Table 2 Key mitigation strategies employed during COVID-19 and remaining gaps
Levels of Socio-ecological framework | Thematic area | Key mitigation strategies employed | Key gaps to address |
|---|---|---|---|
POLICY (national policymakers) | Rapid policy development | • Rapid guidelines development and implementation • Responsive feedback mechanisms and flexibility • Continual updating of policies/guidelines • Training on new policies conducted | • Top-down policy development process lack insight of healthcare workers and communities • Lack of specific guidance for neonates • Minimal funds to support training (Tanzania) |
|  | New collaborations and investment | • Pooled funding streams and new domestic funders • Government funds available for PPE • Local philanthropic funding calls/ community based assistance • Multi-sector collaborations (Education, health, WASH) | • Lack of specific funding allocations for SSNC • Limited cross departmental collaboration • Need to strengthen community engagement and participation |
HEALTH SYSTEM IMPLEMENTATION(mid-level managers)* | Information systems | • Enhanced demand for data • Electronic data shifts speeded up • Increased ownership and accountability of data at facility level | • Culture of data use missing • Lack of ownership of data at facility level • Insufficient equipment to support shift to electronic data (e.g. hardware) • Data not used in funding proposals |
|  | Devices | • Hastened roll out of O2 due to pandemic • New equipment/devices and oxygen systems • Shared O2 allocation decisions within and between hospitals • Good supply of PPE and handwashing devices/systems • Use of telemedicine for training of equipment • Pre-emptive planning for supplies (O2 etc) • Emphasis on planned preventive maintenance | • Lack of toolbox for equipment • Lack of locally available spare parts • Slow procurement process • Equipment shortages • Lack of training/ proper manuals • Minimal coordination between biomeds and clinicians • Lack of airtime for biomeds to support telemedicine |
FACILITY AND WARD SERVICE DELIVERY(facility implementers)* | Service delivery | • Stronger IPC focus • New ward layouts (inborn/outborn, by dependency, by COVID status) • New newborn wards created • Visitation times and numbers limited • Shift to telemedicine for follow up • Changes in opening hours | • Limited space in wards • Early discharge to community • Staff rotations |
|  | Human resources for health (HRH) | • Training on COVID-19 and IPC • Innovative training & troubleshooting (e.g., online, Whatsapp) • Financial support during COVID-19 • Use of locum staff/ students • Supervision/mentoring • Counselling services • Transport and insurance provided (Kenya) | • HRH shortages • Poor mentorship • HRH wellbeing support lacking • No clinician supervision structures • Few specialists • Need to train more biomeds • Shifts by experience (biomeds) • No vaccination offered to health staff (Malawi) |
COMMUNITY LEVEL | Community engagement | • Downward referrals for non-complicated deliveries • Proactive messaging to communities • Working with CHWs, community leaders to support messaging for SSNC and IPC | • Need to strengthen referral systems • Need to strengthen primary healthcare units – including equipment |