In order to rapidly respond to the exponential increase in hospitalisations due to complications of COVID 19 infection, health care systems need to distort their functioning; this will take different forms in different contexts. Patients with chronic conditions are those at most risk of falling out of the health care systems. Given the increased risk of severe illness and death from C19 infection experienced by patients with underlying health issues, there is need for rapid advancement of new methods of service provision, which safely allow patients to continue to utilise health services. This involves shifting to new approaches including telemedicine, phone consultations and strategies to support care within households and communities. Our research project brings together social science and health systems researchers, and applies health systems models to understand short- and long-term impacts of C19 on routine functions of health systems. We will undertake rapid health systems assessments in Liverpool and selected countries in West Africa to produce guidance for healthcare implementers about good practices that can avoid making existing health inequalities worse.

We will explore the perspectives of health care workers employed directly in the C19 response and those working in other key areas of the health system (for example governance actors, laboratory scientists, and health staff working on maternal and child health, and ‘at risk’ patients with chronic conditions). We will explore decision making processes in contexts of scarcity and seek to understand how ethical guidelines are operationalised at the front line of the C19 response and across the health system. We will focus on: (1) Ethics and decision making and processes; (2) The impact of C19 on distortions in equity of routine health care delivery including laboratory and blood transfusion services. We will document adjustments that have been made to maintain routine service delivery and explore the key impacts of decision making on the health workforce. We will work closely with policy makers and front-line staff to develop useful, evidence-based guidance and resource documents to inform the health systems response and to support governance and accountability to promote equity in decision making.

This implementation health systems research responds directly to questions emerging from senior health workers on the frontline of the response in Merseyside and Sub-Saharan Africa and is designed to complement five other areas in the overarching C19 social science research programme which is led by Prof Sally Sheard at the University of Liverpool. This project emerged from Miriam Taegtmeyer’ s clinical C19 experience and brings together researchers from LSTMs Centres for Health Systems Strengthening and Capacity Research. Co-leads are Laura Dean, Imelda Bates, Lucy Frith (UoL), Sally Theobald and Miriam Taegtmeyer together with Joanna Raven; Rachel Tolhurst; Tim Martineau; Kim Ozano; Russ Dacombe with inputs from Taghreed El-Hajj; Yan Ding; Natasha Price; Helen Piotrowski; Victoria Watson; Rozi McCollum; Shahreen Chowdhury, Abiola Aiyenigba and Rachel Anderson de Cuevas.

If you have any queries please email arcnwc@liverpool.ac.uk