Challenges in Providing Health Care Services During COVID-19 Pandemic: Exploration of Providers’ Perspectives in Nepal.

Abstract

IntroductionThe rapid increase of COVID-19 cases since the beginning of May 2020, imposition of lockdown, and preparation activities to detect, manage and treat COVID-19 in public hospitals have impacted on the provision of non-COVID health care services resulting in increased morbidity and mortality in Nepal. This study aims to explore challenges in providing non-COVID as well as COVID-19 health care services through public hospitals in Eastern Nepal.MethodsA qualitative study with 25 key informants from three public hospitals in Eastern Nepal was conducted. Key informants were health care workers (HCWs) and managers of the hospitals. A thematic analysis was carried out to identify challenges in providing non-COVID and COVID-19 health care services.ResultsWe identified four themes: weak implementation; weak co-ordination and management; low accountability of HCWs and staff; and risk of infection and stigma as the challenges to provide COVID-19 health care services. We identified three themes: maintaining safety measures in hospitals, managing patients, and fear of infection as the challenges in provision of non-COVID health care services. Inadequate resources and HCWs, lengthy procurement process, and poor jobs specification were the main reasons for weak implementation. HCWs stated weak hospital administration while managers and focal persons complained of low accountability of HCWs and staff to manage COVID-19 health care services.ConclusionIn addition to inadequate resources; the risk of infection of COVID-19, maintaining safety measures in hospitals, ensuring clear leadership and governance, and preparing motivated and accountable HCWs and staff to get ‘work done’ are unique challenges observed in the study hospitals; and consequently need to be addressed.

A critical analysis of health system in Nepal: Perspectives based on COVID-19 response

“…In our study, the participants reported that the existing human resources were inadequate which appeared as a major challenge in providing COVID-19 services. These findings have been supported by the previous studies [ 34 , 39 , 40 ] where the existing health workers were divided to provide both COVID-19 and non-COVID health care services. The doctors were insufficient in number and there was no additional health workers for substitution.…”

“…Due to the lack of ventilators, ICU and X-ray services, health facilities were unable to manage the critical cases in an effective manner. These findings are supported by the studies [ 34 , 40 ] where hospitals had to run the services in the limited resources such as isolation beds, ICUs and ventilators, oxygen plant, PPEs etc. The existing buildings, other infrastructure and equipment were reportedly made worse by the COVID-19.…”

“…Most participants in our study expressed that the provincial and the local government were providing incentives and allowances such as communication allowance, hazard allowance as the motivations for the frontline health workers, However, a study conducted in 3 public hospitals of Eastern Nepal had a contrast finding. The participants stated that there was an unfair lack of appreciation and compensation for their efforts, which left them less motivated to work during this difficult period [ 40 ].…”