Table 1 Summary of findings

Perceived benefits

of guides

Management of COVID cases

• Improved diagnosis skills and IPC(CHC)

• Improved triaging of patients (CHC)

• Improved diagnosis, IPC and treatment, better communication with patients (hospital)

• Greater confidence in managing patients (hospital)

• Increased awareness of the need for isolation of suspected cases (hospital)

Staff protection

• Improving providers’ knowledge, awareness in managing COVID cases and protecting themselves (CHC/hospital)

Routine services

• A drop and then a recovery in many of the routine clinical services (hospital)

• Encouraging the continuation of the routine health services (district)

Patient awareness

• Improving patient awareness of protection and social distancing, as well as reduced stigma for COVID (CHC)

• Compliance with mask-wearing was reported as declining (hospital)

Facilitators and barriers

Barriers

For use of guides

• Lack of screening, testing and identification of COVID cases (CHC)

• Limited space and equipment (CHC)

• Concern about the difficulty of diagnosing COVID (CHC)

• Lack of guidance on addressing the concerns of patients and diagnosis and treatment guides for other conditions.

Community concerns

• Patients were afraid of coming to the clinic as they are afraid of being infected by health staff and of being diagnosed with COVID and referred to the Government Regional hospital or isolated.(CHC)

• Isolation is especially problematic (CHC)

• TB patients who had similar symptoms to COVID might avoid visiting the facility (CHC)

Drug supplies and equipment

• Common essential drugs were described as out of stock (CHC)

• Routine vaccines were perceived as being in short supply CHC)

• Broader equipment and infrastructure challenges remained evident too (CHC)

Supply of PPE

• There was very poor availability of PPE and health protection among health workers and patients (CHC and hospital)

Health workforce challenges

• Lack of staffing, staff not on payroll and high staff turnover (CHC)

• Lack of training on COVID prior to this intervention (CHC)

Facilitators

For adoption of guides

• Action taken by trainees to share resources and knowledge (CHC)

• Ongoing training and encouragement to use the desk-guide (CHC)

• Actions also described to cascade knowledge to all groups of staff (hospital)

For management of COVID

• Lots of community meetings were held to inform them about COVID and dispel fears (CHC)

• Active collaboration between the DHMT and the district COVID coordination body (hospital)

• Partner investment supported refurbishing the treatment centre and testing for COVID(hospital)

• A substantial focus on IPC measures (hospital)

• Sick people could break the law enforced curfew and attend the hospital for care (hospital)

For maintenance of routine services

• Outreach campaigns improved the immunisation, ANC and under five care awareness and uptake (CHC)

• Routine clinical services continued to be offered as before, including referrals as required (CHC)

• Services were reorganised in response to COVID (CHC)

• Sensitization was reported to help improve awareness and service use by residents (hospital).