Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines

BACKGROUND

Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic.

METHODS

Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach.

RESULTS

We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation.

CONCLUSION

Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.

Utilizing Technology during the COVID-19 Pandemic

National lockdowns and social distancing measures enforced in response to COVID-19 have forced many non-governmental organizations (NGOs) serving in low- and middle-income countries (LMICs) to suspend their operations. While low-income families continue to suffer from hunger and poverty, community quarantine restrictions additionally isolated them from town centers where healthcare, education, food, supplies, and livelihood opportunities are usually accessed. International Care Ministries (ICM) is a Philippine-based NGO that runs a poverty-alleviation program targeted towards extreme low-income households. As we re-evaluated how we may continue to effectively minister and serve our communities despite lockdown measures, we identified two priorities: (1) to serve people’s physical needs by providing food and access to healthcare, and (2) to serve people’s spiritual needs through spiritual feeding and community. In this field report, we describe how ICM was able to identify and use social network platforms as an alternative to continue both service delivery and spiritual feeding remotely. We hope this example may encourage other development NGOs to persevere as we all continue to seek ways to adapt to these extraordinary and seemingly ever-changing circumstances.