Actions and Adaptations Implemented for Maternal, Newborn and Child Health Service Provision During the Early Phase of the COVID-19 Pandemic in Lagos, Nigeria: Qualitative Study of Health Facility Leaders

Abstract

Background:The early phase of the COVID-19 pandemic led to significant disruptions in provision of maternal, newborn, and child health (MNCH) services, especially in low-and middle-income countries (LMICs) with fragile health systems, such as Nigeria. Measures taken to 'flatten the curve' such as lockdowns, curfews, travel restrictions, and suspension of public services inadvertently led to significant disruptions in provision of essential health services. In these countries, health facility leaders are directly responsible for driving changes needed for service delivery.Objective: To explore perspectives of health facility leaders in Lagos, Nigeria, on solutions and adaptations implemented to support MNCH service provision during the early phase of the COVID-19 pandemic.Methods: Key informant interviews were remotely conducted with purposively sampled 33 health facility leaders across primary, secondary, and tertiary public health facilities in Lagos between July and November 2020. Following verbatim transcription of recordings, data familiarization, and coding, thematic analysis was used to synthesize data.Results: Health facility leaders scaled down or discontinued outpatient MNCH services and elective surgeries. However, deliveries, newborn, immunization, and emergency services continued. Service provision was reorganized with long and staggered patient appointments, collapsing of wards and modification of health worker duty rosters. Some secondary and tertiary facilities leveraged technology like WhatsApp, webinars, and telemedicine to support service provision. Continuous capacity-building for health workers through training, motivation, psychological support, and atypical sourcing of PPE was instituted to be able to safely maintain service delivery.

Resilience of primary healthcare system across low- and middle-income countries during COVID-19 pandemic: a scoping review

“…Evidence from Kenya, Maldives, Pakistan, and Sri Lanka revealed the availability of PPE being ensured in PHC facilities [ 24 , 28 , 45 – 48 ] to safeguard the continuity of health services [ 36 ]. The LMICS including Cameroon, Ethiopia, Maldives, Myanmar, Morocco, Nepal, Nigeria, South Africa, and Yemen documented measures to ensure the availability of essential medicines, equipment, and supplies at the facility level during the COVID-19 pandemic [ 24 , 28 , 31 , 34 , 43 ].…”

Parental Acceptance, Parental Hesitancy, and Uptake of Seasonal Influenza Vaccination among Children Aged 6–59 Months: A Systematic Review and Meta-Analysis

“…Several studies were conducted during the COVID-19 pandemic attempting to maintain or enhance children’s vaccination. These studies suggested using innovative approaches may be useful strategies for the post-pandemic period, such as using utilizing online technologies to remind parents and update them parents about their children’s vaccination status and remind them about the vaccination schedule [ 67 , 68 , 69 ], providing phone counselling interventions for children’s vaccination in parents [ 70 ], using telemedicine to provide necessary health information to assist parents in achieving self-efficacy and making decisions for their children’s vaccination [ 67 , 68 , 69 , 70 , 71 , 72 , 73 ], and using a chatbot real-time consultation messenger service to increase in parents’ motivation and self-efficacy to vaccinate their children [ 73 ].…”

Leading in a time of crisis: exploring early experiences of health facility leaders during the COVID-19 pandemic in Nigeria’s epicentre

“…Leaders needed to apply a more transformational style of leadership which meant that they worked with staff to identify their needs and how best to support them while creating a vision to guide the change in approach to service delivery which was critically needed during the early part of the COVID-19 pandemic. Providing support for transportation, communication and feeding requirements during this time while managing the anxieties of the staff through use of personal direct phone calls, direct motivation, provision of the then hard-to-source PPE and psychological support classes were some of the strategies that health leaders used in Lagos (Balogun et al , 2022). However, while many HCWs were beneficiaries of some of these efforts, many issues and cause of anxieties remained unaddressed (Ameh et al , 2021).…”

“…However, while many HCWs were beneficiaries of some of these efforts, many issues and cause of anxieties remained unaddressed (Ameh et al , 2021). Ultimately, the capacity of leaders to provide robust support to staff depends on the resources available to them and health leaders who were able to provide more robust support in Lagos were those that had been building capacity for such crisis pre-pandemic (Balogun et al , 2022). Moreover, it has been widely reported that health systems in Africa were inadequately prepared for the pandemic (Tessema et al , 2021).…”