Extending health systems resilience into communities: a qualitative study with community-based actors providing health services during the COVID-19 pandemic in the Philippines.

BACKGROUND: Amidst ongoing calls for increased health systems resilience, gaps remain in our understanding of how health systems can reach further into communities to ensure resilient service delivery. Indeed, public health emergencies caused by infectious hazards reveal both the value and vulnerability of the workforce delivering health services in communities. This study explores ways in which a non-governmental organization (NGO) in the Philippines protected their frontline workforce during the first year of the COVID-19 pandemic. METHODS: Guided by a qualitative descriptive approach, 34 in-depth interviews were conducted with community-based health actors employed by the NGO between June 2020 and February 2021. Data analysis was guided by an iterative deductive and inductive approach. RESULTS: We identified four key activities that enabled the NGO and their staff to provide health and social services in communities in a safe and consistent manner as part of the organization's pandemic response. These include (1) ensuring adequate personal protective equipment (PPE) and hygiene supplies; (2) providing contextualized and role-specific infection prevention and control (IPC) training; (3) ensuring access to testing for all staff; and (4) providing support during quarantine or isolation. CONCLUSION: Learning from the implementation of these activities offers a way forward toward health emergency preparedness and response that is crucially needed for NGOs to safely leverage their workforce during pandemics. Further, we describe how community-based health actors employed by NGOs can contribute to broader health systems resilience in the context of health emergency preparedness and response.

The contributions of religious leaders in addressing food insecurity during the COVID-19 pandemic in the Philippines: A realist evaluation of the Rapid Emergencies and Disasters Intervention (REDI).

To address the unintended consequences of public health measures during the COVID-19 pandemic (e.g., emergency food insecurity, income loss), non-governmental organizations (NGOs) have partnered with diverse actors, including religious leaders, to provide humanitarian relief in resource-constrained communities. One such example is the Rapid Emergencies and Disasters Intervention (REDI), which is an NGO-led program in the Philippines that leverages a network of volunteer religious leaders to identify and address emergency food insecurity among households experiencing poverty. Guided by a realist evaluation approach, the objectives of this study were to identify the facilitators and barriers to effective implementation of REDI by religious leaders during the COVID-19 pandemic and to explore the context and mechanisms that influenced REDI implementation. In total, we conducted 25 virtual semi-structured interviews with religious leaders actively engaged in REDI implementation across 17 communities in Negros Occidental, Philippines. Interviews were audio recorded, transcribed, and thematically analyzed. Three main context-mechanism configurations were identified in shaping effective food aid distribution by religious leaders, including program infrastructure (e.g., technical and relational support from partner NGO), social infrastructure (e.g., social networks), and community infrastructure (e.g., community assets as well as a broader enabling environment). Overall, this study contributes insight into how the unique positionality of religious leaders in combination with organizational structures and guidance from a partner NGO shapes the implementation of a disaster response initiative across resource-constrained communities. Further, this study describes how intersectoral collaboration (involving religious leaders, NGOs, and local governments) can be facilitated through an NGO-led disaster response network.

Caring in crisis: The experiences of local religious leaders meeting community food needs in the Philippines during the COVID-19 pandemic.

To respond to the unintended consequences of prevention measures to reduce COVID-19 transmission, individuals and groups, including religious leaders, have collaborated to provide care to those negatively impacted by these measures. Amid these various efforts and interventions, there is a need to deepen our understanding of diverse expressions of care across various geographical and social contexts. To address this need, the objective of this study was to investigate how religious leaders in the Philippines practiced care for their communities by meeting emergency food needs amid the COVID-19 pandemic. Guided by an ethics of care theoretical orientation, we conducted 25 remote semi-structured interviews with Filipino religious leaders who partnered with a Philippines-based non-governmental organization (NGO) to mobilize essential food aid to their local communities. Through defining the efforts and activities of these religious leaders as care work, we found that religious leader experiences revolved around navigating care responsibilities, caring alongside others, and engaging holistically with the care work. Additionally, we observed how contextual factors such as the humanitarian settings where religious leaders worked, the partnership with an NGO, and the positionality of local religious leaders within their communities, fundamentally shaped the care work. This study expands our understanding of how care is practiced and experienced and also brings greater visibility to the experiences and efforts of local religious leaders in responding to humanitarian emergencies.

Navigating fear and care: The lived experiences of community-based health actors in the Philippines during the COVID-19 pandemic.

The activities of community-based health actors are widely recognized as critical to pandemic response; yet, there exists a lack of clarity concerning who is included in this ecosystem of actors and how these actors experience the complexity of delivering community-level care in the context of a public health emergency. The objectives of this study were (1) to characterize the lived experiences of community-based health actors during the COVID-19 pandemic in the Philippines; and (2) to identify opportunities for further supporting these critical actors in the health workforce. Virtual semi-structured interviews were conducted (January-February 2021) with 28 workers employed by a Philippines-based non-governmental organization (NGO) to explore their lived experiences during the COVID-19 pandemic. Data were analyzed thematically using a hybrid inductive-deductive coding process, informed by Tronto's conceptualization of an ethic of care. Lived experiences among study participants were shaped by discourses of fear and care, and the interaction between these two affects. Participants reported everyday experiences of fear: NGO workers' fears of contracting and transmitting COVID-19 to others; perceived fear among community members where they worked; and fears around COVID-19 testing, recognizing the personal and social implications (e.g. stigma) of a positive test. Amid fear, participants had everyday experiences of care: care was a powerful motivator to continue their work; they felt supported by a caring organization that implemented safety protocols and provided material supports to those in quarantine; and they engaged in self-care practices. These findings contribute to understanding the ecosystem of actors involved in community-based health care and engagement efforts and the challenges they encounter in their work, particularly in a pandemic context. We highlight implications for civil society organizations charged with protecting the mental and physical well-being of their workers and describe how these actions can contribute to local health systems strengthening.