Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis

Abstract

ObjectiveThis case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic.DesignA qualitative case study triangulated information from 22 documents, 44 key informant interviews and 6 focus group discussions. The framework method was used to thematically examine the factors impacting quality EHS in TLS.SettingNational, municipal, facility levels in Baucau, Dili and Ermera municipalities in TLS.ResultsBased on the TLS National Health Statistics Reports, a reduction in outpatient, emergency department and primary care service delivery visits was observed in 2020 when compared with 2019. However, in contrast, maternal child health services simultaneously improved in the areas of skilled birth attendants, prenatal coverage and vitamin A distribution, for example. From the thematic analysis, five themes emerged as contributing to or impeding the maintenance of quality EHS including (1) high-level strategy for maintaining quality EHS, (2) measurement for quality and factors affecting service utilisation, (3) challenges in implementation of quality activities across the three levels of the health system, (4) the impact of quality improvement leadership in health facilities during COVID-19 and (5) learning systems for maintaining quality EHS now and for the future.ConclusionThe maintenance of quality EHS is critical to mitigate adverse health effects from the COVID-19 pandemic. When quality health services are delivered prior to and maintained during public health emergencies, they build trust within the health system and promote healthcare-seeking behaviour. Planning for quality as part of emergency preparedness can facilitate a high standard of care by ensuring health services continue to provide a safe environment, reduce harm, improve clinical care and engage patients, facilities and communities.

Protection of the Right to Health Care During the Covid-19 Pandemic in Southeast Asia: A Retrospective and Prospective Analysis

“…The provision of high-quality health services both before and throughout public health crises fosters trust in the healthcare system and encourages individuals to seek medical assistance. Incorporating a focus on quality into emergency preparedness planning can facilitate the delivery of exceptional care by ensuring that health services maintain safety standards, minimize harm, enhance clinical care, and actively involve patients, facilities, and communities [30] In conclusion, Timor-Leste, like many other countries, encountered substantial challenges in managing the pandemic. However, concerted efforts were made to enhance healthcare availability, accessibility, quality, and acceptability to effectively respond to the crisis.…”

Assessing System Performance of Maternal and Child Health Care During Covid-19 Pandemic in Community Health Center- Comoro Dili Timor-Leste

“…[21] Two nationals' studies focusing on services delivery component of MCH during COVID-19 pandemic reveal contradictory results of the disruption of MCH services. [22] [23] So far there is no study commissioning to assess health system readiness for delivering MCH services in Timor-Leste. We conducted this study to thoroughly assessed system performances for delivering MCH services during COVID-19 Pandemic in a Community Health Centers, Comoro Dili, Timor-Leste…”

“…[21] Two nationals’ studies focusing on services delivery component of MCH during COVID-19 pandemic reveal contradictory results of the disruption of MCH services. [22] [23]…”

The response to COVID-19 in Timor-Leste: lessons learnt

“…In Timor-Leste, as in other settings, the COVID-19 pandemic had a major impact on the provision of essential health services 38 39. Tuberculosis case detection rates fell, routine vaccine administration rates reduced, and hospital presentation numbers for other illnesses were dramatically lower in 2020 and 2021, presumably because people were afraid to access health services, either because of fear of COVID-19 exposure, or fear of being tested and isolated if positive.…”