Table 2 Themes, Sub-themes and some quotations identified through interview with healthcare workers

Disruption i.e., change or drop in hospital attendance

Service distruption

“… For instance, at the clinic prior to the COVID-19 outbreak, the monthly patient load was 400. But since the COVID-19 outbreak in March, the monthly patients load ranges from 30 to 50, people are afraid to come to hospital …. The monthly admitted male patients used to be 45-50. Since COVID-19, we admitted 11 per month. … .and only 80 women delivered in the health facility instead of the average 150 women per month.” - D 20: Private HF, “We were receiving 2000 clients for vaccination monthly but dropped to 900 -1000 since COVID-19.” - D 27: Private HF.

Causes of health service disruption

Patient’s fear of being diagnosed with COVID

“Because of fear, some sick patients preferred to die at home rather than come to the health facility and were diagnosed with COVID.”- D 28: Public HF. “… “Very ill patients refuse to be referred to the county’s referral hospital due to the fear of being isolated and suspected to have COVID-19 disease.”- D 34: Private HF.

Prevent contracting infection by avoiding the health facility and health care workers

“… the closure of the health facility following a confirmed case of COVID-19 infection among health workers made the community members stigmatize health facility staff and refuse to seek health care in the health facility after reopening.” - D 3: Private HF, and D 33: Private HF

Perception that healthcare workers will inject them and their children with COVID-19 vaccine

. “… health workers have been given money to infect our children with COVID-19 vaccine.” - D 13: Public HF. “Parents are no longer bringing their children for vaccination, … they think that people are moving around vaccinating children with COVID-19 vaccine.” D 34: Private HF.

Recovery strategy from health service disruption

Health promotion and awreness creation

“… the hospital set up a health promotion team that went into the camps to educate the community dwellers, especially for pregnant women and children vaccination.” - D 26: Private HF, “The communities are now cooperating with us; they are attending the hospital with the help of health education and awareness. Before they will not attend the facility if they have signs and symptoms of COVID-19.” - D 16: Public HF

Reduce number of staff per shift

“… the health facility reduced the number of staff working per time on duty to prevent contacting COVID-19 infection.” - D 3: Public HF

Close and reschedule clinic attendance for patients

. “… we postponed TB Clinic for a week for us to come up with a strategy of scheduling patients and observe social distancing.” -D 39: Public HF.