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Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19

McCollum, Rosalind, Zaizay, Zeela, Dean, Laura ORCID:, Watson, Victoria, Frith, Lucy, Alhassan, Yussif ORCID:, Kollie, Karsor, Piotrowski, Helen, Bates, Imelda ORCID:, Anderson de Cuevas, Rachel, Harris, Rebecca, Chowdhury, Shahreen, Berrian, Hannah, Smith, John Solunta, Tate, Wede Seekey, El Hajj, Taghreed ORCID:, Ozano, Kim, Hastie, Olivia, Parker, Colleen, Kollie, Jerry, Zawolo, Georgina, Ding, Yan ORCID:, Dacombe, Russell ORCID:, Taegtmeyer, Miriam ORCID: and Theobald, Sally ORCID: (2022) 'Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19'. BMJ Open, Vol 12, Issue 8, e058626.

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Introduction: COVID-19 has tested the resilience of health systems globally and exposed existing strengths and weaknesses. We sought to understand health systems COVID-19 adaptations and decision making in Liberia and Merseyside, UK.
Methods: We used a people-centred approach to carry out qualitative interviews with 24 health decision-makers at national and county level in Liberia and 42 actors at county and hospital level in the UK (Merseyside). We explored health systems’ decision-making processes and capacity to adapt and continue essential service delivery in response to COVID-19 in both contexts.
Results: Study respondents in Liberia and Merseyside had similar experiences in responding to COVID-19, despite significant differences in health systems context, and there is an opportunity for multidirectional learning between the global south and north. The need for early preparedness; strong community engagement; clear communication within the health system and health service delivery adaptations for essential health services emerged strongly in both settings. We found the Foreign, Commonwealth and Development Office (FCDO) principles to have value as a framework for reviewing health systems changes, across settings, in response to a shock such as a pandemic. In addition to the eight original principles, we expanded to include two additional principles: (1) the need for functional structures and mechanisms for preparation and (2) adaptable governance and leadership structures to facilitate timely decision making and response coordination. We find the use of a people-centred approach also has value to prompt policy-makers to consider the acceptance of service adaptations by patients and health workers, and to continue the provision of ‘routine services’ for individuals during health systems shocks.
Conclusion: Our study highlights the importance of a people-centred approach, placing the person at the centre of the health system, and value in applying and adapting the FCDO principles across diverse settings.

Item Type: Article
Subjects: WA Public Health > WA 20.5 Research (General)
WA Public Health > WA 30 Socioeconomic factors in public health (General)
WA Public Health > Health Administration and Organization > WA 540 National and state health administration
WC Communicable Diseases > Virus Diseases > Viral Respiratory Tract Infections. Respirovirus Infections > WC 506 COVID-19
Faculty: Department: Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI):
SWORD Depositor: JISC Pubrouter
Depositing User: JISC Pubrouter
Date Deposited: 18 Oct 2022 14:49
Last Modified: 13 Jun 2023 10:25


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