Table 2.

Challenges in maintaining essential health services in Nigeria: Themes, emerging subthemes and some quotes

Themes	Emerging subthemes	Examples of quotes
Leadership and governance	Accountability	“….the challenge of diversion. of resources [budget for other facility needs]… for PPEs” (NC)
Finances	Funding availability	“….insufficient funds has always been on ground. It is not really related to COVID-19. It has always been a case in most of the PHCs getting stipends to run the PHC like lightings, generators, pumping of water.” (SW)
Service delivery	Infrastructure	“…majority of the health facilities do not have waiting area…” (SW)
	Accessibility	“…referral, when somebody is positive having to evacuate from the hospital to the treatment centre, was a challenge” (NC)
	Acceptability	“.misconceptions about the disease… with thoughts that there was no COVID-19 in the first place” (SS) “…person [patient], and/or…. relatives were not willing to adhere to the protocols,. what do you do?. socio-cultural issues,… where some people will say my pastor said.” (SE)
Human resources	Human resource shortage	“The major challenge is… inadequate manpower which existed before COVID-19.” (SW) “Then during the pandemic too some health workers absconded…. Health workers who had the requisite capacity were quite few” (SE) “…there was some sort of shifting done to reduce the number of health workers working at the same time…” (NC) “They [workers] find it a bit difficult to get to their work place. Some of them have to use their workplace as home…” (SW) .It included even the health service providers. They were locked down. They could not even access the facilities”(SE) “Well, I will say the issue of the human resource for health; it has been a long-lasting challenge even before the pandemic. So, it was now heightened by the pandemic.” (SE)
	Health workers’ attitude	“.even health workers were scared and they were not so committed to work because there was risk [of infection] now” (NC) “We had challenges with [the] attitude to work you understand? Some people were more reluctant” (SS)
Medicines and supply	Accessibility	“.it was so bad that some doctors will even use their money to buy sanitizers and face masks so as to protect themselves” (SW) “.dearth in supply of PPEs… but that was at the initial period. Before COVID-19, there were no local manufacturers” (SE) “…challenges about the supply chain in terms of internal access to the PPE,… we put the PPE in the store and health workers in the emergency unit were not having access” (NC) “Rapid test equipment was not readily available at the beginning [of the pandemic]…” (NC) “…dearth in supply of PPEs was actually a challenge that was in existence beforehand” (SW)