University of Ibadan, Ibadan, Nigeria.
The Global Financing Facility for Women, Children, and Adolescents, 1818 H ST NW, Washington, DC, 204333, USA.
BMC Health Serv Res. 2024 May 14;24(1):625. doi: 10.1186/s12913-024-11072-2.
The COVID-19 pandemic control strategies disrupted the smooth delivery of essential health services (EHS) globally. Limited evidence exists on the health systems lens approach to analyzing the challenges encountered in maintaining EHS during the COVID-19 pandemic. This study aimed to identify the health system challenges encountered and document the mitigation strategies and adaptations made across geopolitical zones (GPZs) in Nigeria.
The national qualitative survey of key actors across the six GPZs in Nigeria involved ten states and the Federal Capital Territory (FCT) which were selected based on resilience, COVID-19 burden and security considerations. A pre-tested key informant guide was used to collect data on service utilization, changes in service utilization, reasons for changes in primary health centres' (PHCs) service volumes, challenges experienced by health facilities in maintaining EHS, mitigation strategies implemented and adaptations to service delivery. Emerging sub-themes were categorized under the appropriate pillars of the health system.
A total of 22 respondents were interviewed. The challenges experienced in maintaining EHS cut across the pillars of the health systems including: Human resources shortage, shortages in the supply of personal protective equipments, fear of contracting COVID-19 among health workers misconception, ignorance, socio-cultural issues, lockdown/transportation and lack of equipment/waiting area (. The mitigation strategies included improved political will to fund health service projects, leading to improved accessibility, affordability, and supply of consumables. The health workforce was motivated by employing, redeploying, training, and incentivizing. Service delivery was reorganized by rescheduling appointments and prioritizing some EHS such as maternal and childcare. Sustainable systems adaptations included IPC and telehealth infrastructure, training and capacity building, virtual meetings and community groups set up for sensitization and engagement.
The mitigation strategies and adaptations implemented were important contributors to EHS recovery especially in the high resilience LGAs and have implications for future epidemic preparedness plans.
COVID-19 大流行的防控策略在全球范围内扰乱了基本卫生服务（EHS）的顺利提供。关于从卫生系统角度分析 COVID-19 大流行期间维持 EHS 所面临的挑战，相关证据有限。本研究旨在确定在尼日利亚各地缘政治区域（GPZ）遇到的卫生系统挑战，并记录所采取的缓解策略和适应措施。
对尼日利亚六个 GPZ 中关键参与者的国家定性调查涉及十个州和联邦首都特区（FCT），这些州和地区是根据弹性、COVID-19 负担和安全考虑因素选择的。使用经过预测试的关键信息提供者指南收集有关服务利用、服务利用变化、初级保健中心（PHC）服务量变化的原因、卫生设施在维持 EHS 方面遇到的挑战、实施的缓解策略和服务提供的适应措施的数据。新出现的子主题归入卫生系统的适当支柱下。
共访谈了 22 名受访者。维持 EHS 所面临的挑战涉及卫生系统的各个支柱，包括：人力资源短缺、个人防护设备供应短缺、卫生工作者对 COVID-19 的恐惧、误解、社会文化问题、封锁/交通和缺乏设备/等候区。缓解策略包括改善为卫生服务项目供资的政治意愿，从而提高可及性、负担能力和消耗品供应。通过雇用、重新部署、培训和激励来激励卫生工作者。通过重新安排预约和优先考虑某些 EHS（如母婴保健）来重新组织服务交付。可持续系统适应措施包括感染预防和控制以及远程医疗基础设施、培训和能力建设、虚拟会议以及为宣传和参与而设立的社区团体。
实施的缓解策略和适应措施是 EHS 恢复的重要贡献者，特别是在高弹性地方政府区域，对未来的大流行防范计划具有启示意义。
