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The purpose of this study was to document the experience of health providers’ capacity strengthening during health crises and the contribution of such to the health system and the population resilience in the face of the COVID-19 pandemic in Guinea. We conducted a cross-sectional study using routine data collected from 41 health facilities in the project intervention areas, including associative health centers, community health centers, and district hospitals,. These data covered the period between 2019 and 2021. Results showed that all the community health centers (CMCs) had a clean internal and external environment, compared to health centers (95.2%) and district hospitals (33.3%). Hand washing was systematic among visitors attending CMCs and district hospitals (HPs). However, 28.6% of visitors attending associative health centers (AHCs) did not wash their hands. Temperature taking for visitors was not carried out in all CMCs and in 90.5% of the AHCs; unlike in the HC and HP where the temperature of each patient was taken before entering the consultation room. The obligation to wear masks was higher in the HP and in the HC, compared to the CMC and AHC where the order of non-compliance with the wearing of masks was, respectively 36.4 and 19%. Non-compliance with social distancing in the waiting rooms and between users was observed in all facilities. The project’s interventions mainly contributed to improving the utilization of prenatal consultation and institutional delivery services; the beginning of the interventions was marked by an increase of an average of 17 ANC1 per month in CMCs and 116 ANC1 in health centers. Ongoing training on capacity strengthening for providers in infection prevention and control, followed by the offering of delivery kits and materials during epidemics, would contribute to the improvement and utilization of health facilities by the population.
This was a cross-sectional study using routine data from maternal health services, and blinded observations of health care workers regarding the implementation of infection prevention and control (IPC) measures. Routine data covered the pre-COVID-19 period (March 2019 to February 2020), COVID-19 and pre-intervention period (March 2020 to March 2021), and COVID-19 and intra-intervention period (April 2021 to December 2021). Guinea is located in West Africa, with a population of over 12 million people (10) and a literacy rate of 31% for women and 55% for men. Women make up 53 % of the general population and those of childbearing age make up 45 % of the total female population. The country has high maternal and neonatal mortality rates with 576 maternal deaths per 100,000 live births and 31 neonatal deaths per 10,000 live births in 2017 (11). The total fertility rate is estimated at 4.8 children per woman with a total fertility rate of 165 births per 1,000 women of childbearing age per year (10). Guinea has 8 health regions (Conakry, Kindia, Labe, Mamou, Boke, Kankan, Faranah, and N’zérékoré) divided into 38 health districts, 33 of which are rural. The country’s health pyramid is structured into three distinct levels of care: primary, secondary, and tertiary. The primary level includes 414 government health centers, and a dozen community medical cabinets and associative health centers; the secondary level includes 4 communal medical centers, 26 district hospitals, and 7 regional hospitals; and the tertiary level includes 3 national or reference hospitals. Maternal health services in Guinea’s health facilities are aligned with international guidelines for quality care (12). These guidelines define minimum packages of maternal health services by type of health facility. For example, primary health care facilities provide antenatal care (ANC) and eutocic deliveries. Emergency obstetric care for complicated deliveries (including cesarean sections) is required for secondary and tertiary health facilities. In addition, at least four ANC visits are recommended for each pregnant woman and at least 90% of all deliveries should be performed in health facilities (13). In addition, national guidelines recommend that qualified health personnel, including midwives, conduct deliveries in health facilities doctors, nurses, and technical health workers. The health facilities in the intervention zones of the “Strengthening the health system to ensure continuity of services and access to care for vulnerable populations in the context of COVID-19 in Guinea” project served as the setting for this study. 41 health facilities, including 32 in the private sector and nine in the public sector, in four health regions, benefited from the interventions of the above-mentioned project. These health facilities are distributed as follows: 11 community medical cabinets; 21 associative health centers in the city of Conakry; six public health centers, two district hospitals (Pita and Télimélé) and the regional hospital of Labe. Quantitative data collection focused on women who used maternal health services between March 2019 and December 2021 in all facilities in the intervention zones and facility observations on infection prevention and control measures. Data were collected over a three (3) week period from January 23 to February 11, 2022. The sampling was exhaustive; all the health facilities in the intervention zone and benefiting from the project intervention were selected for data collection. These were 41 health facilities, including 11 COMEC-Gui community medical cabinets; 17 associative health centers in the city of Conakry of the Actions Concertées pour la Santé (ACS) network; Maferinyah health center, the HCs of Pita and Télimélé, Labe regional hospital, and the district hospitals (Pita and Télimélé) (Figure 1). Health districts in the region of Kindia, Mamou, Labé and Conakry, Guinea, included in the study. Routine data on maternal health indicators were extracted from the district health information system (DHIS2) for each of the health facilities concerned. However, to ensure good data quality and reduce bias due to missing data, the monthly reports of the health facilities concerned were also used. Data extraction from the two sources mentioned above was done using forms previously established for this purpose. Both data sources were used to minimize the missing data sometimes encountered in the DHIS2. We did not compare the data from the two sources. An observation of the providers’ practices and the internal and external environment of the facilities was carried out using an observation grid. This observation grid was composed of 18 measures of infection prevention and control. These measures could be categorized into two main themes: patients’ safety and security; and facility hygiene. Patient safety and security categories comprised (Is there an area in the facility for sorting incoming patients, are the providers wearing the correct PPE such as gowns, masks, gloves). Meanwhile, facility hygiene was composed of (Is the external and internal environment of the facility clean, Is there running water in the facility) applications, including the assessment of the internal and external environment, patient sorting areas, the presence of handwashing devices at the entrance of the facilities, the use of handwashing kits by visitors to the health facilities, the taking of temperatures by visitors upon entering the facility, the wearing of masks by patients and health care providers, physical distancing, and waste sorting. These observations took place approximately 12 months after the providers were trained in IPC. The observation grids were administered by a multidisciplinary team (composed of two doctors and a sociologist) previously trained in data collection tools. Data collection took place over a period of three (3) weeks, from January 23 to February 11, 2022. We processed and tabulated the data using Microsoft Office Suite Excel, and then analyzed using Stata version 16 software (Stata Corporation, College Station, TX, United States). Data for each indicator were clustered into a panel for exploitation. outine data from March 2019 to December 2021 from the 41 facilities were collected over the same period and these quantitative data were described using proportions with their 95% confidence intervals. Trends in indicators before COVID-19 and during COVID-19 and during intervention were estimated by component using interrupted series analysis, as appropriate. We used segmented regression to measure changes in level and trend that followed the occurrence of COVID-19 and the intervention. Conveniently, we referred to Linden et al. (14) paper, which presents the itsa command and the effect of an intervention on an outcome variable for a given period.The Itsa (Interrupted time-series analysis for single and multiple groups with multiple panels) command on Stata was used to estimate the causal effect of the pandemic on a potential decline in health service use. The Itsa method therefore compares the finding that would have been by extrapolating the trend line of the finding of the period before the pandemic, as if it had never happened. Itsa uses ordinary least squares (OLS) and its use assumes that the observation point data are reported as panel data. A modeling approach was used to assess how the average number of users of each healthcare facility changed immediately after the first COVID-19 cases were recorded, i.e., in March 2020, but also from the start of the project interventions, i.e., in April 2021 (change in level) and gradually over time (change in slope). The data were grouped by type of facility: private (associative health centers and community medical cabinets) and governmental (health centers and hospitals) in the four regions of the intervention areas. To facilitate the analysis, this regression model was used for each indicator: Yt = β0+β1Tt+β2Xt+β3XtTt+∈t, where β0 represents the intercept or intercept or initial level, β1 is the change in the variable of interest (Yt) for 1 unit time, β2 represents the immediate change in Yt following the intervention, β3 represents the change in the trend of Yt before COVID-19 relative to the trend before intervention (change over time) εt the error term: The data from this matrix were grouped according to their similarity and difference and then described to assess the level of compliance with infection prevention and control measures in the health facilities. The research protocol for this study was approved by the National Health Research Ethics Committee of Guinea (number L-080-CNERS-21) before the start of data collection. Then, an authorization had been obtained at the level of the health facilities before the beginning of the data collection including aspect of confidentiality.
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