Prager Gabrielle, Hayek Heba, Fawad Muhammad, Nyakoojo Ronald, Kasozi Julius, Khalifa Adam Musa, Spiegel Paul, Altare Chiara
Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Johns Hopkins Center for Humanitarian Health, Baltimore, Maryland, United States of America.
PLOS Glob Public Health. 2025 May 8;5(5):e0004484. doi: 10.1371/journal.pgph.0004484. eCollection 2025.
Health system adaptations were rapidly introduced at the start of the COVID-19 pandemic to protect the public and maintain access to health services. Given the specific vulnerabilities of forced displacement settings, understanding which adaptations were used, how they were implemented, their success, and challenges is important for preparedness and response efforts. In this paper, we characterize adaptations in health service delivery implemented by Ministries of Health, the UN Refugee Agency, and partners to maintain health services provision for refugees in Jordan and Uganda. We conducted 21 key informant interviews with managerial and operational staff across 12 organizations who delivered healthcare services for refugees in Uganda and Jordan during the COVID-19 pandemic and applied a framework analysis to the adaptations characterized. The results are presented by WHO health system building blocks. Most adaptations focused on health service delivery specifically procedures for screening and isolation in the community, COVID-19 community support, and facility-level infection prevention measures. Health service delivery adaptations focused not only on ensuring capacity for COVID-19 patients but on adapting mechanisms to support access for those needing regular care. Many adaptations worked in tandem with others as packages to achieve this. Workforce adaptations included task shifting and staffing surges. Modifications related to medical products, vaccines, and technologies focused on procurement, medication management, supporting vaccine strategies, and building testing capacity. Adaptations in leadership and governance, financial and health information systems were identified but mainly described as essential enablers for other adaptations. Key enablers to successful adaptation in this context included the integration of refugees in National Health systems, strong relationships between partners and a supportive environment for adaptation, existing preparedness plans and access to financing. This study highlights the scale, scope and diversity of innovative adaptations implemented to maintain health services for refugees in Jordan and Uganda during the COVID-19 pandemic.
在新冠疫情初期，卫生系统迅速做出调整，以保护公众并维持医疗服务的可及性。鉴于被迫流离失所环境的特殊脆弱性，了解采用了哪些调整措施、如何实施这些措施、其成效以及面临的挑战，对于防范和应对工作至关重要。在本文中，我们描述了卫生部、联合国难民署及合作伙伴为维持约旦和乌干达难民的医疗服务而在医疗服务提供方面所做的调整。我们对12个组织中负责管理和运营的工作人员进行了21次关键信息人访谈，这些组织在新冠疫情期间为乌干达和约旦的难民提供医疗服务，并对所描述的调整措施进行了框架分析。结果按世界卫生组织的卫生系统组成部分呈现。大多数调整措施专门聚焦于医疗服务提供，特别是社区筛查和隔离程序、新冠社区支持以及机构层面的感染预防措施。医疗服务提供方面的调整不仅注重确保收治新冠患者的能力，还注重调整机制以支持有常规护理需求者获得服务。许多调整措施相互配合，形成一揽子方案来实现这一目标。人力方面的调整包括任务转移和人员激增。与医疗产品、疫苗和技术相关的调整主要集中在采购、药品管理、支持疫苗策略以及建立检测能力上。还确定了领导与治理、财务和卫生信息系统方面的调整，但主要将其描述为其他调整的必要推动因素。在此背景下，成功调整的关键推动因素包括将难民纳入国家卫生系统、合作伙伴之间的牢固关系以及有利于调整的支持性环境、现有的防范计划和获得融资的机会。本研究突出了在新冠疫情期间为维持约旦和乌干达难民的医疗服务而实施的创新调整措施的规模、范围和多样性。
