Hospitals early challenges and interventions combatting COVID-19 in the Eastern Mediterranean Region

Abstract

Background During rapidly evolving outbreaks, health services and essential medical care are interrupted as facilities have become overwhelmed responding to COVID-19. In the Eastern Mediterranean Region (EMR), more than half of countries are affected by emergencies, hospitals face complex challenges as they respond to humanitarian crises, maintain essential services, and fight the pandemic. While hospitals in the EMR have adapted to combat COVID-19, evidence-based and context-specific recommendations are needed to guide policymakers and hospital managers on best practices to strengthen hospitals’ readiness, limit the impact of the pandemic, and create lasting hospital sector improvements towards recovery and resilience. Aim Guided by the WHO/EMR’s “Hospital readiness checklist for COVID-19”, this study presents the experiences of EMR hospitals in combatting COVID-19 across the 22 EMR countries, including their challenges and interventions across the checklist domains, to inform improvements to pandemic preparedness, response, policy, and practice. Methods To collect in-depth and comprehensive information on hospital experiences, qualitative and descriptive quantitative data was collected between May-October 2020. To increase breadth of responses, this comprehensive qualitative study triangulated findings from a regional literature review with the findings of an open-ended online survey (n = 139), and virtual in-depth key informant interviews with 46 policymakers and hospital managers from 18 out of 22 EMR countries. Purposeful sampling supported by snowballing was used and continued until reaching data saturation, measures were taken to increase the trustworthiness of the results. Led by the checklist domains, qualitative data was thematically analyzed using MAXQDA. Findings Hospitals faced continuously changing challenges and needed to adapt to maintain operations and provide essential services. This thematic analysis revealed major themes for the challenges and interventions utilized by hospitals for each of hospital readiness domains: Preparedness, Leadership, Operational support, logistics, supply management, Communications and Information, Human Resources, Continuity of Essential Services and Surge Capacity, Rapid Identification and Diagnosis, Isolation and Case Management, and Infection, Prevention and Control. Conclusion Hospitals are the backbone of COVID-19 response, and their resilience is essential for achieving universal health coverage. Multi-pronged (across each of the hospitals readiness domains) and multi-level policies are required to strengthen hospitals resilience and prepare health systems for future outbreaks and shocks.

Role of hospitals in recovery from COVID-19: Reflections from hospital managers and frontliners in the Eastern Mediterranean Region on strengthening hospital resilience

“…Fourthly, regarding strengthening hospital resilience throughout the recovery phase; hospital managers highlighted the components of hospital resilience namely resilient staff, sustainable finance, and adaptive leadership and management. Firstly, qualitative findings from this study echoed global literature confirming that the ability to surge staff and redistribute health workers according to hospital needs was critical to the hospital's response, recovery, and ultimately resilience (6, 14,24,27,28,41,42). Given the prolonged response and recovery phases of COVID-19 over the last 3 years, scaling up mental health services and psychosocial support as well as providing training on stress, time, and crisis-management is essential to recovery (2,15,43,44).…”

Preparedness of Eastern Mediterranean countries in view of monkeypox emergence during the COVID-19 pandemic: A call for action

“…Inadequate funds, poor infrastructure, a shortage of qualified and skilled human resources, political instability, and conflicts are some of the major causes that have weakened healthcare systems in some EMR countries, including Afghanistan, Iraq, Libya, Syria, Sudan, Somalia, Yemen and Lebanon. Identical issues also exist in Iran and Pakistan although they are minor [ 13 , 14 ]. It is challenging for Lebanon's healthcare system to manage a new catastrophe, as it is already struggling due to the recent COVID-19 pandemic, economic pressures, political unrest, a neglected refugee crisis, and an increasing number of healthcare professionals leaving the country.…”

“…In addition to these problems, the chemical explosion on August 4, 2020, at the Beirut port also added to these challenges, with the incident destroying nearby hospitals and related loss of healthcare resources [ 15 ]. The rest of the regional countries like Saudi Arabia, UAE, and Qatar may not have these concerns; however, the recent pandemic of COVID-19 has affected all these nations negatively and has strained their healthcare systems [ 13 , 14 ]. Furthermore, several concerns have also been observed during that period, including undesirable technical assistance, medical logistics, supplies management, limited human resource availability, and inadequate and weak public health interventions (e.g., contact tracing and epidemiological surveillance) [ 13 , 14 ].…”

“…The rest of the regional countries like Saudi Arabia, UAE, and Qatar may not have these concerns; however, the recent pandemic of COVID-19 has affected all these nations negatively and has strained their healthcare systems [ 13 , 14 ]. Furthermore, several concerns have also been observed during that period, including undesirable technical assistance, medical logistics, supplies management, limited human resource availability, and inadequate and weak public health interventions (e.g., contact tracing and epidemiological surveillance) [ 13 , 14 ]. All these can cause significant obstacles to preventing the spread of newly emerging diseases, such as the current MPX outbreak [ 13 , 14 ].…”

“…Furthermore, several concerns have also been observed during that period, including undesirable technical assistance, medical logistics, supplies management, limited human resource availability, and inadequate and weak public health interventions (e.g., contact tracing and epidemiological surveillance) [ 13 , 14 ]. All these can cause significant obstacles to preventing the spread of newly emerging diseases, such as the current MPX outbreak [ 13 , 14 ].…”