COVID-19 Health System Challenges and Adaptations: Implications for Resilience and Universal Health Coverage in Zimbabwe

Idah Moyo; Livhuwani Tshivhase; Limkile Mpofu

doi:10.25159/2520-5293/20799

Authors

Idah Moyo University of South Africa https://orcid.org/0000-0002-6122-8151
Livhuwani Tshivhase University of South Africa https://orcid.org/0000-0002-7544-9393
Limkile Mpofu University of South Africa https://orcid.org/0000-0002-9505-5279

DOI:

https://doi.org/10.25159/2520-5293/20799

Keywords:

COVID-19 pandemic, challenges, health system resilience, nurse managers, service delivery adaptations, collaboration and stakeholder engagement, universal health coverage

Abstract

Background: Universal Health Coverage (UHC) seeks to ensure equitable access to quality health services without financial hardship. Progress toward UHC had slowed prior to COVID-19, and the pandemic further exposed systemic gaps. Strengthening resilient health systems is therefore critical to advancing the UHC agenda.

Aim: This study explored health system challenges and service delivery innovations implemented during the COVID-19 pandemic in Bulawayo, Zimbabwe, focusing on nurse managers’ experiences in sustaining healthcare delivery.

Methods: A descriptive phenomenological design was employed to capture the lived experiences of nurse managers involved in the COVID-19 response. The study was conducted across two central hospitals and 19 city health facilities. Ten participants were recruited, with the sample size determined by data saturation. Data was collected using in‑depth telephone interviews and was analysed using Colaizzi’s method.

Results: Three overarching themes emerged: (1) material resource inadequacy, including shortages of oxygen, medicines, and personal protective equipment; (2) human resource constraints, marked by workforce shortages, illness-related absenteeism, and redeployments; and (3) healthcare service delivery adaptations. Despite significant pressures, nurses demonstrated resilience and adaptability. Innovations included dedicated COVID-19 centres, quarantine wards, specialised contact tracing teams, and pooled resource strategies that enhanced efficiency and continuity of care. Collaboration among the Ministry of Health, local authorities, and partners strengthened coordination, surveillance, and response mechanisms.

Conclusion: The study highlights the pivotal role of nurses’ resilience, resource readiness, and collaborative systems in sustaining healthcare delivery during crises. Findings provide insights for future preparedness and health system strengthening to advance resilience and UHC.

Author Biographies

Idah Moyo, University of South Africa

Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria

Livhuwani Tshivhase, University of South Africa

Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria

Limkile Mpofu, University of South Africa

Department of Psychology, College of Human Sciences, University of South Africa, Pretoria

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