Kawuma Rachel, Katongole Joseph, Menya Abdmagidu, Eoju Winnie, Kitonsa Jonathan, Gallagher Katherine, Watson-Jones Deborah, Ruzagira Eugene
Social science department, MRC/UVRI and LSHTM Uganda Research Unit, Entebbe, Uganda.
Uganda Virus Research Institute, Entebbe, Uganda.
PLOS Glob Public Health. 2025 Aug 18;5(8):e0005046. doi: 10.1371/journal.pgph.0005046. eCollection 2025.
Primary healthcare (PHC) systems are the first point of contact for healthcare users and are critical for disease prevention and early treatment. The COVID-19 pandemic overwhelmed PHC systems globally, including in sub-Saharan Africa, significantly impacting access to essential services. We describe the experiences of community PHC users' accessing and utilizing health services at 15 purposively selected health centers during the COVID-19 pandemic in Masaka district, southwestern Uganda. A qualitative study (13th-August-2021-4th-November-2021) was embedded with in a large investigation evaluating the impact of COVID-19 on PHC services across three African regions. We conducted 28 in-depth interviews (IDIs) and 2 focus group discussions (FGDs) among adult (females and males) healthcare users (aged ≥18 years). Data was analyzed by themes and charted against the Andersen's Behavioral Model for healthcare utilization. The analysis revealed that structural adjustments to enforce COVID-19 protocols, such as handwashing stations and reduced waiting times, were viewed positively. Facilitators of healthcare access included community sensitization, positive attitudes of health workers, and users' determination despite movement restrictions. However, barriers included fear of infection, medication shortages, reduced clinic hours, and the prioritization of COVID-19 care over other services. Participants adapted by obtaining travel permission letters and using herbal remedies when conventional care was inaccessible. Our key finding is that despite significant disruptions to PHC services during the COVID-19 pandemic, healthcare users demonstrated resilience in accessing care. However, systemic challenges, such as workforce shortages and limited essential medical supplies, highlighted vulnerabilities within the PHC system. Addressing these structural barriers and investing in more resilient and adaptive healthcare systems is crucial for ensuring equitable access to essential health services during future public health crises.
初级卫生保健（PHC）系统是医疗保健使用者的首个接触点，对疾病预防和早期治疗至关重要。新冠疫情使全球包括撒哈拉以南非洲地区的初级卫生保健系统不堪重负，严重影响了基本服务的可及性。我们描述了在乌干达西南部马萨卡区新冠疫情期间，15个经过有目的选择的卫生中心的社区初级卫生保健使用者获取和利用卫生服务的经历。一项定性研究（2021年8月13日至2021年11月4日）嵌入了一项大型调查，该调查评估了新冠疫情对三个非洲地区初级卫生保健服务的影响。我们对成年（女性和男性）医疗保健使用者（年龄≥18岁）进行了28次深入访谈（IDI）和2次焦点小组讨论（FGD）。数据按主题进行分析，并对照安徒生医疗保健利用行为模型绘制图表。分析表明，为执行新冠疫情防控措施而进行的结构调整，如设置洗手站和减少等候时间，得到了积极评价。医疗保健可及性的促进因素包括社区宣传、医护人员的积极态度以及使用者在行动受限情况下的决心。然而，障碍包括对感染的恐惧、药品短缺、门诊时间减少以及将新冠疫情护理置于其他服务之上的优先安排。参与者通过获取旅行许可信并在无法获得常规护理时使用草药疗法来进行调整。我们的主要发现是，尽管在新冠疫情期间初级卫生保健服务受到重大干扰，但医疗保健使用者在获取护理方面表现出了韧性。然而，劳动力短缺和基本医疗用品有限等系统性挑战凸显了初级卫生保健系统内部的脆弱性。解决这些结构性障碍并投资建设更具韧性和适应性的医疗保健系统，对于在未来公共卫生危机期间确保公平获得基本卫生服务至关重要。
