Qualitative exploration of health system response to COVID-19 pandemic applying the WHO health systems framework: Case study of a Nigerian state

Motivation and experiences of dentists of primary care dental clusters in Hungary: a qualitative inquiry

Background

In recent years, dental clusters and networks have been established in primary care in many countries to improve access to services for the population and develop cooperation between providers. In Hungary, the first dental clusters were established in 2021, and currently, one-third of dental practices have already joined a cluster. The study aimed to gather and analyze early experiences regarding the motivation of participation in primary care dental clusters and experiences of implementation.

Methods

Qualitative in-depth individual interviews with primary care dentists (n = 21). The study was designed to meet the COREQ criteria for reporting qualitative research. The research team members defined a purposive sample of interviewees. All interviews were conducted from March to April 2024. A qualitative content analysis method was used to analyze the interview transcripts. The WHO health system framework was chosen for the theoretical framework of the analysis.

Results

The motivations for joining a dental cluster were financial reasons, professional development and knowledge exchange. Lack of information and distrust were barriers to joining the dental clusters. Different professional management practices have developed within the clusters. In the interviewees' opinion, the population's access to preventive dental services has not yet changed substantially under the new operational model. The portfolio of services offered by dental clusters could be expanded to include a range of types of care. Digital health technologies and innovative solutions should be developed and widely adopted.

Conclusions

In designing policy measures to promote the broader adoption of the dental cluster model, it is helpful to consider the different factors influencing dentists' decisions during implementation. Dental clusters can benefit the public and dentists, but further development of the model and improvement of the primary conditions for the operation of practices are essential.

VUCA in the present-day health workplace and the mental health and wellbeing of health care workers: a systematic scoping review

BACKGROUND

The health workplace is fraught with fluctuations and uncertainties, creating a volatile, uncertain, complex, and ambiguous (VUCA) environment, particularly impacting frontline healthcare workers (HCWs) and leading to an epidemic of stress, burnout and health issues, exacerbated by the COVID-19 pandemic.

OBJECTIVES

This paper aims to explore the multifaceted aspects of HCWs wellbeing, address challenges arising due to COVID-19 and VUCA and highlight innovative approaches within health systems to enhance the quality of life HCWs.

METHODS

A systematic review was conducted using PubMed and Scopus with search terms including 'VUCA,' 'health personnel,' 'frontline healthcare workers,' and 'psychological wellbeing.' Grey literature focusing on Australia and Nigeria was also included. Search was limited to titles on "COVID-19", articles published in English, and articles published from inception to 11th March 2024.

FINDINGS

Initial search terms generated hundreds of thousands of literatures but after limitations to titles on COVID-19, 32 articles were screened and 22 selected for critical review. Seven other grey articles were included with focus on Australia and Nigeria. The summary findings indicate the disruptiveness of VUCA, and associated need to improve healthcare workers' resilience and this calls for further research.

CONCLUSION

This report highlights the further need to explore the volatile, uncertain, complex and/or ambiguous health workplace with a view to improve healthcare workers wellbeing. Intentional organizational support strategies along with personal coping strategies should be further explored towards improving HCWs resilience and wellbeing.

"I feel broken": Chronicling burnout, mental health, and the limits of individual resilience in nursing

Healthcare systems and health professionals are facing a litany of stressors that have been compounded by the pandemic, and consequently, this has further perpetuated suboptimal mental health and burnout in nursing. The purpose of this paper is to report select findings from a larger, national study exploring gendered experiences of mental health, leave of absence (LOA), and return to work from the perspectives of nurses and key stakeholders. Given the breadth of the data, this paper will focus exclusively on the qualitative results from 53 frontline Canadian nurses who were purposively recruited for their workplace insight. This paper focuses on the substantive theme of "Breaking Point," in which nurses articulated a multiplicity of stress points at the individual, organizational, and societal levels that amplified burnout and accelerated mental health LOA from the workplace. These findings exemplify the complexities that underlie nurses' mental health and burnout and highlight the urgent need for multipronged individual, organizational, and structural interventions. Robust and timely interventions are needed to restore the health of the nursing profession and sustain its future.

Effects of the COVID-19 Pandemic on the Implementation of NCD Care at the Primary Care Level in the Philippines: A Qualitative Inquiry

Background and Objective

The focusing of resources to COVID-19 response hampered and disadvantaged primary care services including that for Non-Communicable Diseases (NCDs), compromising continuity of care and hence, patients' disease status. However, studies from low- and middle-income countries (LMICs) remain sparse; therefore, evidence generation on how the pandemic impacted the provision of these primary care services in LMICs will help further understand how policies can be reframed, and programs be made more efficient and effective despite similar crises. To bridge this gap, the study investigated how the pandemic affected the implementation of NCD care at the primary care level in the Philippines.

Methods

Thirty-one online focus group discussions via Zoom Meetings were conducted among 113 consenting physicians, nurses, midwives, and community health workers from various facilities - community health centers and stations, free-standing clinics, infirmaries, and level 1 hospitals - located within two provinces in the Philippines. All interviews were video-recorded upon participants' consent and transcribed verbatim. Inductive thematic analysis was employed through NViVo 12® to generate themes, identify categories, and describe codes.

Results

The impact of COVID-19 on NCD care at the primary care level revolved around heightened impediments to service delivery, alongside worsening of pre-existing challenges experienced by the healthcare workforce; subsequently compelling the public to resort to unhealthy practices. These detriments to the primary healthcare system involved resource constraints, discontinued programs, referral difficulties, infection, overburden among workers, and interrupted training activities. Citizens were also observed to adopt poor healthcare seeking behavior, thereby discontinuing treatment regimen.

Conclusion

Healthcare workers asserted that disadvantages caused by the pandemic in their NCD services at the primary care level possibly threaten patients' health status. Besides the necessity to address such detriments, this also emphasizes the need for quantitative studies that will aid in drawing inferences and evaluating the effect of health crises like the pandemic on such services to bridge gaps in improving quality of care.

Views of Nigerian civil servants about compulsory COVID-19 vaccination: A qualitative study

BACKGROUND

 COVID-19 caused unforeseen global burden, although vaccine strategy rapidly stalled transmission and protected those at risk. Many governments made vaccination mandatory for public space access.

AIM

 This study aimed to elucidate perception of Nigerian civil servants towards mandatory COVID-19 vaccination and elicited their recommendations.

SETTING

 This study was conducted in twelve purposively selected states in the six geopolitical zones and the Federal Capital Territory (FCT), Nigeria. Relevant ministries, departments and agencies were selected within the study sites.

METHODS

 It was a qualitative study that interviewed consenting civil servants. Ethical approval was obtained from the National Health Research Ethics Committee. Interviews were conducted in person, following a pre-test. Data was analysed using NVivo software version 12.

RESULTS

 Most participants were willing to take the vaccine if their safety was assured. However, enforcement to do so was a hindrance. Most participants commended the government for the effort to curb COVID-19 transmission and create awareness but were displeased with planning and handling of misconceptions. They recommended a more committed approach to vaccine production and funding by the government.

CONCLUSION

 Participants were willing to take the COVID-19 vaccines because the gains of protection outweighed the risks. They suggested a less involuntary approach through reinforcing awareness creation and avoiding threats.Contribution: There is limited qualitative research on perception of Nigerian civil servants regarding mandatory COVID-19 vaccination. Being the main driving force of Nigeria's public service, their views are invaluable. Findings could contribute to future policies in times of emergency.

A critical analysis of health system in Nepal; Perspective's based on COVID-19 response

Background

Nepal moved from a unitary government to a federal system of government in 2015 under its constitution. Nepal is a federal democratic republic governed by three levels of government: a federal, provincial, and local level. The response to COVID-19 in Nepal has been majorly led and controlled by the federal government. All three levels of government are performing their responsibilities; however, they face various challenges in responding to COVID-19. This study aimed to critically analyze Nepal's health system in the context of the COVID-19 response.

Methods

We conducted semi-structured in-depth interviews by telephone among the policymakers, health workers, and stakeholders at the federal, provincial, and local levels (n = 41) between January to July 2021. The interviews were audio recorded, transcribed into English, and coded using inductive-deductive approaches.

Results

COVID-19 considerably impacted routine health care, mainly maternity services and immunization. Inadequate financial resources, inadequate human resources, and the lack of ventilators, ICUs, and X-ray services were the significant challenges in tackling and managing COVID-19 effectively.

Conclusion

The study found that all three levels of government perform their roles and responsibilities and effectively manage the pandemic. The federal and provincial governments focused more on the plans and policy development, while the local government demonstrated greater accountability in implementing those plans and policies. Therefore, all three tiers of government need to coordinate together for preparing and communicating information in times of emergency. Besides, it is imperative to empower local governments to maintain Nepal's federal health system.

The rise of resilient healthcare research during COVID-19: scoping review of empirical research

BACKGROUND

The COVID-19 pandemic has presented many multi-faceted challenges to the maintenance of service quality and safety, highlighting the need for resilient and responsive healthcare systems more than ever before. This review examined empirical investigations of Resilient Health Care (RHC) in response to the COVID-19 pandemic with the aim to: identify key areas of research; synthesise findings on capacities that develop RHC across system levels (micro, meso, macro); and identify reported adverse consequences of the effort of maintaining system performance on system agents (healthcare workers, patients).

METHODS

Three academic databases were searched (Medline, EMBASE, Scopus) from 1st January 2020 to 30th August 2022 using keywords pertaining to: systems resilience and related concepts; healthcare and healthcare settings; and COVID-19. Capacities that developed and enhanced systems resilience were synthesised using a hybrid inductive-deductive thematic analysis.

RESULTS

Fifty publications were included in this review. Consistent with previous research, studies from high-income countries and the use of qualitative methods within the context of hospitals, dominated the included studies. However, promising developments have been made, with an emergence of studies conducted at the macro-system level, including the development of quantitative tools and indicator-based modelling approaches, and the increased involvement of low- and middle-income countries in research (LMIC). Concordant with previous research, eight key resilience capacities were identified that can support, develop or enhance resilient performance, namely: structure, alignment, coordination, learning, involvement, risk awareness, leadership, and communication. The need for healthcare workers to constantly learn and make adaptations, however, had potentially adverse physical and emotional consequences for healthcare workers, in addition to adverse effects on routine patient care.

CONCLUSIONS

This review identified an upsurge in new empirical studies on health system resilience associated with COVID-19. The pandemic provided a unique opportunity to examine RHC in practice, and uncovered emerging new evidence on RHC theory and system factors that contribute to resilient performance at micro, meso and macro levels. These findings will enable leaders and other stakeholders to strengthen health system resilience when responding to future challenges and unexpected events.

Leveraging electronic logistics management information systems to enhance and optimize supply chain response during public health emergencies: lessons from COVID-19 response in Uganda

BACKGROUND

Health supply chain is crucial for proper functioning of a health system and advancing national and international health security goals. The Coronavirus 2019 pandemic caused major challenges for health supply chain systems in Uganda and globally.

OBJECTIVES

This study involved literature review to examine how the electronic logistics management information system and related digital systems were harnessed be best support public health emergencies.

METHODS

We describe how the health supply chain system leveraged the emergency Electronic Logistic Management Information System developed during the Ebola epidemic in 2019 to support the COVID-19 response in Uganda. The findings are based on the analysis of reports, guidelines, and discussions with stakeholders involved in implementing the electronic Management Information System during the COVID-19 response. Lessons and experiences are shared on how the system supported data visibility, use and health commodity management.

RESULTS

A web-based emergency Electronic Management Information System was developed to support the supply chain system during preparedness and response to the Ebola Virus. The system facilitated coordination, information management and provided real-time data for planning, decision making, and distribution of commodities during the COVID-19 response. To address any human resource challenges, 863 staff were trained and mentored in the use of the system. The system enabled the Ministry of Health to track the distribution of Medical Counter Measures through the warehouses, eight regional pre-positioning centers, and over 2000 user units in 136 district vaccine stores. In addition, the system provided quality data for the quantification and monitoring of commodities at all levels of care. Over 1800 bulk orders were processed through the system. Real time stock status reports were transmitted from all national, regional, district and health facility levels. Procurement tracking reports, stock gap analysis and partner contribution were all accessible and visible in the system. This supported the Ministry of Health's resource mobilization and coordination efforts.

CONCLUSIONS

Availability of reliable, quality real-time data are essential for effective decision making during public health emergencies. The emergency Electronic Logistic Management Information Systems supported health authorities to mount coordinated and effective responses to ensure timely availability of commodities and supplies to support the COVID-19 pandemic response. Lessons learnt from the Ebola epidemic response were translated into actions that enabled effective preparedness and response to the COVID-19 pandemic.

Current Impact and Long-Term Influence of the COVID-19 Pandemic on Iraqi Healthcare Systems: A Case Study

Decades of wars, sanctions, and internal conflicts have compromised Iraq's health system, which once was the best system in the region. National and international efforts to revitalize the system have been successful to some extent; however, significant challenges still exist. The COVID-19 pandemic has exposed new vulnerabilities and exacerbated the existing ones, affecting the quality and the quantity of the health services delivered. This case study explored the baseline function of Iraq's health system within the context of the World Health Organization (WHO) health system framework. The paper also examined the country's response to the COVID-19 pandemic and some of its impacts. Results show that the system was not functioning optimally nor was it prepared to address the immediate impact of the current pandemic and other emerging public health issues. While mitigating the pandemic's short-term and long-term impacts are essential, it should not divert the focus from restructuring and strengthening the health system. Iraq may need to prioritize the health information system and leadership/governance as they provide the basis for health policies and regulations for all other health system building blocks.

Interventions to Mitigate COVID-19 Misinformation: A Systematic Review and Meta-Analysis

The duration and impact of the COVID-19 pandemic depends largely on individual and societal actions which are influenced by the quality and salience of the information to which they are exposed. Unfortunately, COVID-19 misinformation has proliferated. Despite growing attempts to mitigate COVID-19 misinformation, there is still uncertainty regarding the best way to ameliorate the impact of COVID-19 misinformation. To address this gap, the current study uses a meta-analysis to evaluate the relative impact of interventions designed to mitigate COVID-19-related misinformation. We searched multiple databases and gray literature from January 2020 to September 2021. The primary outcome was COVID-19 misinformation belief. We examined study quality and meta-analysis was used to pool data with similar interventions and outcomes. 16 studies were analyzed in the meta-analysis, including data from 33378 individuals. The mean effect size of interventions to mitigate COVID-19 misinformation was positive, but not statistically significant [d = 2.018, 95% CI (-0.14, 4.18), p = .065, k = 16]. We found evidence of publication bias. Interventions were more effective in cases where participants were involved with the topic, and where text-only mitigation was used. The limited focus on non-U.S. studies and marginalized populations is concerning given the greater COVID-19 mortality burden on vulnerable communities globally. The findings of this meta-analysis describe the current state of the literature and prescribe specific recommendations to better address the proliferation of COVID-19 misinformation, providing insights helpful to mitigating pandemic outcomes.