# Disruption and recovery: a qualitative study on health services for vulnerable populations during the pandemic

## TL;DR

This study explores how vulnerable populations in India faced healthcare challenges during the pandemic and how services were adapted and recovered.

## Contribution

The study provides insights into the specific challenges and recovery strategies for vulnerable populations during the pandemic in a specific Indian district.

## Key findings

- Vulnerable populations faced reduced healthcare access due to fear, transport barriers, and staff shortages.
- Health facilities adapted by prioritizing essential services, using teleconsultations, and ensuring home delivery of medications.
- Catch-up programs helped address missed immunizations and TB care, showing system resilience.

## Abstract

Public health emergencies like pandemics results in systemic disruptions, leading to substantial indirect consequences beyond direct morbidity and mortality. The experiences from previous outbreaks have shown disproportionate effects on the vulnerable groups. This study aims to identify the challenges faced by these groups in attaining routine health services during the COVID-19 pandemic and the strategies used for service recovery. A qualitative study done in Jodhpur district in Western India using inductive thematic approach. Data were collected through eight key informant interviews with healthcare workers and twenty in-depth interviews with patients from vulnerable groups. Vulnerable populations reported reduced healthcare access due to fear, transport barriers, and staff shortages, often resorting to private care. Frontline health workers faced initial service disruptions but later resumed community outreach with COVID-appropriate behavior. Health facilities adapted to the pandemic by prioritizing essential services, utilizing teleconsultations, and ensuring home delivery of medications despite PPE shortages and workforce redistribution. Vaccination faced challenges including digital registration issues, misinformation, and hesitancy, mitigated through local leadership and community engagement. Catch-up programs effectively addressed missed immunizations and TB care, highlighting system resilience and recovery efforts. Vulnerable groups have specific and increased needs during times of crises like pandemics, that must be addressed specifically. Targeted interventions that are acceptable and appropriate should be implemented to bridge gaps in healthcare access. Future preparedness plans must institutionalize adaptive strategies to ensure equitable access to care and safeguard the vulnerable populations during crises.