How interventions to maintain services during the COVID-19 pandemic strengthened systems for delivery of maternal and child health services: a case-study of Wakiso District, Uganda

ABSTRACT

Background

Health systems are resilient if they absorb, adapt, and transform in response to shocks. Although absorptive and adaptive capacities have been demonstrated during the COVID-19 response, little has been documented about their transformability and strengthened service delivery systems. We aimed to describe improvements in maternal and child health service delivery as a result of investments during the COVID-19 response.

Methods

This was a descriptive case study conducted in Wakiso District in central Uganda. It included 21 nurses and midwives as key informants and 32 mothers in three focus group discussions. Data were collected using an interview guide following the Systems Engineering Initiative for Patient Safety theoretical framework for service delivery.

Results

Maternal and child health service delivery during the pandemic involved service provision without changes, service delivery with temporary changes and outcomes, and service delivery that resulted into sustained changes and outcomes. Temporary changes included patient schedule adjustments, community service delivery and negative outcomes such as increased workload and stigma against health workers. Sustained changes that strengthened service delivery included new infrastructure and supplies such as ambulances and equipment, new roles involving infection prevention and control, increased role of community health workers and outcomes such as improved workplace safety and teamwork.

Conclusions

In spite of the negative impact the COVID-19 pandemic had on health systems, it created the impetus to invest in system improvements. Investments such as new facility infrastructure and emergency medical services were leveraged to improve maternal and child health services delivery. The inter-departmental collaboration during the response to the COVID-19 pandemic resulted into an improved intra-hospital environment for other service delivery. However, there is a need to evaluate lessons beyond health facilities and whether these learnings are deliberately integrated into service delivery. Future responses should also address the psychological and physical impacts suffered by health workers to maintain service delivery.

KEYWORDS:

• COVID-19
• emergencies
• service delivery
• child health
• maternal health
• health system

Responsible Editor Maria Nilsson

Responsible Editor Maria Nilsson

Acknowledgments

We thank all individuals who participated in this study including the key informants and mothers in the focus group discussions. We are also grateful to Amina Nambuusi who supported the data collection process.

Authors’ contributions

SNK and RKW were involved in the conceptualization of the study. SNK and HL conducted the data analysis and synthesis of findings. RKW, NR, JMS, TA and HL provided technical oversight and supervision of the implementation of the study. SNK wrote the first draft of the manuscript. All authors reviewed and approved the final version of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Ethics and consent

All key informants provided consent prior to participating in the study. We obtained ethical approval from the Makerere University School of Public Health Higher Degrees Research and Ethics Committee (HDRC #903) and was registered the study with the Uganda National Council for Science and Technology (UNCST #HS1121ES). The District Health Office, Wakiso District also approved the study to be conducted in the district.

Paper context

The COVID-19 pandemic had a negative impact on health systems globally. Little is documented about lessons from the response that informed recovery. This paper reports that the COVID-19 response in Uganda was associated with improvements in the delivery of maternal and child health services such as improved infrastructure and new service delivery strategies. This work contributes to health system resilience research and how this can be integrated into public health emergency preparedness and response efforts.

Data availability statement

The dataset used for analysis can be availed upon reasonable request by writing an email to the corresponding author.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/16549716.2024.2314345.

Additional information

Funding

Financial support for this study was obtained from the Bill and Melinda Gates Foundation. The views, opinions, and content of this publication are those of the authors and do not necessarily reflect the views, opinions, or policies of the Bill and Melinda Gates Foundation. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.