Table 3.

Countermeasures to health systems challenges during COVID-19 pandemic in Nigeria: Themes, emerging subthemes and some quotes

Themes	Emerging subthemes	Examples of quotes
Leadership and governance	Political will	“Government was ready to approve all the ongoing projects; all ongoing services, basic medical services were being provided. They also were fighting stigma within the facilities”( NC) “They [government] made some services affordable, available and accessible and within the reach of the community members. They were taking services even to the community outside the facilities, services like outreach services, information dissemination and empowerment.” (NC)
Finances	Funding availability
Service delivery	Infrastructure	“They [government] provided treatment centres for those who required admission” (NC) “Government built isolation centres all across the 20 local government in Ogun state that is the jurisdiction” (SW)
	Accessibility	“For example, during COVID-19 pandemic women had emergency caesarean sections especially pregnant women. There is an ambulance that picks them and there is also another one that is called EMC[Emergency Maternal Care] services. It is a special service provided by the state government for maternal and new-born child free, up to this moment” (NW) “…The state government also provided ambulances, one ambulance to one local government. They gave ambulances and drivers. They also provided security…” (SE)
	Service prioritization	“We know that personnel shortfall is a challenge, so of course, that is one of the reason why we did the prioritization, and we had to reprioritize some of our facilities” (SS) “During the pandemic we had shortfalls in the number of staff. There were gaps and the strategy we used was to either give appointments if it is not something [health condition] that is so serious; If it is not an emergency or you ask the patient to visit other health facilities that are not too far especially if it is a health facility that has been shut down because of COVID-19 and the services could not be accessed. To obtain the services that they required, we ask them to go to a nearby PHC, give them appointment so that they can access the needed health services…” (SW)
Human resources	Human resource shortage	“They [government] gave allowances to adhoc workers for a few months, so the adhoc workers helped….” (SE) “…the recruitment [of health workers] has been in phases; some doctors have been recruited… we will recruit more nurses… and the community health extension workers…” (SW)
	Training	“We tried to brief the health workers, organize workshops for them and tried to get them properly informed and well equipped by way of training so that they will be able to overcome some of the fear, you know lack of capacity brings fear…”
	Motivation	“Increasing the health workers hazard allowance is something that the government did….” (SW)
Medicines and supply	Accessibility	“The state government provided PPEs, because there were also donations to them. Many private firms also donated and … they made it available for the public hospitals” (SE)