Interventions to improve COVID-19 preparedness among health facilities empaneled on the Lagos State Health Insurance Scheme

ABSTRACT

Introduction/ Background: The index case for SARS-CoV-2 entered in February 2020 through the international airport in Lagos, the most populous state in Nigeria. This epicenter recorded 77,676 confirmed cases as of October 15, 2021. Particularly at the onset, there was a dearth of information on preparedness of health facilities to manage COVID-19. Methods: We developed and applied SafeCare4Covid, a paper-based preparedness checklist, and organized webinars for health providers jointly with the Lagos State Health Management Agency. The tool was digitized, and evolved into a free, globally available self-assessment application, following World Health Organization guidelines. It quantifies COVID-19-related capabilities with 31 questions (score range, 0-100) and availability of COVID-19- related essential medical supplies with a 23- supplies checklist (0-100). Preparedness is assessed r.e. infrastructure, infection prevention, triaging, COVID-19 trainings, staffing, emergency response team, referral, and supplies (PPEs and oxygen). Each facility received an automated quality improvement plan. Data was shared through dashboards with stakeholders for decisionmaking. Results: Between July 2020-March 2021, 66 health facilities in Nigeria completed the SafeCare4Covid selfassessment (56 in Lagos, 44 of those private and 12 public). The average capability score (n=66) was 71 (interquartile range, 61-86), and the average supply score (n=51) was 80 (74-91). Majority of facilities did not offer COVID-19 tests/did not report test-access status (95.5%, 63/66), nor had guidelines for the management of confirmed cases, COVID-19 sample processing/referral, staff mental support and contact tracing. Many centers did not have infection prevention policies (44%, 29/66). Supply of N95/FFP2 respirators was limited. Impact The SafeCare4Covid tool generated an automated customized quality improvement plan outlining corrective actions to improve the facility's preparedness (processes, infrastructure and supplies) to prevent the spread of COVID-19 and other infections within and to the community. Conclusion: Digitizing the SafeCare4Covid tool improved the efficiency and timeliness of assessing health facility epidemic readiness. The tool facilitated corrective actions focusing on capacity building of case management, infection prevention protocols, and procurement of PPEs to prevent facility-acquired COVID-19 infections.