ArticleBMJ open2022
Qualitative study exploring lessons from Liberia and the UK for building a people-centred resilient health systems response to COVID-19.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Mapping factors associated with health system resilience against large-scale infectious disease outbreaks: a qualitative study in China.BMC public health · 2026Article
- Resilience of health systems in Africa to infectious disease shocks: A qualitative evidence synthesis.PLOS global public health · 2026Article
- "…considered 'essential workers', so we report to work and serve the community": experiences of community health workers during COVID-19 pandemic in the Eastern Cape, South Africa.BMC health services research · 2024Article
- Factors of Power and Equity: Enhancing Our Health System Resilience Research Frameworks Comment on "Re-evaluating Our Knowledge of Health System Resilience During COVID-19: Lessons From the First Two Years of the Pandemic".International journal of health policy and management · 2024Article
- The rise of resilient healthcare research during COVID-19: scoping review of empirical research.BMC health services research · 2023Article
- Perceived impacts of COVID-19 responses on routine health service delivery in Liberia and UK: cross-country lessons for resilient health systems for equitable service delivery during pandemics.BMC health services research · 2023Article
- Exploring the impact of COVID-19 on frontline health workers through a photovoice study in Kaduna, Kwara and Ogun States, Nigeria.International health · 2023Article
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Authors and funding
25 authors.
Funding
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Abstract
introductionCOVID-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.
methodsWe 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.
resultsStudy 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.
conclusionOur 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.
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