Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19

Abstract

IntroductionCOVID-19 has tested the resilience of health systems globally and exposed existing strengths and weaknesses. We sought to understand health systems COVID-19 adaptations and decision making in Liberia and Merseyside, UK.MethodsWe used a people-centred approach to carry out qualitative interviews with 24 health decision-makers at national and county level in Liberia and 42 actors at county and hospital level in the UK (Merseyside). We explored health systems’ decision-making processes and capacity to adapt and continue essential service delivery in response to COVID-19 in both contexts.ResultsStudy respondents in Liberia and Merseyside had similar experiences in responding to COVID-19, despite significant differences in health systems context, and there is an opportunity for multidirectional learning between the global south and north. The need for early preparedness; strong community engagement; clear communication within the health system and health service delivery adaptations for essential health services emerged strongly in both settings. We found the Foreign, Commonwealth and Development Office (FCDO) principles to have value as a framework for reviewing health systems changes, across settings, in response to a shock such as a pandemic. In addition to the eight original principles, we expanded to include two additional principles: (1) the need for functional structures and mechanisms for preparation and (2) adaptable governance and leadership structures to facilitate timely decision making and response coordination. We find the use of a people-centred approach also has value to prompt policy-makers to consider the acceptance of service adaptations by patients and health workers, and to continue the provision of ‘routine services’ for individuals during health systems shocks.ConclusionOur study highlights the importance of a people-centred approach, placing the person at the centre of the health system, and value in applying and adapting the FCDO principles across diverse settings.

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

“…However, some communication gaps were also identified; for example, a lack of communication aligned with rapidly changing protocols that increased the difficulty of remaining informed [ 56 ]. Challenges included a lack of intra-and inter professional communication between other units [ 56 ], a lack of access to technology and inconsistent information [ 81 ].…”

“…It was clear from the included studies that navigating the challenges of the COVID-19 pandemic, which came with the need to constantly learn and make adaptations in response to unexpected variation and changes, came at a personal cost to healthcare workers, particularly to those at the frontlines of care. Nine (18%) of the included studies reported that the increased workload and strenuous work conditions had negative physical consequences on healthcare workers [ 54 , 56 , 61 , 67 – 69 , 79 , 81 , 82 ]. For example, nurses reported increased “tiredness”, “exhaustion”, “muscle weakness” and “loss of appetite”, during the pandemic as a result of working longer shifts, often without breaks, while being “weighed down by PPE equipment” [ 67 , 69 ].…”

Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics

“…Findings from the current study highlight important lessons for optimal delivery of routine essential services in the ongoing COVID-19 response and future shocks. These are aligned with the people-centred approach and have been outlined in two separate policy briefs focusing on Liberia [42] and Merseyside [43]. Notably, they suggest the need for pandemic responses to be informed by equity considerations, including tackling immediate pandemic-related and established structural barriers to care [44].…”

“…A collective case study approach involving simultaneous exploration and comparison of the experiences in Liberia and in Merseyside, UK was adopted to gain perspectives on health system responses in both low-and high-income contexts [23,24]. The study was guided by a people-centred health systems resilience framework [25], adapted from existing resilience models [26][27][28] (Fig. 1).…”

“…What Fig. 1 Conceptual framework: people-centred approach to health system resilience [25] are health system actors' perceptions of the impact of these adaptations on equity and quality of routine health care delivery? What cross-context learning may support the strengthening of health systems to maintain essential service delivery during times of crisis?…”