Table 5.

Unsustainable Health systems adaptations suggested by respondents

Themes	Sub-themes	Examples
Financing	Provision of funds, stipends for health workers and payment for campaigns	“Well, you know during that period, State governments provided enough funds for health care workers and since the pandemic has subsided, those funds are not being provided…” (SE) “Well, for me the way I look at it, it is more of funding. You know it is capital intensive, so getting the funding is one of the biggest things, that I think the government can do,” (NC) “Even funding for some of the social media campaigns and all that, not all of them are sustainable, you understand? To be paying the town announcers regularly to go into the communities and all, no, not all are sustainable” (SS) “The changes that are unsustainable are directly linked with sustainable funding, now funding is no longer sustainable because of fatigue. …,.” (NW)
Service delivery	Free healthcare and COVID-19 testing	“Giving health for free, ante natal all these cards that were done [Free health care for example, antenatal care]. In fact, I am not even sure before the end of pandemic that we will be able to sustain it all through I am not sure” (SW) “The only thing that is not sustainable that I can think of right now is, you know if I tell you go and ensure that you stay at that border, anybody that passed there, test them, it is not sustainable because they don’t test people again at the border, so it’s not sustainable.” (SS) “So that continuous free testing may not be sustainable. I think that it’s a very good strategy to remove the load from the government by setting up these private laboratory consortiums”(NC)
	Reshuffling and redistribution of staff	“The reshuffling of staff, redistribution of staff, [is] not sustainable. You know, it’s a process. we are not just doing it at once but we are getting staffs to go back to the different facilities that were not prioritized at that point in time.” (SS)
	COVID-19 treatment centres	“If you talk of changes that were made that are unsustainable of course they would include creation and establishment of treatment centres. For those who were infected, there were a lot of intensive or rather serious expenditure that was required to keep people in that place, for example, every patient that was on treatment, everything was free from the lowest things they eat, from food to medication, providing them with accommodation, providing isolation, providing all the machineries, PPEs that all the people that managed them used, all those things are not sustainable.” (NC)
Medicine and supplies	Free consumables e.g. facemasks, PPEs	“It requires high resources for people to be using mask, buying it daily and using it. It is not economically wise and is not sustainable. Then, traditionally or culturally also people are not used to this kind of life” (NC)