Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi
Social Science Department, Malawi-Liverpool-Wellcome Trust Clinical Research Programme, Blantyre, Malawi.
BMJ Open. 2022 Jun 10;12(6):e051125. doi: 10.1136/bmjopen-2021-051125.
Across Africa, the impact of COVID-19 continues to be acutely felt. This includes Malawi, where a key component of health service delivery to mitigate against COVID-19 are the primary healthcare facilities, strategically placed throughout districts to offer primary and maternal healthcare. These facilities have limited infrastructure and capacity but are the most accessible and play a crucial role in responding to the COVID-19 pandemic. This study assessed health facility preparedness for COVID-19 and the impact of the pandemic on health service delivery and frontline workers.
Primary and maternal healthcare in Blantyre District, Malawi.
We conducted regular visits to 31 healthcare facilities and a series of telephone-based qualitative interviews with frontline workers (n=81 with 38 participants) between August 2020 and May 2021.
Despite significant financial and infrastructural constraints, health centres continued to remain open. The majority of frontline health workers received training and access to preventative COVID-19 materials. Nevertheless, we found disruptions to key services and a reduction in clients attending facilities. Key barriers to implementing COVID-19 prevention measures included periodic shortages of resources (soap, hand sanitiser, water, masks and staff). Frontline workers reported challenges in managing physical distancing and in handling suspected COVID-19 cases. We found discrepancies between reported behaviour and practice, particularly with consistent use of masks, despite being provided. Frontline workers felt COVID-19 had negatively impacted their lives. They experienced fatigue and stress due to heavy workloads, stigma in the community and worries about becoming infected with and transmitting COVID-19.
Resource (human and material) inadequacy shaped the health facility capacity for support and response to COVID-19, and frontline workers may require psychosocial support to manage the impacts of the COVID-19 pandemic.
在整个非洲，COVID-19 的影响仍在持续显现。马拉维也是如此，其卫生服务提供的一个关键组成部分是初级医疗保健设施，这些设施战略性地分布在各地区，提供初级和孕产妇保健服务。这些设施基础设施和能力有限，但却是最容易获得的，在应对 COVID-19 大流行方面发挥着至关重要的作用。本研究评估了初级保健设施应对 COVID-19 的准备情况，以及大流行对卫生服务提供和一线工作人员的影响。
马拉维布兰太尔区的初级和孕产妇保健。
我们于 2020 年 8 月至 2021 年 5 月期间定期访问了 31 个医疗保健设施，并对一线工作人员进行了一系列基于电话的定性访谈（n=81 人，其中 38 人参与）。
尽管存在重大的财务和基础设施限制，医疗中心仍继续开放。大多数一线卫生工作者接受了培训并能够获得预防 COVID-19 的材料。然而，我们发现关键服务出现了中断，来设施就诊的患者数量减少。实施 COVID-19 预防措施的主要障碍包括资源（肥皂、洗手液、水、口罩和工作人员）周期性短缺。一线工作人员报告在实施身体距离措施和处理疑似 COVID-19 病例方面存在困难。我们发现报告的行为和实践之间存在差异，尤其是在持续使用口罩方面，尽管已经提供了口罩。一线工作人员认为 COVID-19 对他们的生活产生了负面影响。由于工作量大、社区的污名化以及担心感染和传播 COVID-19，他们感到疲劳和压力。
资源（人力和物力）不足影响了医疗保健设施支持和应对 COVID-19 的能力，一线工作人员可能需要社会心理支持来应对 COVID-19 大流行的影响。
