Table 1
Individual characteristics of respondents.
| PARTICIPANT | SEX | ROLE | HEALTH FACILITY TYPE | URBAN/RURAL | YEARS IN ROLE |
|---|---|---|---|---|---|
| P1 | Female | HOD Paediatrics | Tertiary | Urban | 6 months |
| P2 | Male | Medical Officer of Health | PHC | Rural | 3 years |
| P3 | Female | Apex Nurse | Secondary | Rural | 12 years |
| P4 | Female | Apex Nurse | PHC | Rural | 4 years |
| P5 | Female | Apex Nurse | PHC | Urban | 2 years |
| P6 | Female | HOD Nursing | Tertiary | Urban | 4 years |
| P7 | Male | HOD Obstetrics & Gynaecology | Tertiary | Urban | 6 months |
| P8 | Male | HOD ART | Tertiary | Urban | 16 years |
| P9 | Female | HOD Nursing | Tertiary | Urban | 3 years |
| P10 | Female | HOD Obstetrics & Gynaecology | Tertiary | Urban | 2 years |
| P11 | Female | Medical Director | Secondary | Rural | 2 months |
| P12 | Female | Medical Director | Secondary | Rural | 3 months |
| P13 | Female | Medical Director | Secondary | Urban | 10 months |
| P14 | Male | Medical Director | Secondary | Urban | 3 years |
| P15 | Male | Medical Officer of Health | PHC | Rural | 1 year |
| P16 | Female | Medical Officer of Health | PHC | Urban | 4 years |
| P17 | Female | Medical Officer of Health | PHC | Urban | 12 years |
| P18 | Male | HOD PMTCT | Tertiary | Urban | 17 years |
| P19 | Female | DCST | Secondary | Urban | 9 months |
| P20 | Female | Apex Nurse | Secondary | Urban | 3 years |
| P21 | Female | Apex Community Health Officer | PHC | Rural | 4 years |
| P22 | Female | Apex Nurse | Secondary | Rural | 4 years |
| P23 | Male | CMAC | Tertiary | Urban | 2 years |
| P24 | Male | HOD Community Health | Tertiary | Urban | 1 year |
| P25 | Female | HOD Paediatrics | Tertiary | Urban | 2 years |
| P26 | Female | Officer in Charge | PHC | Rural | 2 years |
| P27 | Female | Medical Officer of Health | PHC | Urban | 10 years |
| P28 | Female | HOU Neonatology | Tertiary | Urban | 10 years |
| P29 | Male | CMAC | Tertiary | Urban | 2 years |
| P30 | Female | Head Child ART | Tertiary | Urban | 18 years |
| P31 | Male | HOD Community Health | Tertiary | Urban | 7 months |
| P32 | Male | Medical Director | Secondary | Urban | 1½ years |
| P33 | Female | Apex Nurse | PHC | Urban | 2 years |
[i] HOD/HOU – Head of department/Unit; DCST: Director Clinical Training and Services; CMAC: Chairman Medical Advisory Committee; ART: Anti-Retroviral Therapy program.
Table 2
Illustrative quotes for theme 1.
| THEME 1 – SCALING DOWN AND DISCONTINUING CERTAIN MNCH SERVICE DELIVERY |
|---|
| “Before the lockdown, we scaled down activities at the clinic. We stopped regular outpatient clinic and attended mainly to emergencies. This affected both obstetric and gynaecological practices. During the lockdown, the same thing prevailed, and we are only attending to emergencies, no regular clinic and no electives… we also have to scale down the number of doctors and nurses that were around at any particular time” [P23, male, CMAC, urban tertiary facility, two years in role]. |
| “We have a vibrant neonatal service, so we had a lot of premature babies that were in incubators, women still gave birth, they still had childhood problems, newborn issues, and prematurity issues so we kept on admitting and seeing patients” [ P13, female, MD, urban secondary facility, ten months in role]. |
| “Now the immunisation clinic was never closed. It ran throughout the lockdown and is still running now” [P23 male, CMAC, urban tertiary facility, two years in role]. |
| “We could not run any of the outpatient clinics. The gynae clinic, antenatal clinic, and the immunization clinic were affected. We opened the immunization clinic shortly. However, delivery and emergency services continued during that first month of April. From May, all services resumed except the gynaecological clinic, which did not open until about July” [P32 male, MD, urban secondary facility, one year and six months in role]. |
| “You know before lockdown even when you come for clinic whether maternal, whether ante-natal clinic or child welfare clinic. We used to give them health talk but during lockdown no health talk. When they come in, we attend to them they leave. When they come in, we attend them, to them, they leave” [P4 female, Apex Nurse, urban primary health care facility, four years in role]. |
| “Outreach services were affected, because people did not really want to come out and also, you know, limited transportation affected” [P16. female, Medical Officer of Health, urban primary health care facility, four years in role]. |
| “Initially, General Hospital B was shut down because of the incidence of COVID-19 cases. This caused more work to us at PHC E. Patients were trooping in. Though we tried to maintain all the precautions… I mean even in the month of April, we had 82 deliveries, which is not normal” [P26, female, officer-in-charge, peri-urban primary health care facility, two years in role]. |
Table 3
Illustrative quotes for theme 2.
| THEME 2 – REORGANIZING SERVICE PROVISION |
|---|
| “We tried to limit the number of people who were coming around to ensure that there was good social distancing. We staggered appointments and gave long appointment dates for non-emergencies” [P14, male, MD, urban secondary facility, three years in role]. |
| “We did catch-up immunization. For example, those who are supposed to have received the vaccine at six weeks, some of them came at ten weeks and then we continued the cycle” [P24, male, HOD, urban tertiary facility, one year in role]. |
| “The management introduced a kind of triage where people are screened before they even come into the hospital. They introduced the washing of hands, the use of hand sanitizer, the use of facemask” [P18, male, HOD PMTCT, urban tertiary facility, 17 years in role]. |
| “For our nurses, we had to reschedule our roster so that we are not all exposed at the same time. We had some days that we don’t come and days we had to come. Throughout that period, there were nursing services available for every patient at the hospital” [P9, female, HOD Nursing, urban tertiary facility, three years in role]. |
| “We adjusted our roster, so that our staff will come in and do 24 hours. They will then go home for four days. So that is how we were able to scale through that intense period of COVID-19” [P6, female, HOD Nursing, urban tertiary facility, four years in role]. |
| “[To ensure sufficient social distancing], we shut down about half of the wards. So, what I mean is that we have four wards for older children and three wards for younger children. These three wards are divided into two, we have neonatal unit, and we have the post neonatal unit. During the lockdown, we shut down the post neonatal unit and collapsed the neonatal with post neonatal unit. Then the four wards were collapsed to just one ward, so most of the patients were managed in the emergency room and were discharged from the emergency room. Only those that needed follow up care were transferred to the wards” [P19, female, Director Clinical Training and Services, urban secondary facility, nine months in role]. |
Table 4
Illustrative quotes for theme 3.
| THEME 3: LEVERAGING TECHNOLOGY FOR SERVICE PROVISION |
|---|
| “We went to the extent of having our own WhatsApp with our mothers in the ANC where staff related to mothers if they cannot come to the hospital. If they had any problem with their children, that’s a platform where they made their problem known and suggestions are giving there by doctors and nurses” [P22, female, Apex Nurse, rural secondary facility, four years in role]. |
| “We had to refer some of the patients to our website, where they could get some information to guide them on their condition… on our WhatsApp group for our pregnant women, we continued to engage them with health talks, and we were also inviting them to some webinars” [P32, male, MD, urban secondary facility, one year and six months in role]. |
| “We reached out to them by phone calls, which was done by several people and then I called somebody else called the same person, it was done and at least it achieved the goal of the calls because many of them responded” [P32, male, MD, urban tertiary facility, one year and six months in role]. |
| “The pandemic exposed our weak health information management system. Our records are not electronic, most of them are paper-based and incomplete. Even when we tried to reach patients by phone, it was a challenge. Some was either a wrong number was given, or the numbers were not correctly inputted” [P25, female, HOD Paediatrics, urban tertiary facility, two years in role]. |
| “Sometimes you know you call; they won’t pick it. Maybe it’s not theirs, it’s their husband’s phone number they put down or sometimes their own phone is not working, you try to call them it doesn’t go. Some went through and you’ll be able to encourage them to come especially when they’ve missed their clinic” [P18, male, HOD PMTCT, urban tertiary facility, 17 years in role]. |
| “The only problem is that some of the patients were of low socio-economic level and so some of them did not have phones that can actually do some functions like WhatsApp. Their phones are the cheap ones that can only either call or text, which comes at a cost” [P32, male, MD, urban secondary facility, one year six months in role]. |
Table 5
Illustrative quotes for theme 4.
| THEME 4: SOURCING OF RESOURCES FOR SERVICE PROVISION |
|---|
| “PPE is not regular at all. I will be point blank and plain to you. They said they are coming to give us this PPE. I think they gave us five [Hazmat suits] (laughs)… Then they gave us sanitizer, liquid hand wash, nose mask. They found it difficult to give us and you know the hospital is not making much money. The PPE they gave us from central place from Lagos state, it wasn’t enough at all” [P22, female, Apex Nurse, rural secondary facility, four years in role]. |
| “Because we didn’t keep quiet when they didn’t supply us. We began to fight them, that they must supply this PPEs by fire, by force. Maybe you [the leadership] will go and look for it, maybe you [the leadership] will go and buy it. I think with that we were able to scale through the risky period” [P20, female, Apex Nurse, urban secondary facility, 3 years in role]. |
| “During the lockdown they [government] didn’t provide enough for us. The little one they bring we use it and when it finishes, we have to get it by ourselves. They didn’t use to supply us enough” [P21, female, CHO, rural PHC, four years in role]. |
| “Well, we didn’t really have many challenges with PPE stock out. Since February, when we got a wind that the global pandemic started, basically, we doubled up on our supplies. Because usually what we get for a month, we ordered for two months. So, we bought ahead and had lots of supplies for routine work” [P32, male, MD, urban tertiary facility, one year and six months in role]. |
| “Luckily for us people started donating these things [PPE] especially facemasks and surgical masks. We had some donors that gave us face shield… by that time things got improved” [P3, female, HOD Nursing, urban tertiary hospital, four years in role]. |
| “We informed the executive chairman [of the Local Government] at that time and he provided some funds for facemask, gloves and other PPEs” [P15, male, MOH, rural PHC, one year in role]. |
| “When we now had to restock, the prices of commodity had gone up. So, we even had to change some of our suppliers and do direct purchase because we know that there is a mark-up with them [suppliers]. So, we went into the market with our procurement committee to get some of the PPEs ourselves and that was able to save us some cost, even though it was still a bit higher than what we normally use to get” [P32, male, MD, urban secondary facility, one year and six months in role]. |
Table 6
Illustrative quotes for theme 5.
| THEME 5: BUILDING CAPACITY OF HEALTH WORKERS FOR CRISIS |
|---|
| “Well, the first challenge was the anxiety, because there was a lot of anxiety and a lot of concern about their own safety. But through rigorous IPC training, generally reassuring them round and provision of PPEs, these kind of got them onboard” [P32, male, MD, urban secondary facility, one year six months in role]. |
| “We have done training for all departments on infection prevention and control, from clinical staff to cleaners. Because it’s a chain, so we must… even if the cleaner is infected, they can infect everybody in the team. So, everybody had to be trained. And we have also provided the required PPE” [P24, male, HOD, urban tertiary facility, one year in role]. |
| “Initially, they [health workers] thought that they had to wear the Hazmat suit for everything, so the COVID-19 response committee came up with what we called judicious use of PPEs. Knowing what PPE to use at what point in time, in terms of patient care. The training was well-taken up by members of staff. So that made it easier for us to stretch our PPEs” [Male, MD, urban secondary facility, one year and six months in role]. |
| “So, we also had a guideline to assist the staff to know what level of PPE they will require for specific activities. These guidelines were pasted around the hospital at specific places for health workers” [P23, male, CMAC, urban tertiary facility, two years in role]. |
| “We all started wearing scrubs, we all were meticulous about washing our hands, putting on our face mask, head gear, and goggles. We were doing that during lock down. Post lock down we are still doing that” [P19, female, DCST, urban secondary facility, nine months in role]. |
| “What we did was to leverage our department of psychiatry partnering with an NGO and then set up a dedicated team that was ready to listen to staff on phone twenty-four seven (24/7) to provide psychological support to staff [of the facility]. This was satisfactory utilised by staff” [P23, male, CMAC, urban tertiary facility, two years in role]. |