A Comparative Study of the COVID-19 Pandemic's Impact on Non-Communicable Disease Services in Gabon, 2021–2026

This comparative study quantifies the impact of the COVID-19 pandemic on essential health services for non-communicable diseases (NCDs) in Gabon, a representative case study of strained Sub-Saharan African health systems. It employs a rigorous mixed-methods design, comparing quantitative health facility data on hypertension and diabetes mellitus service utilisation from 2021 to 2024 against pre-pandemic (2019) benchmarks. These data are integrated with qualitative insights from interviews with healthcare providers and policymakers conducted in early 2025. Findings demonstrate a significant initial decline in outpatient consultations during 2021–2022, with rural areas experiencing more severe and prolonged disruptions than urban centres. The analysis further identifies and evaluates adaptive strategies, revealing the rapid but inequitable adoption of telemedicine and medication multi-month dispensing by 2024 as key mitigations. The comparative framework underscores how pre-existing systemic fragilities exacerbated healthcare inequities during the crisis. This research provides critical evidence on how public health emergencies disrupt chronic disease management in Africa, while also documenting context-specific resilience. Its implications advocate for the institutionalisation of adaptive models, such as community-based drug distribution, to strengthen health system preparedness and ensure the sustained management of Africa’s growing NCD burden amidst future shocks.