Healthcare workers' beliefs, practices and experiences regarding the COVID-19 pandemic and resulting governance from preparedness and response plans in Faranah, Guinea.

There is a growing interest in the implementation of people-centered components within outbreak preparedness and response plans and their resulting governance. Information on this topic still remains scarce, particularly in settings such as Guinea in West Africa. In the context of COVID-19, we conducted 21 qualitative interviews with healthcare workers (HCWs) from the Faranah Regional Hospital in Guinea to explore pandemic preparedness and response adherence. We also analyzed corresponding senses of vulnerability and risk, information sources, perceived information reliability, associated rumors and previous outbreak experiences. To achieve a broader analysis, we employed the "therapeutic landscape" concept, which conceives health provision as a process constructed through practices, beliefs and experiences. A recurring theme across the interviews was the abundance of information, which caused confusion mainly due to rumors and a lack of trust in the country's health system. Initial fear gradually diminished due to the disease's low mortality rate in the country. HCWs described preparedness enforcement in the city of Faranah that started strongly but gradually relaxed over time. This waning of enforcement marked a difference between the city and the hospital. HCWs appraised the first positive case declaration in the city to be the most significant moment, followed by a strong community reaction hindering the pandemic governance. We conclude that preparedness and response plans must better situate their interventions socially and devote more structural efforts to incorporating the social landscapes of diseases and outbreaks. Incorporating these social landscapes facilitates an understanding of the operational barriers to people-centered approaches. It also serves as an indicator for strengthening infodemic detection and management. Responses should therefore consider 1) hospitals applying different pandemic understandings that transcend biomedical and scientific orders, and 2) HCWs as portraying shifting pre-existing identities leading to marked in-/out-group distinctions, which directly influence healthcare, risk perception, and information and rumor management.