Health system responses to COVID-19: a multi-level systematic review of primary qualitative studies

Abstract

COVID-19 had presented challenges to the healthcare systems and healthcare professionals in all countries. After one year of the pandemic, the evidence begins to consolidate, and the literature demands the documentation of the experiences lived by healthcare professionals and other frontline actors. This systematic review of primary qualitative studies depicts the experiences and perceptions of organizations and actors at multiple levels of health systems internationally in responding to COVID-19. Six main databases of biomedical information, public health and health administration research were searched over the period 1 October 2019 to 21 October 2020. Information extracted from included studies was analysed thematically. Twenty-two articles were selected for full assessment. Considering the professional level experiences, the most predominant themes of the studies consisted of the new roles and responsibilities of healthcare workers, burnout and distress, unseen healthcare workers, and positive changes and emergent solutions amid the crisis. Recommendations of the studies discussed mainly about the urge to provide psychological support, and leadership for managers and health authorities. Continuous training, regulation of working conditions, providing supportive resources, coordinating a diversity of actors, and reviewing and updating regulations were recommendations of a wider system support. The experiences of frontline healthcare workers had been the focus of attention of primary qualitative studies as of October 2020. Knowledge gaps and the need for primary research were identified in the organisational and national levels that could answer to the needs of the workforce.