The following section covers the interventions that were deployed in the Dominican Republic between March 2020 and February 2022 to respond to COVID-19 and maintain essential health services (EHS). Unlike context and systems factors which cannot easily be changed when an outbreak occurs, policies or interventions can. Interventions during the early months of the coronavirus pandemic in the Dominican Republic fell into three main categories: national, governmental, and population-level measures, health system-level measures, and patient-level measures.
Exemplars in COVID-19 conceptual framework for assessing epidemic preparedness and response
Early in the COVID-19 pandemic, the Dominican Republic was among the hardest-hit countries in Latin America and the Caribbean. In this first phase, daily case counts peaked at the end of July 2020, with nearly 1,800 new infections reported on July 31, or about 135 cases per million people—more cases per million than any other country in the region except Brazil, Panama, and Colombia. Daily deaths spiked in early April 2020, although death counts per million people were comparatively lower than its neighbors’ (see figure below). The Dominican Republic reported 23 deaths on September 9, 2020, or almost two deaths per million people. During the first two years of the pandemic, the cumulative fatality rate was lower in the Dominican Republic than every country in the region except Cuba.
Cumulative death rate in the Americas from COVID-19, April 1, 2020 – April 1, 2022
Our World in Data. Coronavirus pandemic (COVID-19). Accessed January 6, 2023.
In March 2020, the National Council for Prevention, Mitigation and Response to Disasters developed a that introduced key strategic lines: leadership; intersectoral and multisectoral coordination; epidemiological surveillance; research and evaluation; laboratory and diagnosis; prevention and control of infections; management and treatment of cases; operational and logistical support; and risk communication.
The contingency plan’s objectives were:
- Establish intersectoral and multisectoral coordination for the preparation and response to COVID-19 cases.
- Determine actions to contain and mitigate cases of COVID-19 through detection, surveillance, investigation, evaluation, and timely isolation of detected cases.
- Strengthen the capacity and coordination of the health service provider network for the management of COVID-19 cases in accordance with the established protocols.
- Ensure risk communication actions aimed at individuals, family and community, and risk groups.
- Guarantee the operational and logistical support of supplies for the preparation and response of COVID-19 cases.
The minister of health, as the highest health authority, is responsible for leading the preparation and response to health emergencies at the highest political and strategic level, and the director general of epidemiology oversees the epidemiological surveillance response.
Officials soon named : a High-Level Commission to coordinate the government’s pandemic response, the Commission for Economic and Employment Affairs, and the Commission to Address Social Affairs.
On March 19, 2020, the Dominican government declared a state of emergency and introduced a nationwide lockdown and quarantine. Officials closed borders, schools, and workplaces nationwide and suspended public transportation. Collaborations also began with the private sector on testing and care coverage between March and May 2020. However, cases and deaths remained high which could be explained by lack of adherence or ineffective messaging during this administration.
When the new government was established in August 2020, they effectively mobilized the entire country toward a common goal: to protect the population from COVID-19 through mass vaccination while gradually reopening the economy to recover growth and employment. They also moved beyond typical COVID-19 response to strengthening a whole-of-government strategy and leadership at the highest levels of decision-making across prevention, mitigation, and response systems, and aligning across sectors to implement public health interventions and promote social protection for vulnerable populations.
Interventions to limit the spread of COVID-19 and maintain essential health services during the early months of the pandemic in the Dominican Republic fell into three main categories:
- National, governmental, and population-level measures
- Health system-level measures
- Patient-level measures
National, governmental, and population-level measures
Health system-level response measures
The Dominican Republic’s health system-level response measures fell into two main categories: direct responses to COVID-19, and interventions for the maintenance of essential health services.
Supply- and demand-side barriers to essential health services maintenance in the Dominican Republic during the COVID-19 pandemic
In many countries around the world, the COVID-19 pandemic and efforts to mitigate it caused supply- and demand-side barriers to essential health service delivery—including provider and patient fear of infection in health facilities; inability to travel because of lockdowns; budgetary shortfalls; and delays and stockouts of essential health commodities such as personal protective equipment, reagents, some vaccines, and critical diagnostic tools (such as GeneXpert cartridges).
In the Dominican Republic, COVID-19 affected both the supply and demand for essential health services, especially at the beginning of the pandemic from March until August 2020. During that period, mobility restrictions and fear of infection in public places kept most people at home and away from health facilities. This was particularly true in Santo Domingo and Santiago, the country’s two major cities.
However, the interruptions to essential health services delivery in the Dominican Republic were less substantial than in many other countries, and most services had fully recovered by the middle of 2021.
In 2020 and 2021, the World Health Organization’s PULSE survey measured pandemic interruptions to the delivery of 25 essential health services in 127 countries around the world.
Degree of disruption to selected essential health services in the Dominican Republic, January 2021 – March 2021
World Health Organization (WHO). Second Round of the National Pulse Survey on Continuity of Essential Health Services During the COVID-19 Pandemic. Geneva: WHO; 2021.
Individual service use statistics from the Dominican public providers’ network (National Health Service) and public insurer (SeNaSa) reflect these findings. According to National Health Service data, individual services—such as primary care consultations, visits with specialists, visits to emergency departments, laboratory visits, and imaging—substantially declined between 2019 and 2020. As WHO found, this was especially true in large cities such as Santo Domingo and Santiago. There was an overall 34% decrease in services provided by the National Health System between 2019 and 2020, however the system was able to increase services by 35% between 2020 and 2021.
Researchers found that the shortage of some supplies and equipment and the redirection of the flow of resources and workforce to pandemic response also interrupted the delivery of maternal and neonatal services. They identified a 27% drop in maternal health service delivery in the Dominican Republic in 2020, less than the regional average of 44%. WHO researchers also identified social distancing measures, and patient reluctance to visit health facilities also disrupted services such as directly observed treatment for tuberculosis and in-person treatment for HIV patients.
Maternal deaths in the Dominican Republic also increased during 2020 and 2021, but preliminary results show that 2022 rates in the first half of the year are trending back to pre-pandemic rates.
Maternal deaths per 100,000 births in the Dominican Republic, 2017-2022
Dominican Republic General Directorate of Epidemiology. Weekly Bulletins. Accessed January 6, 2023.
(see figure below), the Dominican Republic’s health system was able to provide services to populations that reported higher barriers to access in the beginning of the pandemic and lower these rates of interruption. The survey followed people that declared not having access to medical services, people with disabilities without access, children younger than five without access to vaccination, and pregnant women without access to regular checkups.
Interruption in access to medical services during the COVID-19 pandemic in the Dominican Republic, May 2020 – March 2021
United Nations Development Program (UNDP). SEIA-Red Actua Survey. New York, NY: UNDP; 2021. Accessed January 6, 2023.
The pandemic’s effects on the delivery of mental health services in the Dominican Republic have not yet been evaluated.
Statistics from SeNaSa reflect similar trends that demonstrate a relative maintenance of essential health services for ambulatory care, high-cost interventions (complex surgeries such as angioplasty, open heart surgeries, joint replacement, hemodialysis, burn care, cancer, and other interventions), normal deliveries, and cesarean sections (see figure below).
Number of services by type covered by Dominican Republic national health insurance, 2017 – 2021
SeNaSa National Health Insurance. Accessed January 6, 2023.
Overall, ambulatory care consultations suffered a great drop in the first months of the pandemic but began to recover in August 2020, high-cost care did not suffer reductions in the subsidized regime, except in the months of April and May 2020, and both normal deliveries and C-sections generally stayed consistent except for the early part of the pandemic. Note that in the Dominican Republic, almost all births take place in health facilities under the care of specialized doctors.
Services provided in the subsidized regime of the Dominican Republic, 2019-2021 (in thousands)
SISALRIL Superintendencia de Salud y Riesgos Laborales. Accessed January 6, 2023.
The Family Health Insurance (Seguro Familiar de Salud, SFS) subsidized regime protects the unemployed and informal population with incomes below the minimum wage. Most of the health services this population uses are provided by the public network of the National Health Service, just like the uninsured. The difference is if the public network provider does not have the required service or quality, SeNaSa contracts these services in the private sector. In 2020 a substantial proportion of the population was uninsured (about 23%). By the end of that year, in part because of the pandemic, almost all the uninsured population became insured through the subsidized regime.
The table above shows many of the services covered by SeNaSa within the subsidized regime. A reduction of 34% in service coverage can be seen in 2020 compared with 2019. However, there was a complete recovery in 2021.
Services provided in the contributory regime of the Dominican Republic, 2019-2021 (in thousands)
SISALRIL Superintendencia de Salud y Riesgos Laborales. Accessed January 6, 2023.
The population in the contributive regime uses the private network. As shown in the table above, the number of services provided was reduced by 18% in 2020 with respect to 2019 and they have almost recovered by 2021. The most crucial reductions were in dental services, emergencies, surgery, and rehabilitation. Most services almost recovered by the end of year 2021.
Therefore, the subsidized regime suffered much more disruption to their essential health services than the contributive, thus putting more burden on low-income citizens in the Dominican Republic.
Specific services provided in the contributory regime of the Dominican Republic, 2019-2021 (in thousands)
SISALRIL Superintendencia de Salud y Riesgos Laborales. Accessed January 6, 2023.
Specific services (examples shown above) provided in the contributory regime experienced minor variations. A large increase was seen in services provided through the Expanded Immunization Program due to the Dominican Republic’s extensive COVID-19 vaccination program. Overall, these specific services declined by 11% in 2020 and 5% in 2021.
Disruption in DTP3 vaccine doses in the Dominican Republic
Causey K, Fullman N, Sorensen RJD, Galles NC, Zheng P, Aravkin A. Estimating global and regional disruptions to routine childhood vaccine coverage during the COVID-19 pandemic in 2020: a modelling study. Lancet. 2021;398(10299):P522-P534.
Based on an analysis from the Institute for Health Metrics and Evaluation of administrative data, the figure above shows the ratio of the monthly number of doses of DTP3 vaccine (third dose of diphtheria, tetanus, and pertussis vaccine) given to children younger than one year old in 2020 as it compares with the same month in 2019. A value of 1 represents no change and values less than 1 indicate delivery disruption.
In March 2020 at the beginning of the pandemic, there was a in the Dominican Republic. However, this indicator began to recover in April 2020 and continued to climb throughout 2020.