Challenges faced by health policymakers responding to COVID-19 in remote communities in Northwest Territories, Canada.

The health systems' response to the COVID-19 pandemic controlled the virus's spread but exposed fragmented systems and operational challenges globally. Understanding these issues is essential for enhancing health system capabilities and improving future pandemic responses. This study explored the perspectives of health policymakers in Northwest Territories (NWT), Canada, on the challenges to responding to COVID-19 and implementing the necessary public health measures in the jurisdiction. This study utilized a qualitative descriptive design and a community-based participatory research approach. Framework analysis, guided by the World Health Organization's Health Emergency and Disaster Risk Management framework, was used for data analysis. The Consolidated Criteria for Reporting Qualitative Research were followed. Convenience sampling was used to recruit policymakers working in NWT. Data were collected between June and August 2021 from 65 policymakers using semi-structured interviews. Participants worked in territorial (71.7%), regional (14.3%), and community (14.3%) organizations. Four themes were identified: governance (e.g. unclear roles and responsibilities, policy lag, and limited community consultation), public risk communication (e.g. complexity of information and language barriers), community-level (e.g. community's distrust of the health system and geographic barriers), and health system challenges (e.g. limited human resource capacity and material resources, absence of robust information systems). To build a resilient health system in NWT for future pandemics, it is essential to define roles and responsibilities, collaborate with healthcare providers and community leaders, develop efficient data infrastructure, and enhance system capacity. Effective communication and fostering trust between the government and communities are important.