Country learning on maintaining quality essential health services during COVID-19 in Timor-Leste: a qualitative analysis.

OBJECTIVE: This case study examines the enabling factors, strengths, challenges and lessons learnt from Timor-Leste (TLS) as it sought to maintain quality essential health services (EHS) during the COVID-19 pandemic. DESIGN: A qualitative case study triangulated information from 22 documents, 44 key informant interviews and 6 focus group discussions. The framework method was used to thematically examine the factors impacting quality EHS in TLS. SETTING: National, municipal, facility levels in Baucau, Dili and Ermera municipalities in TLS. RESULTS: Based on the TLS National Health Statistics Reports, a reduction in outpatient, emergency department and primary care service delivery visits was observed in 2020 when compared with 2019. However, in contrast, maternal child health services simultaneously improved in the areas of skilled birth attendants, prenatal coverage and vitamin A distribution, for example. From the thematic analysis, five themes emerged as contributing to or impeding the maintenance of quality EHS including (1) high-level strategy for maintaining quality EHS, (2) measurement for quality and factors affecting service utilisation, (3) challenges in implementation of quality activities across the three levels of the health system, (4) the impact of quality improvement leadership in health facilities during COVID-19 and (5) learning systems for maintaining quality EHS now and for the future. CONCLUSION: The maintenance of quality EHS is critical to mitigate adverse health effects from the COVID-19 pandemic. When quality health services are delivered prior to and maintained during public health emergencies, they build trust within the health system and promote healthcare-seeking behaviour. Planning for quality as part of emergency preparedness can facilitate a high standard of care by ensuring health services continue to provide a safe environment, reduce harm, improve clinical care and engage patients, facilities and communities.

Patient perspectives regarding online consultations during the COVID-19 pandemic

BackgroundIntroduction: COVID-19 and the associated lockdown has prevented patients from accessing healthcare professionals through the traditional face-to-face clinic visits. Modes of consultation have therefore adapted to overcome this barrier;virtual or online consultations have become a popular alternative for people with access to technology. The literature on patient perspectives about this mechanism is still evolving.ObjectivesAim: To explore patient perceptions regarding virtual consultationsMethodsA voluntary online survey instrument using a mix of quantitative and qualitative questions was administered to patients across 3 major cities using a social media platform, WhatsApp. The aim was to explore the characteristics of users, perceived advantages and disadvantages of online consultations and patient satisfaction.ResultsThere were 461 respondents (M 51.4%: F 48.6%) that had consulted doctors online. 91% of them lived in 8 major metro cities. Interestingly, over 80% respondents had never sought online consultation before the COVID-19 pandemic. 52% patients accessed multiple (2–3) consultations in the 10 months since the start of the lock-down in March 2020. While 62% consulted their regular doctor, 19% accepted recommendations from friends and family and 10% used online platforms. 45% of consultations were via videocalls, 28% through WhatsApp and 20% via telephone calls. Prescriptions were provided via WhatsApp in 41% cases, online portals in 32%, email in 13% and a photograph of handwritten prescription in 13% cases. The vast majority (90%) felt that the time provided by the doctor was adequate. 55% of patients paid via G pay while 28% were prepaid through online portals. There were no audio or video connectivity issues in 90% cases. 13% patients had to go for a face-to-face consultation within 7 days of the online consultation as the clinical problem had not been resolved adequately. Patients felt that the main advantages of online consultations included a lower risk of infection (77%), reduced waiting time (57%) and travel time (58%). The main disadvantages cited included a lack of physical examination (73%), a perception that this was not as satisfying as a face-to-face consultation (36%), inability to adequately communicate their problem (24%) and an inability to show past reports (13%). 78% patients rated their online consultations as either a 4/5 or 5/5 satisfaction level. Given the choice after the pandemic, almost two-thirds (64%) felt they would still prefer face-face consultations.ConclusionsFor the vast majority of patients (80%), this pandemic provided the first ever opportunity to choose a virtual platform to seek clinical care. The high level of satisfaction for online consultations suggests that this mechanism of patient-provider clinical service provision might well be an increasingly popular intervention after restrictions are lifted. As digital penetration improves, weaknesses identified in the current system of online consultations (e.g., inability to conduct physical examinations and inadequate communication) could be mitigated through evolving technologies like digital stethoscopes and better communication tools. It brings into focus the need for regulations to keep pace with this rapidly evolving trend to ensure that the virtual patient-provider interaction remains a safe, secure and confidential way to access clinical services.