186/s12913-025-13070-4
Open access

Background: Amidst the COVID-19 pandemic, lockdown policies emerged as pivotal measures to contain viral transmission. Questions arose about whether their implementation challenged access to care, particularly in regions with fragile or less resilient health systems, such as sub-Saharan Africa. Robust evidence on the effect of lockdowns on healthcare access remains sparse, partly due to a lack of suitable data. We addressed this gap and assessed the effect of the COVID-19 lockdown policy on facility-based delivery during the first pandemic wave in Kenya. Methods: We triangulated findings from two independent quantitative analyses, exploiting the fact that lockdowns in Kenya were implemented only in selected counties. First, we used nationally representative repeated cross-sectional surveys from 2018 and 2020, applying a pre-post-test design with independent controls. Second, we analyzed monthly data from the Kenya Health Information System (Jan 2019–Nov 2020) using an interrupted time series (ITSA) with independent controls, with April 2020 set as the interruption point. Results: The controlled pre-post analysis found no significant effect of lockdowns on facility-based delivery in lockdown vs. non-lockdown counties. The ITSA showed an immediate increase of 4.97% (CI: 0.51%, 9.43%) in facility deliveries in lockdown counties, followed by a significant monthly decrease of 0.97% (CI: -1.60%, -0.34%) compared with non-lockdown counties. Conclusion: We found no overall effect of lockdowns on facility-based deliveries. Our results suggest that, when managed well, lockdowns do not necessarily disrupt access to maternal health services—demonstrating elements of resilience even under crisis conditions. These findings underscore the value of context-specific, adaptive strategies to ensure continuity of essential services during health emergencies. Future research should explore localized and socioeconomic factors shaping responses to public health interventions and further examine how resilience can be strengthened at all levels of the health system.