Impact of the COVID-19 pandemic on the functioning of front-line health services in the Kati health district in Mali, West Africa: A qualitative study

Abstract

Background

Front-line health services (FHSs) are the gateway to health systems. FHSs in Africa have been hit hard by the COVID-19 pandemic. In Mali, FHSs are provided by community health centres (Centres de Santé Communautaires (CSComs)). The objective of this study, which, to our knowledge, is the first of its kind in Mali, was to assess the impact of the COVID-19 pandemic on the functioning of CSComs within a health district.

Method

This qualitative case study was carried out in four CSComs in the Kati Health District in Mali. A three-dimensional analytical framework was designed and used. Data was collected from 24 key informants through semi-structured interviews. Thematic content analysis was performed, and Nvivo software was used.

Results

Data analysis showed that the COVID-19 pandemic impacted all dimensions of our analytical framework. Within the CSComs, the following were particularly impacted: 1) the management of activities with adaptations in the management of human and financial resources, infrastructure and equipment, the supply of inputs and medicines and the national health information system/surveillance; 2) the provision of curative, preventive and promotional health services; and 3) the interactions among stakeholders with little coordination of their actions.

Conclusion

This study offers insights into how to improve FHSs' resilience to crises. The results indicated dysfunction in routine health services, a decline in patients' use of them, and inadequate coordination among stakeholders. Despite their low level of preparedness, the CSComs were able to ensure continuity of care.