Challenges in delivering urban healthcare services during COVID-19 pandemic: a mixed-methods study in Ahmedabad, India

The COVID-19 pandemic globally posed a great challenge to the existing healthcare system for delivering routine services. Community Healthcare Workers (CHWs) play an important role in delivering routine as well as COVID-19-related services at the forefront. Understanding the complexity of service delivery and the challenges faced by them is very crucial. This study aims to investigate the specific challenges for community-based routine healthcare services during COVID-19. The cross-sectional study was conducted in Ahmedabad City, Gujarat, from November 2021 to October 2022. A mixed-methods approach was adopted for carrying out this study. Ahmedabad was selected as the site of this study as it is a large populous city and has witnessed the outbreak of other diseases like CCHF and SARS, and it also experiences a significant impact of Covid-19. A total of 150 CHWs were included in the study for the quantitative survey, and nine CHWs were interviewed to gather qualitative information. The results show the disruption in the community-based routine services, especially during the first wave. Increased workload (93% of CHWs) was a major challenge during COVID-19 was one of the biggest challenges from the provider side, while fear of leaving the house (97%) was reported as one of the biggest challenges from the demand side. During the first wave, services for Non-Communicable Diseases (NCD) were highly affected. CHWs reported that they were motivated to work in the pandemic to provide the necessary care and services to the community. Findings from this study also suggest the need for structured training in emergency preparedness, mental health support, and coordination skills, with policy implications for urban health systems' resilience. The results suggest that additional training for CHWs on pandemic response and infection control would be highly helpful during emergencies. Recruitment of trained human resources and intersectoral collaboration are very important for the appropriate management of and preparedness for such pandemics in future. These are some of the main pillars of strengthening the health system. This study uniquely contributes by documenting the use of CHWs in a large urban setting and highlighting innovative intersectoral collaboration mechanisms that emerged during the crisis. Further, this study provides an insight into the lessons learnt from the COVID-19 pandemic towards maintaining healthcare services during crises.