Factors influencing COVID-19 testing: a qualitative study in Bhutan.

BACKGROUND: The COVID-19 pandemic has reaffirmed an all-knowing truth-that health is central in the 2030 Sustainable Development Agenda. To fully control the infection in a community, accurate testing of suspected cases along with effective tracing and appropriate treatment (3Ts) is still crucial to slowing transmission of COVID-19 virus This study explored factors that influenced COVID-19 testing in Bhutan. The lessons learned from this study could serve as a roadmap to strengthen the current respond to COVID-19 and for future outbreaks, particularly in low- and middle-income countries. METHODS: The study employed an exploratory qualitative design. Data collection methods included interviews with key informants with a purposively selected sample of 20 participants. The interview findings were augmented by reviewing both published literature and unpublished documents.For the analysis of qualitative interviews, a hybrid approach of inductive and deductive coding and theme development was conducted to analyze findings. A tailored version of the WHO Health System Framework incorporating the Essential Public Health Function was used to guide data interpretation. RESULTS: Political will through the influence and leadership of the King of Bhutan played a crucial role in raising attention to the problem, and provision of adequate financial and technical relief to ensure that all people irrespective of their socioeconomic status do not pay to get tested of COVID-19. A compassionate leadership, Whole of Society approach is backed by the scientific community, functional health systems and community-based approaches, use of information technology for awareness creation and improved surveillance system, and fast-tracked COVID-19 testing service delivery. CONCLUSION: Bhutan's success relied greatly on multi-sectoral and systematic approach during policy design, implementation and monitoring, and active collaborative efforts involving consultation and engagements with a broad range of local (community members), national and global actors for accelerated COVID-19 testing. These efforts were made possible through improved health governance and leadership at all levels of the society.

COVID-19 Testing: A Qualitative Study Exploring Enablers and Barriers in the Greater Accra Region, Ghana.

Introduction: The COVID-19 pandemic is a global crisis and has reaffirmed that extensive testing along with effective tracing is still crucial to slowing transmission of the COVID-19 virus despite the rolling out of vaccines. This study explored enablers and barriers to COVID-19 testing in the Greater Accra region of Ghana. We envision lessons learned from this study could serve as a road map to strengthen the current response to COVID-19 and preparedness for future outbreaks, particularly in low- and middle-income countries. Methods: A qualitative design was undertaken to explore the phenomenon. Data collection methods included in-depth interviews with key informants with a purposively selected sample of 20 participants. Interviews were conducted using flexible semi-structured interview guides. Depending on the participant's position and involvement in COVID-19 testing, the guides were modified, and key elements were drawn from a tailored version of the WHO Health System Framework, incorporating the Essential Public Health Functions (EPHF). The interview findings were augmented by reviewing published literature. Results: Better health governance through political leadership, community participation, multisectoral collaboration, effective resource management, and information systems played a crucial role in catalyzing COVID-19 testing. The primary barriers to testing were mainly COVID-19 infodemic, inadequacy of material resources to meet growing health needs, and a lack of opportunities to have equal and easy access to testing services. Furthermore, although human resources were adequate, they were unevenly distributed across settings. Conclusion: Despite rolling out vaccines against COVID-19, testing remains an important measure to control the virus. To effectively be prepared for extensive COVID-19 testing and respond to future outbreaks, the following are recommended: there should be improved political commitments, coordination, and communication with diverse actors to ensure even distribution of all resources across the country; empowerment of community members should be encouraged to develop community-oriented pandemic preparedness and management of COVID-19 infodemic; investment in strengthening capacity of Good Manufacturing Practice (GMP); incorporation of health policy and systems research (HPSR) into the post-COVID-19 pandemic recovery process and future pandemic preparedness.

Applied systems thinking: unlocking theory, evidence and practice for health policy and systems research.

While systems thinking has been generally acknowledged as important to the field of health policy and systems research (HPSR), it remains underutilized. In particular, systems thinking has been perceived as predominantly conceptual, with fewer applications of systems thinking documented. This commentary makes three key points, namely that (1) advances in applied systems thinking in HPSR have been hindered by an imprecision in terminology, conflating '[health] systems approaches' with complex adaptive systems theory; (2) limited examples of applied systems thinking have been highlighted and recognized in research, but have not been fully and equally appreciated in policymaking and practice and (3) explicit use of theory, long-term research-policy collaborations and better documentation of evidence can increase the use and usefulness of applied systems thinking in HPSR. By addressing these matters, the potentials of systems thinking in HPSR can be truly unlocked.

Domestic funding for health policy and systems research: why is it invisible?

Objectives and importance of study: Health policy and systems research (HPSR) informs stronger health systems but it remains chronically underfunded, especially in low- and middle-income countries (LMICs). Domestic funding for HPSR helps to ensure research is aligned with local priorities. As LMICs transition from international donor assistance for health research, HPSR will increasingly need to rely on domestic funding. However, domestic funding flows remain poorly understood. This study aims to understand how, and how much, HPSR is funded domestically in LMICs. It explores challenges associated with estimating HPSR funding and suggests strategies to improve domestic support for HPSR. STUDY TYPE: Mixed methods. METHODS: We reviewed regional technical reports commissioned by the Alliance for Health Policy and Systems Research, which studied domestic HPSR funding through desk reviews and key informant interviews. Data were qualitatively and quantitatively analysed and findings were triangulated. We also conducted a separate bibliometric analysis to understand HPSR capacity. RESULTS: Despite many efforts from different angles, we were unable to reliably estimate HPSR funding in most of the countries studied. The reasons for this included a lack of a common understanding of HPSR, difficulty disentangling HPSR funding from other research funding, and bureaucratic and data transparency hurdles. We also describe which domestic bodies fund HPSR and examine the interrelatedness of HPSR capacity and funding. CONCLUSION: Domestic funding flows for HPSR remain almost invisible. This finding informs concrete recommendations to improve HPSR funding transparency, and for national research funders and ministries of health and finance to invest in HPSR for stronger health systems.