From: Factors influencing COVID-19 testing: a qualitative study in Bhutan
Categories | Sub-categories | Themes | |
---|---|---|---|
Facilitators | 1. Governance and leadership | 1.1 Political leadership | Compassionate leadership and guidance Personal assistance in provision of relief measures Improved community participation led by the King Political will and support to get the mass tested Health as a high-priority sector in national governance |
1.2 Community leadership | Designated volunteer and champions in the community High community willingness to be tested Community engagement to provide key information and services Adherence to COVID-19 guidelines Engagement of religious heads and leaders in advocacy programs | ||
1.3 Health governance system | Adherence to WHO recommendations National COVID-19 response plan/protocol Effective early preparedness and planning Evidence-based testing protocols and strategies Effective response to procurement challenges through health governance Lessons learned from the previous pandemic, MERS | ||
2. Resources | 2.1 Capacities of in-service personnel | Positive attitude of health professionals Training for community members, medical students to fill the human resource gap Improved interpersonal relationships across agencies Improved confidence of health professionals to work in high-risk areas with Personal Protective Equipment (PPEs) | |
2.2 Financial and material Resources | Government's financial support to get tested of COVID-19 Effective resource mobilization Door-to-door sampling strategy eased testing procedures Sufficiency in supplies—PPEs, test kits, cold chain, Rapid expansion of testing sites and facilities | ||
3. Health service delivery | 3.1 Primary Health Care (PHC) | Stronger PHC health system targeting Universal Health Coverage (UHC) Establishment of flu clinics to screen suspected COVID cases away from the hospitals 24 hours health helpline for all, including ambulatory services | |
3.2 Surveillance | System in place to trace and treat vulnerable population Online reporting and monitoring system Ability to identify defaulters and get them tested Effective monitoring system to ensure the adequacy of materials for testing Zoning system to facilitate easy access for testing at the place of dwelling | ||
4. Whole of Society Approaches (WOS) | Active engagement of intergovernmental organizations and private sectors, armed forces, civil society organizations and volunteer groups | ||
5. Use of digital technology | Good data management system that updates daily COVID-19 situation Systematic and comprehensive collection of samples using the national demographic data Geographic information system (GIS) mapping to identify a high-risk population | ||
Barriers | 1. Geographical barriers | 1.1 Porous border with neighboring countries | Potential risks and outbreaks from neighboring countries |
1.2 Poor transport networks | Delays in the transportation of supplies to remote districts Poor transport networks due to season changes | ||
2. Lack of human resources | Lack of epidemiologists and biomedical engineers Shortage of health professionals and mid-level managers for conducting COVID-19 testing Challenges of using online technology when training health professionals in all regions of Bhutan | ||
3. Misconceptions about COVID-19 testing | 3.1 Misconceptions about symptoms of COVID-19 | Misconceptions about symptoms of COVID-19 as symptoms of seasonal flu | |
3.2 Fear of nasal swab for COVID-19 testing | Misconceptions about negative health implications associated with nasal swab due to misinformation through mass media |