exacerbating health crises. We aimed to assess the effect of the COVID-19 pandemic on essential health-care services
Methods Using county-level data routinely collected from the health information system from health facilities across
the country, we used a robust mixed-effect model to examine changes in 17 indicators of essential health services
across four periods: the pre-pandemic period (from January, 2018 to February, 2020), two pandemic periods (from
March to November 2020, and February to October, 2021), and the period during the COVID-19-associated health-care
workers’ strike (from December, 2020 to January, 2021).
Findings In the pre-pandemic period, we observed a positive trend for multiple indicators. The onset of the
pandemic was associated with statistically significant decreases in multiple indicators, including outpatient
visits (28·7%; 95% CI 16·0–43·5%), cervical cancer screening (49·8%; 20·6–57·9%), number of HIV tests conducted
(45·3%; 23·9–63·0%), patients tested for malaria (31·9%; 16·7–46·7%), number of notified tuberculosis cases
(26·6%; 14·7–45·1%), hypertension cases (10·4%; 6·0–39·4%), vitamin A supplements (8·7%; 7·9–10·5%), and
three doses of the diphtheria, tetanus toxoid, and pertussis vaccine administered (0·9%; 0·5–1·3%). Pneumonia
cases reduced by 50·6% (31·3–67·3%), diarrhoea by 39·7% (24·8–62·7%), and children attending welfare clinics by
39·6% (23·5–47·1%). Cases of sexual violence increased by 8·0% (4·3–25·0%). Skilled deliveries, antenatal care,
people with HIV infection newly started on antiretroviral therapy, confirmed cases of malaria, and diabetes cases
detected were not significantly affected negatively. Although most of the health indicators began to recover during
the pandemic, the health-care workers’ strike resulted in nearly all indicators falling to numbers lower than those
observed at the onset or during the pre-strike pandemic period.
Interpretation The COVID-19 pandemic and the associated health-care workers’ strike in Kenya have been associated
with a substantial disruption of essential health services, with the use of outpatient visits, screening and diagnostic
services, and child immunisation adversely affected. Efforts to maintain the provision of these essential health
services during a health-care crisis should target the susceptible services to prevent the exacerbation of associated
disease burdens during such health crises.