Delivering Health Services during Early Days of COVID-19 Pandemic: Perspectives of Frontline Healthcare Workers in Kenya’s Urban Informal Settlements

The COVID-19 pandemic has caused widespread disruptions to health, economic and social lives globally. This qualitative study explores frontline healthcare workers’ (HCWs) experiences delivering routine care in Kenya’s informal settlements during the early phases of the pandemic, amidst stringent COVID-19 mitigation measures. Thirteen telephone interviews were conducted with facility and community-based HCWs serving three informal settlements in Nairobi and Mombasa. Data were analyzed using the framework approach. Results indicate there were widespread fears and anxieties surrounding COVID-19 and its management. Secondly, access to facility-based care at the onset of the pandemic was reported to decline, with service availability hampered by the imposed curfew hours and guidance on the maximum allowable number of clients. HCWs experienced heightened risk of COVID-19 infection due to poor working conditions including inadequate personal protective equipment (PPE) and unavailable isolation areas for COVID-19 positive patients. HCWs also experienced stigma associated with contact with persons suspected of having COVID-19 infection, thereby causing a strain on their mental health and wellbeing. The study recommends the need for interventions to support and protect HCWs’ physical and mental health, alongside health system preparedness. Additionally, it is vital to identify ways of taking health services closer to the community to address access barriers in health emergency contexts.