Assessing COVID-19 pandemic's impact on essential diabetes care in Manila, the Philippines: A mixed methods study

The COVID-19 pandemic directly increased mortality and morbidity globally. In addition, it has had extensive indirect ill effects on healthcare service delivery across health systems worldwide. We aimed to describe how patient access to diabetes care was affected by the pandemic in Manila, the Philippines. We used an explanatory, sequential mixed method approach including a cross-sectional survey (n = 150) and in-depth interviews of patients (n = 19), focus group discussions of healthcare workers (n = 22), and key informant interviews of health facility administrators (n = 3) from October 2021 to January 2022. Larger proportions of patients reported absence of livelihood (67.3%), being in the lowest average monthly household income group (17.3%), and disruptions in diabetes care (54.0%) during the pandemic. They identified the imposition of lockdowns, covidization of the healthcare system, and financial instability as contributors to the reduced availability, accessibility, and affordability of diabetes-related consultations, medications, and diagnostics. At least a quarter of the patients experienced catastrophic health expenditures across all areas of diabetes care during the pandemic. Most healthcare workers and administrators identified telemedicine as a potential but incomplete tool for reaching more patients, especially those deemed lost to follow-up. In the Philippines, the pandemic negatively impacted access to essential diabetes care.